Common use of Medication Synchronization Clause in Contracts

Medication Synchronization. Medication Synchronization allows Members to refill all of their Prescriptions on the same day, eliminating the need for multiple trips to the Pharmacy each month. Prescriptions are filled for less than the normal prescribed day supply in order to align the refill date across multiple prescriptions, allowing all refills on the same day and time period. Daily Cost Sharing reduces the patient pay for the prescription that is less than the standard defined days’ supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. Benefit Limitations‌‌ This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In- network Pharmacy. If you choose the 90 days at retail option, you will be charged one copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can contact our Presbyterian Customer Service Center at (000) 000-0000 or 1-800- 923-6980, Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711.

Medication Synchronization. Medication Synchronization allows Members to refill all of their Prescriptions on the same day, eliminating the need for multiple trips to the Pharmacy each month. Prescriptions are filled for less than the normal prescribed day supply in order to align the refill date across multiple prescriptions, allowing all refills on the same day and time period. Daily Cost Sharing cost share reduces the patient pay for the prescription that is less than the standard defined days’ days supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. Benefit Limitations‌‌ Limitations This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In- In-network Pharmacy. If you choose chose the 90 days at retail option, you will be charged one on copayment per 30-day supply up to a maximum of a 90-day supply. You will be charged three applicable Copayments for up to a 90-day supply up to the maximum dosing recommended by the manufacturer/FDA. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregivercare-giver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional are limited to an initial fill up to a 15-day supply limitationsto ensure patients can tolerate the new medication. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can contact call our Presbyterian Customer Service Center Center, Monday through Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 10-800- 923000-6980, Monday through Friday from 7 a.m. to 6 p.m. 000-0000. Hearing impaired users may call TTY 711. A Medical Drug is any drug administered by a Health Care Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. These drugs may be subject to a separate Copayment/Coinsurance to a maximum as outlined in your Summary of Benefits and Coverage. For a complete list of Medical Drugs to determine which require Prior Authorization please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phscontent/pel_0005273 9.pdf.

Medication Synchronization. Medication Synchronization allows Members to refill all of their Prescriptions on the same day, eliminating the need for multiple trips to the Pharmacy each month. Prescriptions are filled for less than the normal prescribed day supply in order to align the refill date across multiple prescriptions, allowing all refills on the same day and time period. Daily Cost Sharing reduces the patient pay for the prescription that is less than the standard defined days’ supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. Benefit Limitations‌‌ limitations This benefit has one or more exclusions as specified in the Exclusions Section. Section You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In- In-network Pharmacy. If you choose the 90 90-days at retail option, you will be charged one copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can contact call our Presbyterian Customer Service Center Center, Monday through Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 10-800- 923000-6980, Monday through Friday from 7 a.m. to 6 p.m. 000-0000. Hearing impaired users may call TTY 711.

Medication Synchronization. Medication Synchronization allows Members to refill all of their Prescriptions on the same day, eliminating the need for multiple trips to the Pharmacy each month. Prescriptions are filled for less than the normal prescribed day supply in order to align the refill date across multiple prescriptions, allowing all refills on the same day and time period. Daily Cost Sharing reduces the patient pay for the prescription that is less than the standard defined days’ supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. Benefit Limitations‌‌ Limitations This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In- In-network Pharmacy. If you choose chose the 90 days at retail option, you will be charged one on copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregivercare-giver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can contact call our Presbyterian Customer Service Center Center, Monday through Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 10-800- 923000-6980, Monday through Friday from 7 a.m. to 6 p.m. 000-0000. Hearing impaired users may call TTY 711. A Medical Drug is any drug administered by a Healthcare Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. These drugs may be subject to a separate Copayment/Coinsurance to a maximum as outlined in your Summary of Benefits and Coverage.

Medication Synchronization. Medication Synchronization allows Members to refill all of their Prescriptions on the same day, eliminating the need for multiple trips to the Pharmacy each month. Prescriptions are filled for less than the normal prescribed day supply in order to align the refill date across multiple prescriptions, allowing all refills on the same day and time period. Daily Cost Sharing reduces the patient pay for the prescription that is less than the standard defined days’ day’s supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. Benefit Limitations‌‌ limitations This benefit has one or more exclusions as specified in the Exclusions Section. Section You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In- In-network Pharmacy. If you choose the 90 90-days at retail option, you will be charged one copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can contact call our Presbyterian Customer Service Center Center, Monday through Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 10-800- 923000-6980, Monday through Friday from 7 a.m. to 6 p.m. 000-0000. Hearing impaired users may call TTY 711.

Medication Synchronization. Medication Synchronization allows Members to refill all of their Prescriptions on the same day, eliminating the need for multiple trips to the Pharmacy each month. Prescriptions are filled for less than the normal prescribed day supply in order to align the refill date across multiple prescriptions, allowing all refills on the same day and time period. Daily Cost Sharing reduces the patient pay for the prescription that is less than the standard defined days’ supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. Benefit Limitations‌‌ Limitations This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In- In-network Pharmacy. If you choose the 90 90-days at retail option, you will be charged one copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdfxxxx://xxxx.xxx.xxx/idc/groups/public/documents/ communication/pel_00000000.pdf. You can contact call our Presbyterian Customer Service Center Center, Monday through Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 10-800- 923000-6980, Monday through Friday from 7 a.m. to 6 p.m. 000-0000 Hearing impaired users may call TTY 711.

Medication Synchronization. Medication Synchronization allows Members to refill all of their Prescriptions on the same day, eliminating the need for multiple trips to the Pharmacy each month. Prescriptions are filled for less than the normal prescribed day supply in order to align the refill date across multiple prescriptions, allowing all refills on the same day and time period. Daily Cost Sharing cost share reduces the patient pay for the prescription that is less than the standard defined days’ days supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. Benefit Limitations‌‌ Limitations This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In- In-network Pharmacy. If you choose chose the 90 days at retail option, you will be charged one on copayment per 30-day supply up to a maximum of a 90-day supply. You will be charged three applicable Copayments for up to a 90-day supply up to the maximum dosing recommended by the manufacturer/FDA. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregivercare-giver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional are limited to an initial fill up to a 15-day supply limitationsto ensure patients can tolerate the new medication. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can contact call our Presbyterian Customer Service Center Center, Monday through Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 10-800- 923000-6980, Monday through Friday from 7 a.m. to 6 p.m. 000-0000. Hearing impaired users may call TTY 711. A Medical Drug is any drug administered by a Healthcare Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. These drugs may be subject to a separate Copayment/Coinsurance to a maximum as outlined in your Summary of Benefits and Coverage. For a complete list of Medical Drugs to determine which require Prior Authorization please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phscontent/pel_0005273 9.pdf.