Limited Outpatient Prescription Drugs and Supplies definition

Limited Outpatient Prescription Drugs and Supplies section of the Traditional, Deductible, and High Deductible Health Plan “Benefit Summary” has been modified for consistency within the contract. The word “formulary” has been removed from the row for contraceptive drugs, as all prescription drugs received from a Participating Pharmacy are formulary.
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Limited Outpatient Prescription Drugs and Supplies section of the EOC has been modified for better alignment with the “Outpatient Prescription Drug Rider” and to provide clarity regarding how to get covered drugs and supplies.  The “Limited Outpatient Prescription Drugs and Supplies” section of the EOC has been modified to clarify that lancets and injection aids are covered under the “Outpatient Durable Medical Equipment (DME)” section.  The “Outpatient Durable Medical Equipment (DME)” section of the EOC has been modified to reflect that lancets and injection aids are covered under the DME benefit.
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Limited Outpatient Prescription Drugs and Supplies section of the EOC has been modified. Language has been added to explain that while a Member may obtain a first fill of a prescription drug at any participating pharmacy, all refills must be obtained at a pharmacy owned and operated by Xxxxxx Permanente (including our mail-order pharmacy), or at another participating pharmacy we designate for covered refills. The “Help with Your Claim and/or Appeal” section of the EOC has been modified. The name of the Consumer Advocacy Unit has been updated to the Consumer Advocacy Section, a fax number has been added, the email address has been revised, and the URL has been updated for accuracy. In the “Grievances, Claims, Appeals, and External Review” section of the EOC, the Member Relations fax number has changed to accommodate a new digital fax process. Language in the “Termination Due to Loss of Eligibility” section of the EOC has been revised for clarity. The “Nondiscrimination” section of the EOC has been modified to confirm that we do not discriminate based on a Member’s marital status.
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More Definitions of Limited Outpatient Prescription Drugs and Supplies

Limited Outpatient Prescription Drugs and Supplies. EOC section has been modified. The exclusion of sexual dysfunction drugs has been modified to clarify that drugs that are FDA-approved to treat mental health symptoms of sexual dysfunction are not excluded.  The “Maternity and Newborn Care” Benefit Summary and EOC sections have been modified to clarify coverage for management of maternal diabetes.  The “Mental Health Services” Benefit Summary and EOC sections have been modified. Medically Necessary applied behavior analysis (ABA) for autism spectrum disorder, Medically Necessary treatment for pervasive developmental disorder (PDD), Medically Necessary habilitative Services or health care devices, and Participating Provider Services provided by a licensed behavioral analyst, licensed assistant behavioral analyst, or registered behavioral analyst interventionist are covered, subject to Utilization Review by Company using criteria developed by Medical Group and approved by Company.  “Special Diagnostic Procedures” under the “Outpatient Laboratory, X-ray, Imaging, and Special Diagnostic Procedures” EOC section has been modified to clarify that PET scans are covered.  The “Outpatient Laboratory, X-ray, Imaging, and Special Diagnostic Procedures” Benefit Summary section has been modified to clarify coverage for genetic testing.
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Related to Limited Outpatient Prescription Drugs and Supplies

  • Prescription drugs means drugs, medicine and controlled substances which by law can only be prescribed for human use by persons authorized by law.

  • Prescription drug means any drug required by federal law or regulation to be dispensed only

  • Nonprescription drugs means nonnarcotic medicines or drugs which may be sold without a prescription and are prepackaged and labeled for use by the consumer in accordance with the requirements of the statutes and regulations of this state and the federal government;

  • Nonprescription drug or "over-the-counter drug" means any

  • In Patient Care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

  • Routine patient care costs means Covered Medical Expenses which are typically provided absent a clinical trial and not otherwise excluded under the Policy. Routine patient care costs do not include:

  • Nursing home-type patients means a patient who has been in hospital more than 35 days, no longer requires acute hospital care, cannot live independently at home or be looked after at home, and either cannot be placed in a nursing home or a nursing home place is not available.

