Common use of Pharmacy Clause in Contracts

Pharmacy. i. Generic first across all plans: The member/dependent(s) will be required to use generic medication first. The member/dependent(s) will be offered to use brand-name drugs only after first trying similar generic medications and the generic medication has not been effective in treating member’s/dependent(s) condition. If brand-name medication is required, the member/dependent(s) will be responsible for the difference in cost of the generic medication versus the brand medication. ii. Mail-Order/90-Day Limited Network Retail Pharmacy Solution for maintenance/preventive drugs: The member/dependent(s) will be required to use mail order or pick up prescriptions at an in-network retail pharmacy for all maintenance/preventive drugs needed for a long-term health condition. First time prescription will only be filled at retail pharmacy three (3) times and subsequent refills would be filled using mail order pharmacy or an in-network 90 day retail pharmacy. The member/dependent(s) will pay only two (2) copays for a 90 day refill of mail order or a limited network 90-day retail pharmacy for prescriptions.

Pharmacy. i. Generic first across all plans: The memberemployee/dependent(s) member will be required to use generic medication first. The member/dependent(s) will be offered allowed to use brand-name drugs only after first trying similar generic medications and the generic medication has not been effective in treating the member’s/dependent(sdependent’(s) condition. If brand-name medication is required, the member/dependent(s) will be responsible for the difference in cost of the generic medication versus the brand medication. ii. Mail-Order/90-Day Limited Network Retail Pharmacy Solution for maintenance/preventive drugs: The member/dependent(s) will be required to use mail order or pick up prescriptions at an in-network retail pharmacy for all maintenance/preventive drugs needed for a long-term health condition. First time prescription will only be filled at retail pharmacy three (3) times and subsequent refills would be filled using mail order pharmacy or an in-network 90 90-day retail pharmacy. The member/dependent(s) will pay only two (2) copays for a 90 90-day refill of mail order or a limited network 90-day retail pharmacy for prescriptions.