Common use of Formulary Clause in Contracts

Formulary. PIC uses its drug formulary to determine which benefit level applies to a specific prescription drug. The formulary is subject to periodic review by ▇▇▇’s Pharmacy and Therapeutics Quality Subcommittee and modification by PIC, including at the start of or during the plan year. A current list of drugs on PIC’s formulary for individual plans may be obtained by accessing PIC’s website at ▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/pharmacy-information/formulary and choosing “Individual Plans” or by calling PIC Customer Service. PIC will provide reasonable advance notice to you if, during the plan year, a prescription drug which you have previously received during such plan year and which PIC has previously considered to be an eligible charge under this contract is removed from the formulary or if such prescription drug is placed in a higher cost-sharing tier during the plan year. You have a right to appeal the decision or to request an exception to gain access to a non-formulary drug when clinically appropriate and not otherwise covered under this contract. Refer to the section entitled “Internal Appeals Process” for details on how to appeal. Refer to the paragraphs entitled “Exceptions” below for details on how to request an exception.