Prescription Drug Benefits. A-9.01 All eligible employees shall be entitled to prescription drug benefits for themselves and their eligible dependants. Prescription drug benefits shall cover one hundred (100%) percent of the cost of prescription drugs up to the employee’s Pharmacare deductible based on those drugs covered by Pharmacare. (Any employees currently on drugs not covered by Pharmacare shall be allowed to continue as long as medically required.)
Prescription Drug Benefits. The Summary of Pharmacy Benefits only applies to prescription drugs purchased at a retail, mail order, or specialty, pharmacy. For information about our pharmacy network, visit our website or call our Customer Service Department.
Prescription Drug Benefits. Benefits are available for outpatient prescription Drugs. Outpatient prescription Drugs are self-administered Drugs approved by the U.S. Food and Drug Administration (FDA) for sale to the public through retail or mail-order pharmacies that are prescribed and are not provided for use on an inpatient basis. Drugs also include diabetic testing supplies. A Physician or Health Care Provider must prescribe all Drugs covered under this Benefit, including over-the-counter items. You must obtain all Drugs from a Participating Pharmacy, except as noted below. Drugs, items, and services that are not covered under this Benefit are listed in the Exclusions and limitations section. Some Drugs, most Specialty Drugs, and prescriptions for Drugs exceeding specific quantity limits require prior authorization to be covered. The prior authorization process is described in the Prior authorization/exception request/step therapy process section. You or your Physician may request prior authorization from Blue Shield. Blue Shield’s Drug Formulary is a list of FDA-approved preferred Generic and Brand Drugs. This list helps Physicians or Health Care Providers prescribe Medically Necessary and cost-effective Drugs. Blue Shield’s Formulary is established and maintained by Blue Shield’s Pharmacy and Therapeutics (P&T) Committee. This committee consists of Physicians and pharmacists responsible for evaluating Drugs for relative safety, effectiveness, evidence-based health benefit, and comparative cost. The committee also reviews new Drugs, dosage forms, usage, and clinical data to update the Formulary four times a year. Your Physician or Health Care Provider might prescribe a Drug even though it is not included in the Blue Shield Formulary. The Formulary is divided into Drug tiers. The tiers are described in the chart below. Your Copayment or Coinsurance will vary based on the Drug tier. Drugs are placed into tiers based on recommendations made by the P&T Committee. Tier 1 • Most Generic Drugs or low-cost preferred Brand Drugs Tier 2 • Non-preferred Generic Drugs • Preferred Brand Drugs • Any other Drugs recommended by the P&T Committee based on drug safety, efficacy, and cost Tier 3 • Non-preferred Brand Drugs • Drugs recommended by the P&T Committee based on drug safety, efficacy, and cost • Drugs that generally have a preferred and often less costly therapeutic alternative at a lower tier Tier 4 • Drugs that are biologics, and Drugs the FDA or drug manufacturer requires to be distrib...
Prescription Drug Benefits. 1. Employees who enroll in the Century Preferred Managed Care Program or the Blue Care POS Plan shall enroll in the Anthem Public Sector Three-Tier Prescription Drug Plan with co-payments of $10 for generic drugs, $20 for listed brand name drugs, and $30 for non-listed brand name drugs, and required generic substitution, for a 30-day supply. Mail order co-payments for a 90-day supply of maintenance medications are twice the co-pay for a 30-day supply. For non-participating pharmacies, the plan pays 70% of the Anthem allowance. The annual maximum benefit is $1,000.00.
2. Employees who enroll in Blue Care XXX shall enroll in the Anthem Public Sector Three-Tier Prescription Drug Plan with co-payments of $5 for generic drugs, $10 for listed brand name drugs, and $15 for non-listed brand name drugs, and required generic substitution, for a 30-day supply. Mail order co-payments for a 90-day supply of maintenance medications are twice the co-pay for a 30 day supply. The annual maximum benefit is $1,000.00.
Prescription Drug Benefits. Please refer to the Schedule of Benefits for Cost-Sharing requirements, supply limits, and any Preauthorization or Referral requirements that apply to these benefits.
Prescription Drug Benefits. All designated Retail Pharmacies. (Up to a 30-day formulary supply for each prescription or refill). $10 for Tier 1 $20 for Teir 2 $35 for Teir 3 Through the designated Mail Service Pharmacy. (Up to a 90- day supply for each prescription or refill). $10 for Tier 1 $20 for Teir 2 $35 for Teir 3 The School District will maintain the current employee-funded Section 125 plans relating to pre-tax health and dental coverage. The parties agree that there shall be no change in premium contribution (premium split) or plan design (co- payments and out-of-pocket expenses) for the current Network Blue New England plan for the duration of this agreement. When an employee retires, the employee may elect to remain in the Group Health Insurance Plan if the employee contributed to and is receiving a pension from the City of Xxxxxxxx Retirement Board. Pursuant to MGL c. 32B § 18A, a retired employee, spouse, or dependent who is Medicare eligible shall be transferred to the School District’s Medicare health plan upon reaching the age of sixty-five (65).
Prescription Drug Benefits. 180. 1. Effective July 1, 2012, employees who enroll in the Century Preferred Managed Care Program will also be enrolled in the City's integrated prescription drug program with copayments of $15 for generic drugs, $25 for listed brand name drugs, and $40 for non listed brand name drugs, and required generic substitution, for a 30-day supply. Mail order co-payments for a 90-day supply of maintenance medications are twice the co-pay for a 30-day supply. The annual maximum benefit is $1,000.00. After the participant reaches the $1,000.00 annual maximum benefit, all future claims are treated as an out-of network benefit subject to the deductible and reimbursement at 70% of the provider allowance.
Prescription Drug Benefits. Many of you will recall that we had quite a fight with the Company in 2006 over the unilateral imple- mentation of several Pharmacy Management programs. We took our case to arbitration and prevailed. The Company was insistent about obtaining what they weren’t awarded during the arbitration, but your bargaining committee held the line. Not only were we successful in not having any changes made to the current copayments charged for Retail or Mail Order prescriptions, we reached a fair and reasonable tentative Agreement on the implementation of any Pharmacy Management Programs. The following outlines the changes that will become effective January 1, 2009.
Prescription Drug Benefits. A-9.01 To employees who qualify, the Plan will offer prescription drug benefits for themselves and their eligible dependants. A card will be issued to each employee to direct bill prescription drug purchases.
Prescription Drug Benefits. Prescription Drug Benefits for all three (3) plans are detailed in the chart above and in the summary of benefits in Exhibit IX. The prescription drug benefit includes the following “edits” (managed care):
(1) generic substitution with a “dispensed as written” (DAW) provider override for a brand name drug, and (2) mandatory specialty drugs dispensed through Accredo mail order specialty pharmacy. Specialty medications are used to treat complex medical conditions, are typically injected, and may need special handling.
