Common use of Outpatient Prescription Drug Benefit Clause in Contracts

Outpatient Prescription Drug Benefit. Subject to the terms and conditions of this Section, bene- fits are provided for outpatient prescription Drugs, which are prescribed by a licensed Physician and are obtained from a Participating Pharmacy. Benefits are provided for Formulary Drugs, which are Drugs listed on Blue Shield’s Drug Formulary. This Formulary is updated on a periodic basis by Blue Shield’s Pharmacy and Thera- peutics Committee. Benefits may also be provided for Non-Formulary Drugs subject to higher Copayments. Select Drugs and Drug dosages and most Home Self- Administered Injectables require prior authorization by Blue Shield of California for Medical Necessity appro- priateness of therapy or when effective, lower cost alter- natives are available. Your Physician may request prior authorization from Blue Shield. Coverage for selected Drugs may be limited to a specific quantity as described in the section entitled Limitation on Quantity of Drugs that May be Obtained per Prescription or Refill.

Outpatient Prescription Drug Benefit. Subject to the terms and conditions of this Section, bene- fits are provided for outpatient prescription Drugs, which are prescribed by a licensed Physician and are obtained from a Participating Pharmacy. Benefits are provided for Formulary Drugs, which are Drugs listed on Blue Shield’s Drug Formulary. This Formulary is updated on a periodic basis by Blue Shield’s Pharmacy and Thera- peutics Committee. Benefits may also be provided for Non-Formulary Drugs subject to higher Copayments. Select Drugs and Drugs, Drug dosages dosages, and most Home Self- Administered Injectables require prior authorization by Blue Shield of California for Medical Necessity appro- priateness of therapy or when effective, lower cost alter- natives are available. Your Physician may request prior authorization from Blue Shield. Coverage for selected Drugs may be limited to a specific quantity as described in the section entitled Limitation on Quantity of Drugs that May be Obtained per Prescription or Refill.

Outpatient Prescription Drug Benefit. Subject to the terms and conditions of this Section, bene- fits benefits are provided for outpatient prescription Drugs, which are prescribed by a licensed Physician and are obtained from a Participating Pharmacy. Benefits are provided for Formulary Drugs, which are Drugs listed on Blue Shield’s Drug Formulary. This Formulary is updated on a periodic basis by Blue Shield’s Pharmacy and Thera- peutics Therapeutics Committee. Benefits may also be provided for Non-Formulary Drugs subject to higher Copayments. Select Drugs and Drug dosages and most Home Self- Self-Administered Injectables require prior authorization au- thorization by Blue Shield of California for Medical Necessity appro- priateness appropriateness of therapy or when effective, lower cost alter- natives alternatives are available. Your Physician may request prior authorization from Blue Shield. Coverage for selected Drugs may be limited to a specific specif- ic quantity as described in the section entitled Limitation Limita- tion on Quantity of Drugs that May be Obtained per Prescription or Refill.

Outpatient Prescription Drug Benefit. Subject to the terms and conditions of this Section, bene- fits are provided for outpatient prescription Drugs, which Drugs that are prescribed by a licensed Physician and are obtained from a Participating Pharmacy. Benefits are provided for Formulary Drugs, which are Drugs listed on Blue Shield’s Drug Formulary. This Formulary is updated on a periodic basis by Blue Shield’s Pharmacy and Thera- peutics Committee. Benefits may also be provided for Non-Formulary Drugs subject to higher Copayments. Select Drugs and Drugs, Drug dosages dosages, and most Home Self- Self-Administered Injectables require prior authorization by Blue Shield of California for Medical Necessity appro- priateness appropriateness of therapy ther- apy or when effective, lower cost alter- natives alternatives are availableavaila- ble. Your Physician may request prior authorization from Blue Shield. Coverage for selected Drugs may be limited to a specific quantity as described in the section entitled Limitation on Quantity of Drugs that May be Obtained per Prescription or Refill.