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Prescription drugs |
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Prescription Drug
benefits cover the initial prescription and refills for medications which are
not available without a prescription. To qualify, the container must read:
“Caution: Federal Law prohibits dispensing without a prescription.” Injectable
insulin, which may not require a prescription, is covered by the plan. Allergy
serums which are prescribed for you on an ongoing basis are covered. Also, the
retail price of the quantity prescribed must be over the co-payment amount.
Generally, benefits are
paid for up to a 34-day supply of covered medication at any one time. Exceptions
to this rule are maintenance legend drugs, and some prescriptions filled through
the mail-order prescription drug provider, both of which are described later.
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Insulin |
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Benefits are provided
for a one-month supply of disposable syringes and needles for injection of
insulin when prescribed with a one-month supply of insulin or, if greater, 100
disposable syringes and needles when prescribed with a three-month supply of
insulin.
One co-payment applies to
the total prescription—insulin, needles and syringes. If syringes and needles
are prescribed separately from a prescription for insulin, they are not covered.
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What
Prescription Drugs are not covered?
Under the traditional Plan, no benefits are paid for the prescription drug
charges below.
Prescription Drug benefits provided under the traditional Plan do not cover
certain services, supplies and medications. These include:
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F |
Drugs for which the provider’s
charge is less than the applicable co-payment |
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F |
Drugs requiring a prescription by
state but not by federal law |
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F |
Covered drugs which are consumed
entirely at the time and place where the prescription is written |
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F |
Nonprescription contraceptive
medication, devices, appliances, or supplies |
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F |
Reusable syringes and needles,
multi-use syringes and disposable needles |
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F |
Charges for administering a covered
drug |
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F |
Charges for more than a 34-day
supply of a covered drug, except for certain maintenance legend drugs |
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F |
Charges for more than a 90-day
supply of a drug through the mail-order provider |
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F |
Charges for more refills than your
physician or dentist specifies or refills after a year from the original
date of the prescription |
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F |
Charges for medication furnished on
an inpatient or outpatient basis, if the charge is covered by any other
health care coverage |
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F |
Medication provided under Workers’
Compensation or other government plans |
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What
are the Prescription Drug co-payments?
For
Traditional Plan co-payment information, click on the link below.
If you buy from a participating pharmacy
When
you go to a participating pharmacy for a prescription or refill, you pay the
applicable co-payment. Prescriptions filled by pharmacies are limited to a 34-day
supply in most cases.
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Effective August 1, 2006 our Prescription
Drug Coverage was modified. Click on the blue button below for a summary of
those changes.
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