Common use of Plan Design Changes - XXXX Clause in Contracts

Plan Design Changes - XXXX. (a) ERMA’s Prescription Drug Card and Mail Order Prescription Drug Programs shall be revised as follows: (1) Prior Authorization by ERMA’s current pharmacy benefit manager (or any successor pharmacy benefit manager) (“PBM”) shall be required, in accordance with such PBM’s Prior Authorization Program then in effect, before any prescription drugs in the therapeutic drug categories shown on Exhibit C hereto as subject to such Program shall be dispensed; provided, however, that no more than a three to five-day supply of such a drug may be dispensed at retail in accordance with the PBM’s Temporary Override Program without Prior Authorization. (2) Retirees and their covered dependents shall be required to adhere to Step Therapy and Quantity/Duration Limits Programs then in effect of ERMA’s PBM with respect to the prescription drugs in the therapeutic drug categories shown on Exhibit C hereto as subject to such Step Therapy Program and/or Quantity/Duration Limits Program, as the case may be. (3) Retirees and their covered dependents may, on a wholly voluntary basis and in accordance with program criteria, participate in the PBM’s Personalized Medicine and/or Generic Rx Advantage Program then in effect. (b) The design changes contained in this Section shall become effective on July 1, 2012, and shall apply only to individuals who become eligible for XXXX coverage on or after July 1, 2012.

Plan Design Changes - XXXX. (a) ERMA’s Prescription Drug Card and Mail Order Prescription Drug Programs shall be revised as follows: (1) Prior Authorization by ERMA’s current pharmacy benefit manager (or any successor pharmacy benefit manager) (“PBM”) shall be required, in accordance with such PBM’s Prior Authorization Program then in effect, before any prescription drugs in the therapeutic drug categories shown on Exhibit C hereto as subject to such Program shall be dispensed; provided, however, that no more than a three to five-day supply of such a drug may be dispensed at retail in accordance with the PBMPEB’s Temporary Override Program without Prior Authorization. (2) Retirees and their covered dependents shall be required to adhere to Step Therapy and Quantity/Duration Limits Programs then in effect of ERMA’s PBM with respect to the prescription drugs in the therapeutic drug categories shown on Exhibit C hereto as subject to such Step Therapy Program and/or Quantity/Duration Limits Program, as the case may be. (3) Retirees and their covered dependents may, on a wholly voluntary basis and in accordance with program criteria, participate in the PBM’s Personalized Medicine and/or Generic Rx Advantage Program then in effect. (b) The design changes contained in this Section shall become effective on July January 1, 20122012 or as soon thereafter as practicable, and shall apply only to individuals who become eligible for XXXX coverage on or after July January 1, 2012.