Common use of Prescription Drug Coverage Clause in Contracts

Prescription Drug Coverage. The Kawartha Pine Ridge District School Board Health Care Plan for District 14 OSSTF will contain all drugs and supplies listed in the KPR Benefits Carrier Formulary, or its equivalent, covered at 100% reimbursement through a pay- direct drug card. The KPR Benefits Carrier Formulary is reviewed and updated four times each year using an independent panel of medical experts’ recommendations on new drugs and new information on existing drugs. Note: Drugs which are not covered under the KPR Formulary Prescription Drug Plan are listed as per the master agreement between the Board and its carrier provider. A reference to drugs when administered through a hospital (whether in-patient or out-patient) will be added to the list. In the event that the Kawartha Pine Ridge District School Board Health Care Formulary for District 14 OSSTF does not contain an acceptable substitute with equivalent therapeutic value, or should the insured individual insist that a prescription be filled when a drug is not a covered expense under the plan, the plan shall provide 70% reimbursement of said prescription drug at point-of- sale, providing said prescription drug was an eligible expense under the KPR Benefits Carrier or its equivalent and providing that at least one of the following conditions is met: • There is no reasonable substitute for the drug prescribed. • There is a life threatening or debilitating disease. • There is a hazard to the person’s health. The employee will submit this information on the Drug Exception Request Application to the pharmacist at the KPR Benefits Carrier for review and the matter shall be resolved within twenty (20) instructional days of the Teacher’s initial written request. If the time line is not met, the Teacher shall be entitled to 100% reimbursement.

Prescription Drug Coverage. The Kawartha Pine Ridge District School Board Health Care Plan for District 14 14, OSSTF will contain all drugs and supplies listed in the KPR Benefits Carrier Assure National Formulary® (NASA), or its equivalent, covered at 100% reimbursement through a pay- pay-direct drug card. The KPR Benefits Carrier Formulary Assure National Formulary® (NASA) is reviewed and updated four times each year using an independent panel of medical experts’ recommendations on new drugs and new information on existing drugs. Note: Drugs which Fertility drugs are not a covered expense under the KPR Formulary Prescription Drug Plan are listed as per the master agreement between the Board and its carrier provider. A reference to drugs when administered through a hospital (whether in-patient or out-patient) will be added to the listdrug plan. In the event that the Kawartha Pine Ridge District School Board Health Care Formulary Plan for District 14 14, OSSTF does not contain an acceptable substitute with equivalent therapeutic value, or should the insured individual insist that a prescription be filled when a drug is not a covered expense under the plan, the plan shall provide 70% reimbursement of said prescription drug at point-of- of-sale, providing said prescription drug was an eligible expense under the KPR Benefits Carrier Assure Health Plan 84 or its equivalent. The employee may then proceed at their option to have the full cost of said prescription drug paid by the plan utilizing the Drug Exception Process. Drugs may be reimbursed at 100% and added to the pay- direct drug card for future purchases (if applicable), providing said prescription drug must have been an eligible expense under the Assure Health Plan 84 or its equivalent and providing that at least one of the following conditions is met: • There is no reasonable substitute for the drug prescribed. • There is a life threatening or debilitating disease. • There is a hazard to the person’s health. The employee will submit this information on the Drug Exception Request Application to the pharmacist at the KPR Benefits Carrier Assure for review and the matter shall be resolved within twenty (20) instructional days of the Teacher’s initial written request. If the time line is not met, the Teacher shall be entitled to 100% reimbursement.

Prescription Drug Coverage. The Kawartha Pine Ridge District School Board Health Care Plan for District 14 OSSTF will contain all drugs and supplies listed in the KPR Benefits Carrier Formulary, or its equivalent, covered at 100% reimbursement through a pay- direct drug card. The KPR Benefits Carrier Formulary is reviewed and updated four times each year using an independent panel of medical experts’ recommendations on new drugs and new information on existing drugs. Note: Drugs which are not covered under the KPR Formulary Prescription Drug Plan are listed as per the master agreement between the Board and its carrier provider. A reference to drugs when administered through a hospital (whether in-patient or out-patient) will be added to the list. In the event that the Kawartha Pine Ridge District School Board Health Care Formulary for District 14 OSSTF does not contain an acceptable substitute with equivalent therapeutic value, or should the insured individual insist that a prescription be filled when a drug is not a covered expense under the plan, the plan shall provide 70% reimbursement of said prescription drug at point-of- sale, providing said prescription drug was an eligible expense under the KPR Benefits Carrier or its equivalent and providing that at least one of the following conditions is met: • There •There is no reasonable substitute for the drug prescribed. • There •There is a life threatening or debilitating disease. • There •There is a hazard to the person’s health. The employee will submit this information on the Drug Exception Request Application to the pharmacist at the KPR Benefits Carrier for review and the matter shall be resolved within twenty (20) instructional days of the Teacher’s initial written request. If the time line is not met, the Teacher shall be entitled to 100% reimbursement.