Opioid Antagonists. Benefits will be provided for at least one opioid antagonist drug, including the medication product, administration devices and any Pharmacy administration fees related to the dispensing of the opioid antagonist. This includes refills for expired or utilized opioid antagonists. Diabetic Supplies for Treatment of Diabetes Benefits are available for medically necessary items of diabetic supplies for which a Health Care Practitioner has written an order. Such diabetes supplies shall include, but are not limited to, the following: • Test strips specified for use with a corresponding blood glucose monitor • Lancets and lancet devices • Visual reading strips and urine testing strips and tablets which test for glu cose, ketones, and protein • Insulin and insulin analog preparations • Injection aids, including devices used to assist with insulin injection and needleless systems • Insulin syringes • Biohazard disposable containers • Prescriptive and non‐prescriptive oral agents for controlling blood sugar levels • Glucagon emergency kits Cancer Medications — Benefits will be provided for orally administered or self-injected cancer medications that are used to kill or slow the growth of can cerous cells. Your Copayment Amount will not apply to orally administered cancer medications.
Opioid Antagonists. Benefits will be provided for at least one opioid antagonist drug, including the medication product, administration devices and any Pharmacy administration fees related to the dispensing of the opioid antagonist. This includes refills for expired or utilized opioid antagonists. Note: Benefits for naloxone hydrochloride, will be provided at no charge, when obtained from a Participating Pharmacy.
Opioid Antagonists. Benefits will be provided for at least one opioid antagonist drug, including the medication product, administration devices and any Pharmacy administration fees related to the dispensing of the opioid antagonist. This includes refills for expired or utilized opioid antagonists. Diabetic Supplies for Treatment of Diabetes Benefits are available for medically necessary items of diabetic supplies for which a Health Care Practitioner has written an order. Such diabetes supplies shall include, but are not limited to, the following: • Test strips specified for use with a corresponding blood glucose monitor • Lancets and lancet devices • Visual reading strips and urine testing strips and tablets which test for glu cose, ketones, and protein • Insulin and insulin analog preparations • Injection aids, including devices used to assist with insulin injection and needleless systems • Insulin syringes • Biohazard disposable containers • Prescriptive and non‐prescriptive oral agents for controlling blood sugar levels • Glucagon emergency kits Compound Drugs Benefits are available for medically necessary Compound Drugs. The drugs used must meet the following requirements:
