Common use of Optometrist or Podiatrist Clause in Contracts

Optometrist or Podiatrist. To determine if a specific drug is subject to this limitation, you can refer to the Drug List by accessing the Web site at xxx.xxxxxx.xxx or call the Customer Service toll‐free number on your identification card. If you require a Prescription Order in excess of the dispensing limit established by the Plan, ask your Physician, Dentist, Optometrist or Podiatrist to submit a request for clinical review on your behalf. The request will be approved or xx­ xxxx after evaluation of the submitted clinical information. The Plan has the right to determine dispensing limits and they may change from time to time. Payment for benefits covered under this benefit section may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum quantity limitation. Day Supply The Plan has the right to determine the day supply. Payment for benefits cov­ ered under this benefit section may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumvent­ ing, the stated maximum day supply limitation. Specialty Drugs are limited to a 34 day supply.

Optometrist or Podiatrist. To determine if a specific drug is subject to this limitation, you can refer to the For­ mulary Drug List by accessing the Web site at xxx.xxxxxx.xxx or call the Customer Service toll‐free number on your identification card. If you require a Prescription Order in excess of the dispensing limit established by the Plan, ask your Physician, Dentist, Optometrist or Podiatrist to submit a request for clinical review on your behalf. The request will be approved or xx­ xxxx after evaluation of the submitted clinical information. The Plan has the right to determine dispensing limits and they may change from time to time. Payment for benefits covered under this benefit section may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum quantity limitation. Day Supply The Plan has the right to determine the day supply. Payment for benefits cov­ ered under this benefit section may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumvent­ ing, the stated maximum day supply limitation. Specialty Drugs are limited to a 34 30 day supply.

Optometrist or Podiatrist. To determine if a specific drug is subject to this limitation, you can refer to the Drug List by accessing the Web site at xxx.xxxxxx.xxx or call the Customer Service toll‐free number on your identification card. If you require a Prescription Order in excess of the dispensing limit established by the Plan, ask your Physician, Dentist, Optometrist or Podiatrist to submit a request for clinical review on your behalf. The request will be approved or xx­ xx- xxxx after evaluation of the submitted clinical information. The Plan has the right to determine dispensing limits and they may change from time to time. Payment for benefits covered under this benefit section may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum quantity limitation. Day Supply The Plan has the right to determine the day supply. Payment for benefits cov­ cov- ered under this benefit section may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumvent­ circumvent- ing, the stated maximum day supply limitation. Specialty Drugs are limited to a 34 day supply.