Prescription Program Clause Samples
The Prescription Program clause establishes the terms and conditions under which prescription medications are provided to eligible individuals, typically as part of an employee benefits or health insurance plan. It outlines the scope of covered medications, any requirements for prior authorization, and may specify cost-sharing arrangements such as copayments or deductibles. By clearly defining how prescription drug benefits are administered, this clause ensures that participants understand their entitlements and responsibilities, thereby reducing confusion and helping to manage healthcare costs effectively.
Prescription Program. The Board shall provide to all full-time employees and their dependents a prescription program for the term of their contract only, and only in the manner set out in the 1995 modification of the annual prescription plan as follows:
1. Secretarial Unit personnel will be reimbursed 100 percent of the amount of claims up to $200 (up to $100 per association member and up to $100 for dependents).
2. Secretarial Unit personnel shall also be reimbursed for 20% of the cost of all covered prescription charges up to an amount of $2,000 per person, annually, following the first $100 per individual member and $100 for dependents. It is agreed that these reimbursements cannot exceed the following monetary limitations: less the maximum to be deducted for clerical and administrative costs incurred for administering the prescription program ($410).
3. It is further agreed and understood between the parties that the Board shall pay all costs of prescriptions not covered by major medical insurance provided by the Board, or by other insurance coverage covering the member or individual family members to an amount not to exceed an aggregate of $3,000. This $3,000 amount is separate and apart from the monetary limitation provided for in Article V, Section 5.1, B2.
4. Benefits for employees who leave the system prior to June 30 of each contract year shall terminate as of date of severance.
5. It is distinctly understood and agreed that should claims exceeding the limits set forth in subparagraph B2 above be presented, all approved claims shall be paid on a pro-rata basis out of said amounts, and that approved claims shall be paid by September 30 of each year.
6. This prescription program shall cover for drugs and medicines (except for vitamins) which under Federal or State law may only be dispensed upon a written prescription by a licensed physician for the treatment or prevention of an illness, injury or condition, and if dispensed by a licensed pharmacy or by a legally constituted and operated hospital for an insured employee or dependent who is not then a bed patient in that hospital.
7. The prescription program does not cover any charge for a drug and/or medicine expense:
a. If the expense is not required in accordance with accepted standards of medical practice;
b. To the extent that the charge exceeds the reasonable and customary charge for the particular drug and/or medicine;
c. To the extent that such charge is covered by any other insurance under which the member of the...
Prescription Program. The Board shall provide to all full-time teachers and their dependents a prescription program for the term of their contract only, and only in the manner set out in the 1995 modification of the annual prescription plan as follows:
Prescription Program. Only Members who have accurately and fully completed the Medical Assessment and History Questionnaire and established a physician/patient relationship are eligible to receive medications. NO controlled medications are available through Teladoc.
Prescription Program. The Board shall provide a "family prescription plan" comparable in cost and benefits to the umbrella contract between the N.J.E.A. and the New Jersey Blue Cross.
1. Effective July 1, 2003 the prescription plan co-pay shall be as follows for the term of the contract: $0 Mail Order $10.00 Generic $20.00 Brand Name
Prescription Program. Prescription drugs shall be paid for under the prescription benefit plan only. Medically necessary prescription drugs not available through the prescription drug plan will be payable at the in-network level described in 15.3 (90/10 of the first $12,000). Employees shall be enrolled in a prescription card program, and shall be subject to the following conditions:
1. The employee co-pay for generic prescription medication shall be $15.00 per prescription. Where the actual cost of the prescription is less than fifteen dollars ($15.00) that actual cost shall apply.
2. The employee co-pay for name brand drugs that are part of the formulary list shall be
Prescription Program. For the term of this Agreement, the District agrees to provide for each full-time member, single/family coverage. The percent contribution to be paid by the employee is equal to the percent contribution the employee pays for his/her health benefits. The District reserves the right to meet its commitment hereunder by obtaining equal to or better benefits from any other carrier of its choosing.
Prescription Program. Prescription drugs shall be paid for under the prescription benefit plan only. Medically necessary prescription drugs not available through the prescription drug plan will be payable at the in-network level described in 15.3 (90/10). Employees shall be enrolled in a prescription card program, and shall be subject to the following conditions:
1. The employee co-pay for generic prescription medication shall be $15.00 per prescription. Where the actual cost of the prescription is less than fifteen dollars ($15.00) that actual cost shall apply.
2. The employee co-pay for name brand drugs that are part of the formulary list shall be $30.00. Where the actual cost of the prescription is less than thirty dollars ($30.00) the actual cost shall apply.
3. The employee co-pay for brand name drugs that are not on the formulary list and Special Pharmacy medications shall be $50.00. Covered members filling prescriptions for specialty medications will do so through the City’s specialty pharmacy program. Where the actual cost of the prescription is less than fifty ($50.00) the actual cost shall apply.
4. The co-pay provisions apply to prescriptions in 30-day increments. Maintenance drugs/prescriptions may continue to be issued in 90-day increments; however, if filled at a retail pharmacy, three (3) individual co-pays shall apply. Maintenance drugs/prescriptions issued as a 90- day supply via mail order shall be limited to two (2) co-pays.
Prescription Program. As part of the health insurance program the City also provides a pharmacy benefit through the prescription drug program. The prescription co-pays for 2009, 2010, and 2011 are as follows: Co-Payments 2009 Co-Payments 2010 Co-Payments 2011 Generic $10.00 $12.50 $12.50 Preferred $25.00 $31.25 $31.25 Non Formulary $50.00 $62.50 $62.50