Prescription Drug Benefit Changes Applicable to Employees and Eligible Dependents Sample Clauses

Prescription Drug Benefit Changes Applicable to Employees and Eligible Dependents. The prescription drug coverage currently offered to employees and eligible dependents will be amended by the provisions outlined in this Section VI.2.C.5 of this 2017 MOU. Effective as soon as administratively feasible following ratification, the Advanced Utilization Management Program sponsored by Express Scripts (ESI), will replace the current Non-standard Limited Drugs Utilization Management Program. In the event of a change in Prescription Drug TPA, the same type of program will be utilized. Effective as soon as administratively feasible following ratification, the Opioid Management Program sponsored by Express Scripts (ESI), will be implemented. In the event of a change in Prescription Drug TPA, the same type of program will be utilized. The drugs and supplies that shall from time to time be covered under the Plan shall consist of at least the same drugs and supplies that are covered by the prescription drug plan then in effect for U.S.-based management employees of the Company and shall consist of at least the same drugs and supplies that are covered under the most prevalent formulary program of the TPA then in effect based on commercial lives covered; provided that compound drugs may be excluded only to the extent that such drugs are also excluded under the most prevalent compound exclusion program of the TPA then in effect based on commercial lives covered. Notwithstanding the foregoing, a participant may seek pre-authorization of a prescription for a compound drug that may have otherwise been excluded from the Plan. The standards and processes that will apply in that pre-authorization process, including the requirement that the participant’s doctor establish medical necessity, will be equivalent to those that apply to an appeal of the denial of a prescription for a compound drug under the Plan. The TPA shall from time to time designate whether a covered drug is preferred or non-preferred and the manner in which prescriptions may be filled; provided that the covered drugs that are designated as preferred shall consist of at least the same drugs that are designated as preferred under the prescription drug plan then in effect for U.S.-based management employees of the Company, and shall consist of at least the same drugs that are designated as preferred under the most prevalent formulary program of the TPA then in effect based on commercial lives covered.
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Related to Prescription Drug Benefit Changes Applicable to Employees and Eligible Dependents

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  • Please see the current Washtenaw Community College catalog for up-to-date program requirements Conditions & Requirements

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