  • Participating Prescription Drug Provider means an independent retail Pharmacy, chain of retail Pharmacies, mail-order Pharmacy or specialty drug Pharmacy which has entered into an agreement to provide pharmaceutical services to participants in the benefit program. A retail Participating Pharmacy may or may not be a select Participating Pharmacy as that term is used in the Vaccinations Obtained Through Participating Pharmacies section.

  • Hospice patient s family" means a hospice patient's immediate family members, including a spouse, brother, sister, child, or parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

  • Substance abuse treatment means outpatient or inpatient services or participation in Alcoholics Anonymous or a similar program.

  • Prescription monitoring program “PMP,” or “program” means the program established pursuant to 657—Chapter 37 for the collection and maintenance of PMP information and for the provision of PMP information to authorized individuals.

  • Medical Specialist means any medical practitioner who is vocationally registered by the Medical Council under the Health Practitioners Competence Assurance Act 2003 in one of the approved branches of medicine and who is employed in either that branch of medicine or in a similar capacity with minimal oversight.

  • Prescription drug order means an original or new order from a practitioner for drugs, drug-related devices or treatment for a human or animal, including orders issued through collaborative care agreements. Lawful prescriptions result from a valid practitioner-patient relationship, are intended to address a legitimate medical need, and fall within the prescribing practitioner's scope of professional practice;

  • Outpatient means a person who is receiving care other than on an inpatient basis, such as: • in a provider’s office; • in an ambulatory surgical center or facility; • in an emergency room; or • in a clinic. .

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Nonprescription medication means a drug or medication authorized pursuant to federal or state law for general distribution and use without a prescription in the treatment of human disease, ailments, or injuries.

  • COVID-19 symptoms means fever of 100.4 degrees Fahrenheit or higher, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea, unless a licensed health care professional determines the person’s symptoms were caused by a known condition other than COVID-19.

  • Radiopharmaceutical quality assurance means, but is not limited to, the performance of appropriate chemical, biological, and physical tests on potential radiopharmaceuticals and the interpretation of the resulting data to determine their suitability for use in humans and animals, including internal test assessment, authentication of product history, and the keeping of proper records.

  • Inpatient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

  • Medical marijuana waste or "waste" means unused,

  • Medical cannabis pharmacy means the same as that term is defined in Section 26-61a-102.

  • Clinical laboratory means a facility for the microbiological, serological, chemical, hematological, radiobioassay, cytological, immunohematological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of a disease or assessment of a medical condition.

  • Outpatient treatment means mental health or substance abuse treatment services rendered to a

  • Assisted outpatient treatment or "AOT" means the categories of outpatient services ordered by the court under section 468 or 469a. Assisted outpatient treatment may include a case management plan and case management services to provide care coordination under the supervision of a psychiatrist and developed in accordance with person-centered planning under section 712. Assisted outpatient treatment may also include 1 or more of the following categories of services: medication; periodic blood tests or urinalysis to determine compliance with prescribed medications; individual or group therapy; day or partial day programming activities; vocational, educational, or self-help training or activities; assertive community treatment team services; alcohol or substance use disorder treatment and counseling and periodic tests for the presence of alcohol or illegal drugs for an individual with a history of alcohol abuse or substance use disorder; supervision of living arrangements; and any other services within a local or unified services plan developed under this act that are prescribed to treat the individual's mental illness and to assist the individual in living and functioning in the community or to attempt to prevent a relapse or deterioration that may reasonably be predicted to result in suicide, the need for hospitalization, or serious violent behavior. The medical review and direction included in an assisted outpatient treatment plan shall be provided under the supervision of a psychiatrist.

  • Collaborative drug therapy management means participation by an authorized pharmacist and a physician in the management of drug therapy pursuant to a written community practice protocol or a written hospital practice protocol.

  • Medication means any drug, chemical, compound, suspension, or preparation in suitable form for use as a curative or remedial substance taken either internally or externally by any person.