Common use of Radiation Therapy/Chemotherapy Services Clause in Contracts

Radiation Therapy/Chemotherapy Services. If you are dispensed a specialty prescription drug from a Rhode Island network provider, the charge for the specialty prescription drug is not reimbursed and the Rhode Island network provider may not seek reimbursement from you. If you are dispensed a specialty prescription drug from a non-network provider or by a provider that participates with an out of state Blue Cross and Blue Shield plan, the charge for the specialty prescription drug is not reimbursed. You are liable to pay the for the specialty prescription drug. Prescription drugs are reimbursed based on the type of service and the site of service. See the Summary of Pharmacy Benefits for benefit limits and the amount that you pay. Coverage for prescription drugs is subject to the pharmacy program. The pharmacy program’s formulary includes a five-tier copayment structure and requires prescription drug preauthorization for certain Prescription Drugs. It also includes dose optimization conditions. Each of these items is described in more detail below. Coverage is provided for prescription drugs bought at a pharmacy, per the terms, conditions, exclusions, and limitations of this agreement.

Radiation Therapy/Chemotherapy Services. If you are dispensed a specialty prescription drug from a Rhode Island network provider, the charge for the specialty prescription drug is not reimbursed and the Rhode Island network provider may not seek reimbursement from you. If you are dispensed a specialty prescription drug from a non-network provider or by a provider that participates with an out of state Blue Cross and or Blue Shield plan, the charge for the specialty prescription drug is not reimbursed. You are liable to pay the charge for the specialty prescription drug. Prescription drugs are reimbursed based on the type of service and the site of service. See the Summary of Pharmacy Benefits for benefit limits and the amount that you pay. Coverage for prescription drugs is subject to the pharmacy program. The pharmacy program’s formulary includes a five-tier copayment structure and requires prescription drug preauthorization for certain Prescription Drugsprescription drugs. It also includes dose optimization conditions. Each of these items is described in more detail below. Coverage is provided for prescription drugs bought at a pharmacy, per the terms, conditions, exclusions, and limitations of this agreement.