Common use of Prescription Drug Clause in Contracts

Prescription Drug. (1) If an employee and/or eligible dependent receives prescription drugs at a participating PPO pharmacy, the employee shall be responsible for a five dollar ($5.00) co-pay for a generic drug. If there is no generic drug equivalent for the prescribed drug, the co-pay is ten dollars ($10.00). If the prescription is for a brand-name drug, or the prescription is written "dispense as written" and a generic equivalent exists, the co-pay is twenty-five dollars ($25.00). If participating pharmacies are not used, additional ten dollar ($10.00) co-pay shall be imposed. Effective January 1, 2018, the employee shall be responsible for a five dollar ($5.00) co-pay for a Tier 1 drug. For a Tier 2 drug, the co-pay is fifteen dollars ($15.00). For a Tier 3 drug or if the prescription is written “dispense as written” and a lower tier drug exists, the co-pay is thirty dollars ($30.00). The annual out-of-pocket maximum per single contract per year will be two thousand dollars ($2,000.00); the annual out-of-pocket maximum per family contract per year will be four thousand dollars ($4,000.00). (2) Mail order prescription drugs will be limited to a thirty (30) day minimum and a ninety (90) day maximum supply. Under the mail order program, the employee shall be responsible for a ten dollar ($10.00) co-pay for a generic drug. If there is no generic drug equivalent for the prescribed drug, the co-pay is twenty dollars ($20.00). If the prescription is for a brand-name drug, or the prescription is written "dispense as written" and a generic equivalent exists, the co-pay is fifty dollars ($50.00). Maintenance drugs may be obtained through the mail order program, if such maintenance drugs are available through the mail order program. Effective January 1, 2018, the supply limits described above will remain the same; the out-of-pocket maximums for prescription drugs fulfilled through mail order will remain the same as described in Section 18.1(B) above. Under the mail order program, the employee shall be responsible for a twelve dollar and fifty cent ($12.50) co-pay for a Tier 1 drug. For a Tier 2 drug, the co-pay is twenty-five dollars ($25.00). If the prescription is for a Tier 3 drug or if the prescription is written “dispense as written” and a lower tier drug exists, the co-pay is sixty dollars ($60.00). (3) Effective January 1, 2018, the City will provide a prescription drug coverage plan that provides for the use of a formulary and prior authorization requirements for certain types of drugs; and some drugs will require the employee and/or dependent to undergo step therapy (trial of a lower cost drug before a higher-cost drug is covered). The prescription drug program administrator will determine which drugs require prior authorization and/or step therapy. After the formulary takes effect, the City’s obligation to provide substantially similar prescription drug benefits and coverages under Article 18.1 applies to the formulary.

Prescription Drug. (1) If an employee and/or eligible dependent receives Prescriptions dispensed under the prescription drugs at drug ID card program and direct reimbursement program will be limited to a participating PPO pharmacythirty (30) day maximum supply, the employee member shall be responsible for a five dollar ($5.00) co-pay for a generic drug. If there is no generic drug equivalent for the prescribed drug, the co-pay is ten dollars ($10.00). If the prescription is for a brand-name drug, or the prescription is written "dispense as written" and a generic equivalent exists, the co-pay is twenty-five dollars ($25.00). If participating pharmacies are not used, additional ten The five dollar ($10.005.00) co-pay shall be imposedapplies to all allergy prescriptions under the direct reimbursement program. Effective January 1, 2018, the employee shall be responsible for a five dollar ($5.00) co-pay for a Tier 1 drug. For a Tier 2 drug, the co-pay is fifteen dollars ($15.00). For a Tier 3 drug drug, or if the prescription is written “"dispense as written” " and a lower tier drug exists, the co-co- pay is thirty dollars ($30.00). The annual out-of-pocket maximum per for single contract per year will be two thousand dollars ($2,000.00); the annual out-of-pocket maximum per family contract per year will be four thousand dollars ($4,000.00). (2) Mail Prescriptions dispensed under the mail order prescription drugs will be limited to a thirty (30) day minimum and a ninety (90) day maximum supply. Under the mail order program, the employee member shall be responsible for a ten dollar ($10.00) co-pay for generic drugs. If there is no generic drug equivalent for the prescribed drug, the co-pay is twenty dollars ($20.00). If the prescription is for a brand- name drug, or the prescription is written "dispense as