Injectable Medications Clause Samples
The Injectable Medications clause outlines the terms and conditions under which injectable drugs are provided, administered, or covered within an agreement or policy. It typically specifies which medications are included, who is authorized to administer them (such as healthcare professionals), and any requirements for prior approval or documentation. This clause ensures that the use of injectable medications is clearly regulated, helping to manage costs, maintain patient safety, and prevent misuse or unauthorized administration.
Injectable Medications. Benefits will be provided for injectable medications required in the treatment of an injury or illness administered by a Participating Professional Provider. Specialty Medical Injectable Pharmaceuticals require Preauthorization. Injectables that are “primarily self-administered” are not covered under the Member’s medical benefit under any circumstances, even if the member is unable to self-administer. In the event a member is unable to self- administer an injectable medication, only the charges for the administration of the injectable will be covered when administered and reported by an eligible provider in an office, hospital outpatient, or home setting. Members can view the list of medications that Keystone considers to be primarily self-administered by accessing the Self-Administered Medications Policy at ▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇.
Injectable Medications. Benefits will be provided for injectable medications required in the treatment of an injury or illness administered by a Participating Professional Provider. Specialty Medical Injectable Pharmaceuticals require Preauthorization. Self-administered injectables may be covered under the Supplemental Drug Rider.
Injectable Medications. Injectable medications, except Self-Injectable Drugs eligible under the Prescription Drug Rider, are a Covered Benefit, unless specifically excluded as described in the Exclusions and Limitations section. Medications must be prescribed by a Provider licensed to prescribe federal legend prescription drugs or medicines, and approved in advance of treatment by HMO. If the drug therapy treatment is approved for self-administration, the Member is required to obtain covered medications at an HMO Participating pharmacy designated to fill injectable prescriptions. Injectable drugs or medication used for a treatment for which it has not been approved by the FDA for that indication are covered, provided that such drug is recognized for treatment of such indication in one of the standard reference compendia (the United States Pharmacopoeia Drug Information, the American Medical Association Drug Evaluations, or the American Hospital Formulary Service Drug Information) or is recommended by a clinical study or review article in a major-peer reviewed professional journal. Any coverage of an injectable drug as described in this paragraph shall also include Medically Necessary Services associated with the administration of the injectable drug.