Common use of Third-Party Assistance for Specialty Medications Clause in Contracts

Third-Party Assistance for Specialty Medications. If you use any third-party Copayment assistance (sometimes also referred to as a “copay card” or “copay coupon”) provided by a drug manufacturer or any other entity to pay any applicable Calendar Year Deductible, Copayment, or Coinsurance amounts for any brand Specialty Medications that have an available and medically appropriate generic equivalent, you will not receive credit toward your Calendar Year Out-of-Pocket Maximum or Calendar Year Deductible for any such assistance you use. Where there is no generic equivalent available or medically appropriate, third-party Copayment assistance will be counted toward your annual limitation on cost sharing.

Third-Party Assistance for Specialty Medications. If you use any third-party Copayment assistance (sometimes also referred to as a “copay card” or “copay coupon”) provided by a drug manufacturer or any other entity to pay any applicable Calendar Year Deductible, Copayment, or Coinsurance amounts for any brand Specialty Medications that have an available and medically appropriate generic equivalent, you will not receive credit toward your Calendar Year Out-of-Pocket Maximum or Calendar Year Deductible for any such assistance you use. Where there is no generic equivalent available or medically appropriate, third-party Copayment assistance will be counted toward your annual limitation on cost sharing.sharing.‌