written" and a generic equivalent exists, the co-pay is fifty dollars ($50.00). Effective January 1, 2018, mail order prescription drugs will be limited to a thirty (30) day minimum and a ninety (90) day maximum supply. The out-of-pocket maximum for prescription drugs fulfilled through mail order will be the same as described in Section 27.1(B)(1) above. Under the mail order program, the employee shall be responsible for a twelve dollar and fifty cents ($12.50) co-pay for a Tier 1 drug. For a Tier 2 drug, the co-pay is twenty-five dollars ($25.00). For a Tier 3 drug, or if the prescription is written "dispense as written" and a lower tier drug exists, the co-pay is sixty dollars ($60.00). Maintenance drugs may be obtained through the mail order program. (3) For prescriptions dispensed under the prescription Drug Preferred Provider Organization (PPO) arrangement, the member shall be responsible for a five dollar ($5.00) co- pay for a generic drug. If there is no generic drug equivalent for the prescribed drug, the co-pay is twenty ten dollars ($20.0010.00). If the prescription is for a brand-name drug, or the prescription is written "dispense as written" and a generic equivalent exists, the co-pay is fifty twenty-five dollars ($50.00)25.00) for participating pharmacies. Maintenance drugs may If participating pharmacies are not used, an additional ten dollar ($10.00) co-pay shall be obtained through the mail order program, if such maintenance drugs are available through the mail order programimposed. Effective January 1, 2018, the supply limits described above will remain the same; the out-of-pocket maximums for prescription drugs fulfilled through mail order will remain the same as described in Section 18.1(B) above. Under the mail order program, the employee shall be responsible for a twelve dollar and fifty cent ($12.50) co-pay for a Tier 1 drug. For a Tier 2 drug, the co-pay is twenty-five dollars ($25.00). If the prescription is for a Tier 3 drug or if the prescription is written “dispense as written” and a lower tier drug exists, the co-pay is sixty dollars ($60.00). (3) Effective January 1, 2018, the City will provide a prescription drug coverage plan that provides for the use of a formulary and program will include prior authorization requirements for certain types of drugs; and some drugs will require the employee and/or dependent to undergo step therapy (trial of a lower cost drug before a higher-cost drug is covered). The prescription drug program administrator will determine which drugs require prior authorization and/or step therapy. After the formulary takes effect, the City’s obligation to provide substantially similar prescription drug benefits and coverages under Article 18.1 applies to the formulary.

Prescription Drug. (1) If an employee and/or eligible dependent receives prescription drugs at a participating PPO pharmacy, the employee shall be responsible for a five dollar ($5.00) co-pay for a generic drug. If there is no generic drug equivalent for the prescribed drug, the co-pay is ten dollars ($10.00). If the prescription is for a brand-brand- name drug, or the prescription is written "dispense as written" and a generic equivalent exists, the co-pay is twenty-five dollars ($25.00). If participating pharmacies are not used, additional ten dollar ($10.00) co-pay shall be imposed. Effective January 1, 2018, the employee shall be responsible for a five dollar ($5.00) co-co- pay for a Tier 1 drug. For a Tier 2 drug, the co-pay is fifteen dollars ($15.00). For a Tier 3 drug or if the prescription is written “dispense as written” and a lower tier drug exists, the co-pay is thirty dollars ($30.00). The annual out-of-pocket maximum per single contract per year will be two thousand dollars ($2,000.00); the annual out-of-of- pocket maximum per family contract per year will be four thousand dollars ($4,000.00). (2) Mail order prescription drugs will be limited to a thirty (30) day minimum and a ninety (90) day maximum supply. Under the mail order program, the employee shall be responsible for a ten dollar ($10.00) co-pay for a generic drug. If there is no generic drug equivalent for the prescribed drug, the co-pay is twenty dollars ($20.00). If the prescription is for a brand-name drug, or the prescription is written "dispense as written" and a generic equivalent exists, the co-pay is fifty dollars ($50.00). Maintenance drugs may be obtained through the mail order program, if such maintenance drugs are available through the mail order program. Effective January 1, 2018, the supply limits described above will remain the same; the The out-of-pocket maximums for prescription drugs fulfilled through mail order will remain the same as described in Section 18.1(B18.1(B)(1) above. Under the mail order program, the employee shall be responsible for a twelve dollar and fifty cent ($12.50) co-pay for a Tier 1 drug. For a Tier 2 drug, the co-pay is twenty-five dollars ($25.00). If the prescription is for a Tier 3 drug or if the prescription is written “dispense as written” and a lower tier drug exists, the co-pay is sixty dollars ($60.00). (3) Effective January 1, 2018, the tThe City will provide a prescription drug coverage plan that provides for the use of a formulary and prior authorization requirements for certain types of drugs; and some drugs will require the employee and/or dependent to undergo step therapy (trial of a lower cost drug before a higher-cost drug is covered). The City’s Pharmacy Benefits Manager (PBM) prescription drug program administrator will determine which drugs require prior authorization and/or step therapy. After the formulary takes effect, the City’s obligation to provide substantially similar prescription drug benefits and coverages under Article 18.1 applies to the formulary.. The City’s prescription drug coverage plan will include the following clinical programs:

Prescription Drug. (1) If an employee and/or eligible dependent receives Prescriptions dispensed under the prescription drugs at drug ID card program and direct reimbursement program will be limited to a participating PPO pharmacythirty (30) day maximum supply, the employee member shall be responsible for a five dollar ($5.00) co-pay for a generic drug. If there is no generic drug equivalent for the prescribed drug, the co-pay is ten dollars ($10.00). If the prescription is for a brand-name drug, or the prescription is written "dispense as written" and a generic equivalent exists, the co-pay is twenty-five dollars ($25.00). If participating pharmacies are not used, additional ten dollar ($10.00) co-pay shall be imposed. Effective January 1, 2018, the employee shall be responsible for a The five dollar ($5.00) co-pay for a Tier 1 drug. For a Tier 2 drug, applies to all allergy prescriptions under the co-pay is fifteen dollars ($15.00). For a Tier 3 drug or if the prescription is written “dispense as written” and a lower tier drug exists, the co-pay is thirty dollars ($30.00). The annual out-of-pocket maximum per single contract per year will be two thousand dollars ($2,000.00); the annual out-of-pocket maximum per family contract per year will be four thousand dollars ($4,000.00)direct reimbursement program. (2) Mail Prescriptions dispensed under the mail order prescription drugs will be limited to a thirty (30) day minimum and a ninety (90) day maximum supply. Under the mail order program, the employee member shall be responsible for a ten dollar ($10.00) co-pay for a generic drugdrugs. If there is no generic drug equivalent for the prescribed drug, the co-pay is twenty dollars ($20.00). If the prescription is for a brand-brand- name drug, or the prescription is written "dispense as written" and a generic equivalent exists, the co-pay is fifty dollars ($50.00). Maintenance drugs may be obtained through the mail order program, if such maintenance drugs are available through . The original prescription with no refills may be purchased locally but subsequent refills must use the mail order program. Effective January 1, 2018. (3) For prescriptions dispensed under the prescription Drug Preferred Provider Organization (PPO) arrangement, the supply limits described above will remain the same; the out-of-pocket maximums for prescription drugs fulfilled through mail order will remain the same as described in Section 18.1(B) above. Under the mail order program, the employee member shall be responsible for a twelve five dollar and fifty cent ($12.505.00) co- pay for a generic drug. If there is no generic drug equivalent for the prescribed drug, the co-pay is ten dollars ($10.00). If the prescription is for a Tier 1 brand-name drug. For , or the prescription is written "dispense as written" and a Tier 2 druggeneric equivalent exists, the co-pay is twenty-five dollars ($25.00)) for participating pharmacies. If the prescription is for a Tier 3 drug or if the prescription is written “dispense as written” and a lower tier drug existsparticipating pharmacies are not used, the an additional ten dollar ($10.00) co-pay is sixty dollars ($60.00)shall be imposed. (3) Effective January 1, 2018, the City will provide a prescription drug coverage plan that provides for the use of a formulary and prior authorization requirements for certain types of drugs; and some drugs will require the employee and/or dependent to undergo step therapy (trial of a lower cost drug before a higher-cost drug is covered). The prescription drug program administrator will determine which drugs require prior authorization and/or step therapy. After the formulary takes effect, the City’s obligation to provide substantially similar prescription drug benefits and coverages under Article 18.1 applies to the formulary.