Prescription Drugs and Diabetic Equipment and Supplies. Prescription drugs and diabetic equipment and supplies purchased at a retail, specialty, or mail order pharmacy. See Summary of
Prescription Drugs and Diabetic Equipment and Supplies. Prescription drugs and diabetic equipment and supplies purchased at a retail, specialty, or mail order pharmacy. See Summary of PharmacyBenefits See Summary of PharmacyBenefits Medical prescription drugs requiring administration by a licensed health care provider*: Medical prescription drugs other than infused drugs - includes but is not limited to: medications by injection or inhalation, as well as nasal, topical, or transdermal medications. 0% - After deductible 20% - After deductible Infused drugs 0% - After deductible 20% - After deductible
Prescription Drugs and Diabetic Equipment and Supplies. Prescription drugs and diabetic equipment and supplies dispensed at a pharmacy. See Summary of Pharmacy Benefits for prescription drugs purchased at a retail, specialty, or mail order pharmacy. Prescription drugs dispensed and administered by a licensed health care provider (other than a pharmacist), and not purchased from a retail, specialty or mail order pharmacy: Injectable drugs* 0% - After deductible 20% - After deductible Infused drugs* 0% - After deductible 20% - After deductible Medications other than injected and infused rugs* Are included in the allowance for the medical service being rendered. Are included in the allowance for the medical service being rendered.
Prescription Drugs and Diabetic Equipment and Supplies. Prescription drugs and diabetic Equipment and Supplies dispensed at a pharmacy. See Summary of Pharmacy Benefits for prescription drugs purchased at a retail, specialty, or mail order pharmacy. Prescription drugs dispensed and administered by a licensed health care provider (other than a pharmacist), and not purchased from a retail, specialty or mail order pharmacy: Injectable drugs* 0% - After deductible 40% - After deductible Infused drugs* 0% - After deductible 40% - After deductible Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Medications other than injected and infused rugs* Are included in the allowance for the medical service being rendered. Are included in the allowance for the medical service being rendered.
Prescription Drugs and Diabetic Equipment and Supplies. Prescription drugs and diabetic equipment and supplies dispensed at a pharmacy. See Summary of Pharmacy Benefits for prescription drugs purchased at a retail, specialty, or mail order pharmacy. Prescription drugs dispensed and administered by a licensed health care provider (other than a pharmacist), and not purchased from a retail, specialty or mail order pharmacy: Injectable drugs* 0% - After deductible Not Covered Infused drugs* 0% - After deductible Not Covered Medications other than injected and infused rugs* Are included in the allowance for the medical service being rendered. Not Covered
Prescription Drugs and Diabetic Equipment and Supplies. Prescription drugs and diabetic equipment and supplies purchased at a retail, specialty, or mail order pharmacy. See Summary of PharmacyBenefits See Summary of PharmacyBenefits Prescription drugs requiring administration by a licensed health care provider*: Prescription drugs other than infused drugs - includes but is not limited to: medications by injection or inhalation, as well as nasal, topical, or transdermal medications. 0% - After deductible Not Covered Infused drugs 0% - After deductible Not Covered Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay
Prescription Drugs and Diabetic Equipment and Supplies. Prescription drugs and diabetic equipment and supplies dispensed at a pharmacy. See Summary of Pharmacy Benefits for prescription drugs purchased at a retail, specialty, or mail order pharmacy. Prescription drugs dispensed and administered by a licensed health care provider (other than a pharmacist),
Prescription Drugs and Diabetic Equipment and Supplies. Prescription drugs and diabetic equipment and supplies dispensed at a pharmacy. See Summary of Pharmacy Benefits for prescription drugs purchased at a retail, specialty, or mail order pharmacy. Prescription drugs dispensed and administered by a licensed health care provider (other than a pharmacist), and not purchased from a retail, specialty or mail order pharmacy: Injectable drugs* 10% - After deductible Not Covered Infused drugs* 10% - After deductible Not Covered Medications other than injected and infused rugs* Are included in the allowance for the medical service being rendered. Not Covered Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Care Coordinated by Your Primary Care Provider and Permitted Self-referrals Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay
Prescription Drugs and Diabetic Equipment and Supplies. Prescription drugs and diabetic equipment and supplies purchased at a retail, specialty, or mail order pharmacy. See Summary of PharmacyBenefits See Summary of PharmacyBenefits Prescription drugs requiring administration by a licensed health care provider* : Prescription drugs other than infused drugs - includes but is not limited to: medications by injection or inhalation, as well as nasal, topical, or transdermal medications. Includes chemotherapy drugs used for other than cancer treatment. 20% - After deductible 20% - After deductible Infused drugs Includes chemotherapy drugs used for other than cancer treatment. 20% - After deductible 20% - After deductible Limited to injectable and infused chemotherapy drugs used for cancer treatment.* 0% - After deductible 20% - After deductible
Prescription Drugs and Diabetic Equipment and Supplies. Prescription drugs and diabetic equipment and supplies dispensed at a pharmacy. See Summary of Pharmacy Benefits for prescription drugs purchased at a retail, specialty, or mail order pharmacy. Prescription drugs dispensed and administered by a licensed health care provider (other than a pharmacist), and not purchased from a retail, specialty or mail order pharmacy: Injectable drugs* Includes chemotherapy drugs used for other than cancer treatment. 20% - After deductible 20% - After deductible** Infused drugs* Includes chemotherapy drugs used for other than cancer treatment. 20% - After deductible 20% - After deductible** Limited to injectable and infused anti-neoplastic drugs used for cancer treatment. 0% - After deductible 20% - After deductible Medications other than injected and infused drugs* Are included in the allowance for the medical service being rendered. Are included in the allowance for the medical service being rendered.
