Common use of Your Prescription Drug Benefits Clause in Contracts

Your Prescription Drug Benefits. 1. Does this plan exclude certain drugs my health care provider may prescribe, or encourage substitution for some drugs? Your prescription drug benefit uses a drug list. (This is sometimes referred to as a "formulary.") We review medical studies, scientific literature and other pharmaceutical information to choose safe and effective drugs for the prescription drug formulary. This plan doesn’t cover certain categories of drugs. These are listed above under “What’s Not Covered.” Non-formulary medications may be covered only on an exception basis for members meeting medical necessity criteria. Certain formulary drugs are subject to pre-dispensing medical necessity review. As part of this review, some prescriptions may require additional medical information from the prescribing provider, or substitution of equivalent medication. See Prior Authorization for details.

Your Prescription Drug Benefits. 1. Does this plan exclude certain drugs my health care provider may prescribe, or encourage substitution for some drugs? Your prescription drug benefit uses a drug list. (This is sometimes referred to as a "formulary.") We review medical studies, scientific literature and other pharmaceutical information to choose safe and effective drugs for the prescription drug formulary. This plan doesn’t cover certain categories of drugs. These are listed above under “What’s Not Covered.” Non-formulary medications may be covered only on an exception basis for members meeting medical necessity criteria. Certain formulary drugs are subject to pre-pre- dispensing medical necessity review. As part of this review, some prescriptions may require additional medical information from the prescribing provider, or substitution of equivalent medication. See Prior Authorization for details.