Nonpreferred drug definition

Nonpreferred drug means a specialty drug formulary classification for certain specialty drugs deemed nonpreferred and therefore subject to limits on eligibility for coverage or to higher cost-sharing amounts than preferred specialty drugs.
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Nonpreferred drug means)) - A drug that has not been selected as a preferred drug within the therapeutic class(es) of drugs on the preferred drug list.
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Nonpreferred drug means a specialty drug formulary classification for certain specialty drugs
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Examples of Nonpreferred drug in a sentence

  • The Managed Care Plan shall ensure its PBM provides the following electronic message alerting the pharmacist to provide Medicaid recipients with the Hernandez notice/pamphlet when coverage is rejected due to the drug not being on the PDL: Non-preferred drug; Contact provider for change to preferred drug or to obtain prior authorization.

  • For pharmacy contracts, ensure its pharmacy benefits manager provides the following electronic message alerting the pharmacist to provide Medicaid recipients with the HSA notice/pamphlet when coverage is rejected due to the drug not being on the PDL: Non-preferred drug; Contact provider for change to preferred drug or to obtain prior authorization.

  • For pharmacy contracts, ensure its pharmacy benefits manager provides the following electronic message alerting the pharmacist to provide Medicaidrecipients with the HSA notice/pamphlet when coverage is rejected due to the drug not being on the PDL: Non-preferred drug; Contact provider for change to preferred drug or to obtain prior authorization.

  • The Health Plan shall ensure its PBA provides the following electronic message alerting the pharmacist to provide Medicaid recipients with the Hernandez notice/pamphlet when coverage is rejected due to the drug not being on the Health Plan’s PDL: Non-preferred drug; Contact provider for change to preferred drug or to obtain prior authorization.

  • Generic drugs are in plain type· Each covered drug is in 1 of 4 cost-sharing tiers· Drug tier description:Tier 1: Preferred generic Tier 2: Preferred brand Tier 3: Non-preferred drug Tier 4: Specialty tier· Each tier has a copay or coinsurance amount· For a description of the tiers, see the Summary of Benefits in this book· Some drugs may have coverage rules or limits on the amount you can get PAPrior authorizationThe plan requires you or your doctor to get prior approval for certain drugs.

  • In most cases, the Preferred drug is the same chemical entity/ active ingredient as the Non-preferred drug.

  • New prescriptions may require pre-authorization or other limits.Aetna DAW: If a Preferred drug is available and an Alternative or Non-preferred drug is dispensed, you will be charged the applicable co-pay plus the diference in cost between the Alternative or Non-preferred drug and Preferred drug cost even if your provider requests the Alternative drug.

  • The Managed Care Plan shall ensure its PBM provides the following electronic message alerting the pharmacist to provide Medicaid recipientswith the Hernandez notice/pamphlet when coverage is rejected due to the drug not being on the PDL: Non-preferred drug; Contact provider for change to preferred drug or to obtain prior authorization.

  • The Non-Formulary or Non-preferred drug or biologic requires documentation that the patient has tried and failed the Formulary/Preferred agents (FDA approved or medically accepted for the patient’s indication) OR a medical reason has been provided as to why these agents are unable to be used to treat the patient’s condition (e.g. intolerance, contraindication, etc.).

  • Generic drugs are in plain type• Each covered drug is in 1 of 4 cost-sharing tiers• Drug tier description:Tier 1: Preferred generic Tier 2: Preferred brand Tier 3: Non-preferred drug Tier 4: Specialty tier• Each tier has a copay or coinsurance amount• For a description of the tiers, see the Summary of Benefits in this book• Some drugs may have coverage rules or limits on the amount you can get PAPrior authorizationThe plan requires you or your doctor to get prior approval for certain drugs.

Related to Nonpreferred drug

  • controlled drug means an article or substance prescribed under a regulation to be a controlled drug.

  • Covered drug means any prescription drug that:

  • New drug means: (i) any drug, except a new animal drug or an animal feed bearing or containing

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

  • Legend drugs means any drugs which are required by state

  • 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;

  • Legend drug or "prescription drug" means any drug or device that has been determined to be unsafe for self- medication or any drug or device that bears or is required to bear the legend:

  • Narcotic drug means any of the following, whether produced directly or indirectly by extraction from substances of vegetable origin, or independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis:

  • New Drug Application means a New Drug Application filed with the FDA in accordance with Applicable Law.

  • Invalid Drug Test means the result of a drug test for an oral fluid specimen that contains an unidentified adulterant, or an unidentified substance, that has abnormal physical characteristics, or that has an endogenous substance at an abnormal concentration preventing the laboratory from completing or obtaining a valid drug test result.

  • Generic Drug means any Prescription Drug approved by the FDA that has the same bio-equivalency as a specific Brand Name Drug.

  • FDA Act means the U.S. Federal Food, Drug and Cosmetic Act, as amended, and the rules and regulations promulgated thereunder.

  • Biologics License Application or “BLA” means an application requesting permission from the FDA to introduce, or deliver for introduction, a biological product into interstate commerce, or any similar application or submission for marketing authorization of a product filed with a Regulatory Authority to obtain Regulatory Approval for such product in a country or group of countries.

  • Criminal drug statute means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, possession or use of any controlled substance.

  • Diagnostic x-ray system means an x-ray system designed for irradiation of any part of the human or animal body for the purpose of diagnosis or visualization.

  • Analytical x-ray system means a group of components utilizing x-rays to determine the elemental composition or to examine the microstructure of materials.

  • Drug abuse means any pattern of pathological use of drugs that causes impairment in social or occupational functioning, or that produces physiological dependency evidenced by physical tolerance or by physical symptoms when it is withdrawn.

  • FDCA shall have the meaning ascribed to such term in Section 3.1(hh).

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

  • Prescription drug order means a lawful order of a practitioner for a drug or device for a specific patient that is communicated to a pharmacist.

  • Automated drug dispensing system means a mechanical or electronic system that performs

  • FD&C Act means the U.S. Federal Food, Drug and Cosmetic Act, as amended, and the regulations promulgated thereunder.

  • Drug addiction means a disease characterized by a

  • FFDCA means the United States Federal Food, Drug, and Cosmetic Act, 21 U.S.C. § 301 et seq., as amended from time to time, together with any rules, regulations and requirements promulgated thereunder (including all additions, supplements, extensions, and modifications thereto).

  • Food and food ingredients means substances, whether in liquid, concentrated, solid, frozen, dried, or dehydrated form, that are sold for ingestion or chewing by humans and are consumed for their taste or nutritional value. Food and food ingredients do not include alcoholic beverages and tobacco.

  • Drug Master File or “DMF” is described in 21 C.F.R. Part 314.420. A DMF is a submission to the FDA that may be used to provide confidential detailed information about facilities, processes, or articles used in the manufacturing, processing, packaging, and storing of one or more human drugs.