Common use of Prescriptions Clause in Contracts

Prescriptions. We cover a variety of over-the-counter (OTC) medications when ordered by a physician. You can find a list of covered over-the-counter medications in our formulary – they will be marked as “OTC”. Your prescription must meet all legal requirements. The total amount you will be required to pay for a covered insulin drug will not exceed any state and/or federally mandated limits. Prescriptions can be filled at an in-network retail pharmacy or through our mail-order pharmacy. If you decide to have your prescription filled at an in-network pharmacy, you can use the Provider Directory to find a pharmacy near you. You can access the Provider Directory at XxxxxxxxxxXxxxxxxx.xxx on the “Find a Provider” page. You can also call Member Services to help you find a pharmacy. At the pharmacy, you will need to provide the pharmacist with your prescription and your member identification card. We also offer a three-month (90-day) supply of maintenance medications by mail or from in-network retail pharmacies for specific benefit plans. These drugs treat long-term conditions or illnesses, such as high blood pressure, asthma and diabetes. You can find a list of covered medications on XxxxxxxxxxXxxxxxxx.xxx. You can also request to have a copy mailed directly to you. Maintenance medications are generally taken daily for chronic and lifelong conditions. Extended days' supply fills of select maintenance medications are available exclusively at CVS Mail Order. Members obtaining a 90-day fill via CVS Mail Order will pay only 2.5 times their standard retail cost sharing.

Prescriptions. We cover a variety of over-the-counter (OTC) medications when ordered by a physician. You can find a list of covered over-the-counter medications in our formulary – they will be marked as “OTC”. Your prescription order must meet all legal requirements. The total amount you will be required to pay for a covered insulin drug will not exceed any state and/or federally mandated limits. Prescriptions Prescription orders can be filled at an in-a network retail pharmacy or through our mail-order pharmacy. If you decide to have your prescription order filled at an in-a network pharmacy, you can use the Provider Directory to find a pharmacy near you. You can access the Provider Directory at XxxxxxxxxxXxxxxxxx.xxx on the “Find a ProviderDoctor” page. You can also call Member Services to help you find a pharmacy. At the pharmacy, you will need to provide the pharmacist with your prescription order and your member identification card. We also offer a three-month (90-day) supply of maintenance medications by mail or from in-network retail pharmacies for specific benefit plans. These drugs treat long-term conditions or illnesses, such as high blood pressure, asthma and diabetes. You can find a list of covered medications on XxxxxxxxxxXxxxxxxx.xxx. You can also request to have a copy mailed directly to you. Maintenance medications are generally taken daily for chronic and lifelong conditions. Extended days' supply fills (up to 90 days) of select maintenance medications are available exclusively through select pharmacies. For more information, please consult our website. Members are limited to 15-day supplies for the first 90 days when starting new therapy using certain medications (like oral oncology). Members pay half the 30-day cost share for a 15-day supply, and would be responsible for the other half of the 30-day cost share for each additional 15- day supply. After 90 days, members will fill their medications for 30-day supplies. Medication refills are prohibited until a member's cumulative balance-on-hand is equal to or fewer than 15 days' supply of medication. This provision operates in addition to any applicable medication quantity limit or refill guidelines. Mail Order Pharmacy offers a convenient way to receive your prescriptions. Eligible prescriptions will be safely delivered right to your door at CVS no extra charge to you. You will still be responsible for your regular copayment/coinsurance. To enroll for mail order delivery or for any additional questions, please refer to our Ambetter website. Once on our website, click on “For Member,” followed by “Drug Coverage.” Under the “Mail Order” section, you will find details on your in- network mail order pharmacies and next steps for enrollment. Members obtaining Under Illinois law you have the right to request synchronization of your medications. Synchronization is alignment of your fill dates so that all of your medication-refill dates are on the same day. For example if you fill medication A on the 5th of each month and your prescriber prescribes you a 90-day new prescription B on the 20th of the month, you have the right to request a refill for prescription B that is shorter or longer than 30 days. This may help you adjust your fill via CVS Mail Order dates for medication B and synchronize the fill dates with medication A. We will pay only 2.5 times their standard retail cost sharingadjust Copays to reflect shorter or longer coverage. If you would like to exercise this right please call our customer service line.

Prescriptions. We cover a variety of over-the-counter (OTC) medications when ordered by a physician. You can find a list of covered over-the-counter medications in our formulary – they will be marked as “OTC”. Your prescription order must meet all legal requirements. The total amount you will be required to pay for a covered insulin drug will not exceed any state and/or federally mandated limits. Prescriptions Prescription orders can be filled at an in-a network retail pharmacy or through our mail-order pharmacy. If you decide to have your prescription order filled at an in-a network pharmacy, you can use the Provider Directory to find a pharmacy near you. You can access the Provider Directory at XxxxxxxxxxXxxxxxxx.xxx on the “Find a Provider” page. You can also call Member Services to help you find a pharmacy. At the pharmacy, you will need to provide the pharmacist with your prescription order and your member identification card. We also offer a three-month (90-day) supply of maintenance medications by mail or from in-network retail pharmacies for specific benefit plans. These drugs treat long-term conditions or illnesses, such as high blood pressure, asthma and diabetes. You can find a list of covered medications on XxxxxxxxxxXxxxxxxx.xxx. You can also request to have a copy mailed directly to you. Maintenance medications are generally taken daily for chronic and lifelong conditions. Extended days' supply fills of select maintenance medications are available exclusively at CVS Mail Order. Members obtaining a 90-day fill via CVS Mail Order will pay only 2.5 times their standard retail cost sharing.