Inpatient. We cover inpatient drugs as a hospital service. See Section 8.0 – definition of hospital services. Outpatient/In Your Doctor’s Office/In Your Home Generic, preferred brand name, or non-preferred brand name prescription drugs are covered at different benefit levels depending upon the route of administration. Our allowance for services rendered by the facilities, agencies, and professional providers may include the cost of the prescription drugs administered and/or dispensed. We will determine coverage based upon the route of administration that is customary and least invasive method to treat the condition. There are several ways to administer drugs into the body including: • inhalation (into the lungs, usually through the mouth); • intramuscular (injected into a muscle); • intra-articular (injected into a skeletal joint space); • intrathecal (injected into the space around the spinal cord); • intravenous/infused/intra-arterial (into a vein or artery); • nasal (sprayed into the nose); • ocular (instilled in the eye); • oral (by mouth); • rectal or vaginal (inserted into the rectum or vagina); • subcutaneous (injected beneath the skin); • sublingual (under the tongue); • topical (applied to the skin); or • transdermal (delivered through the skin by a patch). The prescription drug is included in our allowance for the medical service being rendered. If the sole service is drug dispensing, the prescription drug is NOT covered.
Appears in 6 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
