Common use of Outpatient Prescription Drug Benefits Clause in Contracts

Outpatient Prescription Drug Benefits. Prescription Drugs obtained from a Participating Pharmacy. You may call the 800 number on your identification card for assistance in a Participating Pharmacy. The Formulary is subject to change. Drugs may be deleted from the Formulary during the year if significant safety issues arise, or if new products come to the market that are superior in efficiency and or safety. If a new drug is determined as safe and effective as currently available therapies, the cost effectiveness of the drug is reviewed. Typically, if the cost is comparable or better than existing therapies, the drug is added to the Formulary. Drugs listed on the Formulary will be included in Covered Drugs if they not excluded, the appropriate Copay and/or Deductible and Coinsurance is paid, and any required Prior Authorization is received. Some Prescription Drugs are subject to Step Therapy. Step Therapy is an automated process that defines how and when a particular drug can be dispensed based on your drug history. Step therapy usually requires the use of one or more prerequisite drugs prior to the use of another drug. You may request access to clinically appropriate drugs not covered or obtain a copy of the current Formulary at no charge by contacting us at: Address: US Health and Life Insurance Company Attention: Customer Service [000 Xxxxx Xxxxx, Xxxxx 000 Troy, MI 48098] Telephone: [000-000-0000] Website: [xxx.xxxxxxxxxxxxxxxxxxxxxxxxx.xxx] Covered Prescription Drugs The Company covers only drugs that are:

Outpatient Prescription Drug Benefits. Prescription Drugs obtained from a Participating Pharmacy. You may call the 800 number on your identification card for assistance in a Participating Pharmacy. The Formulary is subject to change. Drugs may be deleted from the Formulary during the year if significant safety issues arise, or if new products come to the market that are superior in efficiency and or safety. If a new drug is determined as safe and effective as currently available therapies, the cost effectiveness of the drug is reviewed. Typically, if the cost is comparable or better than existing therapies, the drug is added to the Formulary. Drugs listed on the Formulary will be included in Covered Drugs if they not excluded, the appropriate Copay and/or Deductible and Coinsurance is paid, and any required Prior Authorization is received. Some Prescription Drugs are subject to Step Therapy. Step Therapy is an automated process that defines how and when a particular drug can be dispensed based on your drug history. Step therapy usually requires the use of one or more prerequisite drugs prior to the use of another drug. You may request access to clinically appropriate drugs not covered or obtain a copy of the current Formulary at no charge by contacting us at: Address: US Health and Life Insurance Company Attention: Customer Service [000 Xxxxx Xxxxx, Xxxxx 000 Troy0000 Xxxxxx Xxxx Sterling Heights, MI 4809848312] Telephone: [000-000-0000] Fax: [000-000-0000] Website: [xxx.xxxxxxxxxxxxxxxxxxxxxxxxx.xxx] Covered Prescription Drugs The Company covers only drugs that are: