Common use of Other Medications – Covered Under Medical Benefits Clause in Contracts

Other Medications – Covered Under Medical Benefits. Medications that are administered by a Covered Provider will process under the medical Benefits of this Contract. Certain medications administered by a Covered Provider require Prior Authorization. The medications that require Prior Authorization are subject to change by The Plan. In making determinations of coverage, The Plan may rely upon Pharmacy policies developed through consideration of peer reviewed medical literature, FDA approvals, accepted standards of medical practice in Montana, Medical Necessity, and Medical Policies. The Pharmacy policies and Medical Policies are located on The Plan website at xxx.xxxxxx.xxx/xxxx-xxxx/xxxxx-xxx-xx-xxxxxxx/xxxxxxxxxxx-xxxxxxxxxx.xxx. To determine which medications are subject to Prior Authorization, the Member or provider should refer to the list of medications which applies to the Member’s Plan on The Plan website at xxx.xxxxxx.xxx or call the Customer Service toll-free number identified on the Member’s identification card or The Plan website at xxx.xxxxxx.xxx/xxxx-xxxx/xxxxx- you-go-matters/xxxxxxxxxxx-xxxxxxxxxx.xxx.