Common use of Preventive Drugs Clause in Contracts

Preventive Drugs. You can get a list of covered preventive drugs by calling Customer Service at the number listed on the back of this contract booklet or by logging into your secure web page at xxxxxxxxxx.xxx and visiting "My LifeWise Plan" for a list of preventive drugs required by federal health care reform. This list includes drugs such as aspirin, folic acid and certain supplements. These drugs require a prescription and may be limited to a certain age, condition, dosage or type Pharmacy Management Sometimes benefits for prescription drugs may be limited to one or more of the following:  A specific number of days’ supply or a specific drug or drug dosage appropriate for a usual course of treatment  Certain drugs for a specific diagnosis  Certain drugs from certain pharmacies, or you may need to get prescriptions from an appropriate medical specialist or a specific provider  Step therapy, meaning you must try a generic drug or a specified brand name drug first  Drug synchronization, meaning when a member requests a new prescription to be filled and the cost-sharing adjusted in compliance with state law These limitations are based on medical criteria, the drug maker’s recommendations, and the circumstances of the individual case. They are also based on U.S. Food and Drug Administration guidelines, published medical literature and standard medical references. Dispensing Limits

Preventive Drugs. You can get a list of covered preventive drugs by calling Customer Service at the number listed on the back of this contract booklet or by logging into your secure web page at xxxxxxxxxx.xxx xxxxxxx.xxx and visiting "My LifeWise Premera Plan" for a list of preventive drugs required by federal health care reform. This list includes drugs such as aspirin, folic acid and certain supplements. These drugs require a prescription and may be limited to a certain age, condition, dosage or type Pharmacy Management Sometimes benefits for prescription drugs may be limited to one or more of the following:  A specific number of days’ supply or a specific drug or drug dosage appropriate for a usual course of treatment  Certain drugs for a specific diagnosis  Certain drugs from certain pharmacies, or you may need to get prescriptions from an appropriate medical specialist or a specific provider  Step therapy, meaning you must try a generic drug or a specified brand name drug first  Drug synchronization, meaning when a member requests a new prescription to be filled and the cost-sharing adjusted in compliance with state law These limitations are based on medical criteria, the drug maker’s recommendations, and the circumstances of the individual case. They are also based on U.S. Food and Drug Administration guidelines, published medical literature and standard medical references. Dispensing Limits

Preventive Drugs. You can get a list of covered preventive drugs by calling Customer Service at the number listed on the back of this contract booklet or by logging into your secure web page at xxxxxxxxxx.xxx and visiting "My LifeWise Plan" for a list of preventive drugs required by federal health care reform. This list includes drugs such as aspirin, folic acid and certain supplements. These drugs require a prescription and may be limited to a certain age, condition, dosage or type Pharmacy Management Sometimes benefits for prescription drugs may be limited to one or more of the following:  A specific number of days’ supply or a specific drug or drug dosage appropriate for a usual course of treatment  Certain drugs for a specific diagnosis  Certain drugs from certain pharmacies, or you may need to get prescriptions from an appropriate medical specialist or a specific provider  Step therapy, meaning you must try a generic drug or a specified brand name drug first  Drug synchronization, meaning when a member requests a new prescription to be filled and the cost-sharing adjusted in compliance with state law These limitations are based on medical criteria, the drug maker’s recommendations, and the circumstances of the individual case. They are also based on U.S. Food and Drug Administration guidelines, published medical literature and standard medical references. Dispensing Limits.

Preventive Drugs. You can get a list of covered preventive drugs by calling Customer Service at the number listed on the back of this contract booklet or by logging into your secure web page at xxxxxxxxxx.xxx xxxxxxx.xxx and visiting "My LifeWise Premera Plan" for a list of preventive drugs required by federal health care reform. This list includes drugs such as aspirin, folic acid and certain supplements. These drugs require a prescription and may be limited to a certain age, condition, dosage or type Pharmacy Management Sometimes benefits for prescription drugs may be limited to one or more of the following:  • A specific number of days’ supply or a specific drug or drug dosage appropriate for a usual course of treatment  • Certain drugs for a specific diagnosis  • Certain drugs from certain pharmacies, or you may need to get prescriptions from an appropriate medical specialist or a specific provider  • Step therapy, meaning you must try a generic drug or a specified brand name drug first  • Drug synchronization, meaning when a member requests a new prescription to be filled and the cost-sharing adjusted in compliance with state law These limitations are based on medical criteria, the drug maker’s recommendations, and the circumstances of the individual case. They are also based on U.S. Food and Drug Administration guidelines, published medical literature and standard medical references. Dispensing Limits

Preventive Drugs. You can get a list of covered preventive drugs by calling Customer Service at the number listed on the back of this contract booklet or by logging into your secure web page at xxxxxxxxxx.xxx and visiting "My LifeWise Plan" for a list of preventive drugs required by federal health care reform. This list includes drugs such as aspirin, folic acid and certain supplements. These drugs require a prescription and may be limited to a certain age, condition, dosage or type Pharmacy Management Sometimes benefits for prescription drugs may be limited to one or more of the following:  • A specific number of days’ supply or a specific drug or drug dosage appropriate for a usual course of treatment  • Certain drugs for a specific diagnosis  • Certain drugs from certain pharmacies, or you may need to get prescriptions from an appropriate medical specialist or a specific provider  • Step therapy, meaning you must try a generic drug or a specified brand name drug first  • Drug synchronization, meaning when a member requests a new prescription to be filled and the cost-sharing adjusted in compliance with state law These limitations are based on medical criteria, the drug maker’s recommendations, and the circumstances of the individual case. They are also based on U.S. Food and Drug Administration guidelines, published medical literature and standard medical references. Dispensing Limits