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).

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).