Common use of Mail Order Program Clause in Contracts

Mail Order Program. If You elect to use the mail-order service, You must mail Your Prescription Order to the address provided on the mail-order prescription form and send in Your payment for each prescription filled or refilled. Each prescription or refill is subject to the Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS and any applicable pricing differences, payable by Member directly to the mail order Pharmacy. Some drugs may not be available through the mail-order program. If You have any questions about this mail-order program, need assistance in determining the amount of Your payment, or need to obtain the mail-order prescription claim form, access the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇ or contact customer service at the toll-free number on Your identification card. Mail the completed form, Your Prescription Order(s) and payment to the address indicated on the form. The HMO Specialty Pharmacy Program delivery service offers: • coordination of coverage between You, Your Health Care Practitioner and HMO; • educational materials about the patient’s particular condition and information about managing potential medication side effects; • syringes, sharps containers, alcohol swabs and other supplies with every shipment for FDA approved self- injectable medications; and • access to a pharmacist for urgent medication issues 24 hours a day, 7 days a week, 365 days each year. The Drug List which includes these Specialty Drugs is available by accessing the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇/▇▇▇▇▇▇▇▇▇▇▇▇-▇▇▇▇-▇▇▇▇-▇▇▇▇▇▇▇▇▇▇▇/▇▇▇▇-▇▇▇▇▇ or by contacting customer service at the toll-free number on Your identification card. Your cost will be the applicable Copayment shown in the Schedule of Copayments and Benefit Limits as well as any applicable pricing differences. Prescription Drugs Purchased Outside of the Service Area. HMO will reimburse You for the Allowable Amount of the prescription drugs less the Out-of-Area Drug Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS, for covered prescription drugs which You purchase outside of the Service Area. You must submit a completed claim form to HMO, within ninety (90) days of the date of purchase to qualify for reimbursement under the PHARMACY BENEFITS. You may access the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇/▇▇▇▇▇/▇▇▇▇▇▇▇▇▇▇ to obtain a prescription drug claim form.

Mail Order Program. If You elect to use the mail-order service, You must mail Your Prescription Order to the address provided on the mail-order prescription form and send in Your payment for each prescription filled or refilled. Each prescription or refill is subject to the Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS and any applicable pricing differences, payable by Member directly to the mail order Pharmacy. Some drugs may not be available through the mail-order program. If You have any questions about this mail-order program, need assistance in determining the amount of Your payment, or need to obtain the mail-order prescription claim form, access the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇ or contact customer service at the toll-free number on Your identification card. Mail the completed form, Your Prescription Order(s) and payment to the address indicated on the form. The HMO Specialty Pharmacy Program delivery service offers: • coordination of coverage between You, Your Health Care Practitioner and HMO; • educational materials about the patient’s particular condition and information about managing potential medication side effects; • syringes, sharps containers, alcohol swabs and other supplies with every shipment for FDA approved self- injectable medications; and • access to a pharmacist for urgent medication issues 24 hours a day, 7 days a week, 365 days each year. The Drug List which includes these Specialty Drugs is available by accessing the website at ▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇.▇▇▇/member/▇▇▇▇▇▇prescription-drug-plan-information/▇▇▇▇▇▇▇▇▇▇▇▇drug-▇▇▇▇-▇▇▇▇-▇▇▇▇▇▇▇▇▇▇▇/▇▇▇▇-▇▇▇▇▇ lists or by contacting customer service at the toll-free number on Your identification card. Your cost will be the applicable Copayment shown in the Schedule of Copayments and Benefit Limits as well as any applicable pricing differences. Prescription Drugs Purchased Outside of the Service Area. HMO will reimburse You for the Allowable Amount of the prescription drugs less the Out-of-Area Drug Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS, for covered prescription drugs which You purchase outside of the Service Area. You must submit a completed claim form to HMO, within ninety (90) days of the date of purchase to qualify for reimbursement under the PHARMACY BENEFITS. You may access the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇/▇▇▇▇▇/▇▇▇▇▇_▇▇▇▇▇ to obtain a prescription drug claim form.

Mail Order Program. If You elect to use the mail-order service, You must mail Your Prescription Order to the address provided on the mail-order prescription form and send in Your payment for each prescription filled or refilled. Each prescription or refill is subject to the Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS and any applicable pricing differences, payable by Member directly to the mail order Pharmacy. Some drugs may not be available through the mail-order program. If You have any questions about this mail-order program, need assistance in determining the amount of Your payment, or need to obtain the mail-order prescription claim form, access the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇ or contact customer service at the toll-free number on Your identification card. Mail the completed form, Your Prescription Order(s) and payment to the address indicated on the form. The HMO Specialty Pharmacy Program delivery service offers: • coordination of coverage between You, Your Health Care Practitioner and HMO; • educational materials about the patient’s particular condition and information about managing potential medication side effects; • syringes, sharps containers, alcohol swabs and other supplies with every shipment for FDA approved self- injectable medications; and • access to a pharmacist for urgent medication issues 24 hours a day, 7 days a week, 365 days each year. The Drug List which includes these Specialty Drugs is available by accessing the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇/▇▇▇▇▇▇▇▇▇▇▇▇-▇▇▇▇-▇▇▇▇-▇▇▇▇▇▇▇▇▇▇▇/▇▇▇▇-▇▇▇▇▇ or by contacting customer service at the toll-free number on Your identification card. Your cost will be the applicable Copayment shown in the Schedule of Copayments and Benefit Limits SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS as well as any applicable pricing differences. Coverage for Specialty Drugs are limited to a 30-day supply. However, some Specialty Drugs have FDA approved dosing regimens exceeding the 30-day supply limits and may be allowed greater than a 30 day-supply, if allowed by your plan benefits. Cost-share will be based on the day supply (1-30 day supply, 31-60 day supply, 61-90 day supply) dispensed. Prescription Drugs Purchased Outside of the Service Area. HMO will reimburse You for the Allowable Amount of the prescription drugs less the Out-of-Area Drug Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS, for covered prescription drugs which You purchase outside of the Service Area. You must submit a completed claim form to HMO, within ninety (90) days of the date of purchase to qualify for reimbursement under the PHARMACY BENEFITS. You may access the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇/▇▇▇▇▇/▇▇▇▇▇▇▇▇▇▇ to obtain a prescription drug claim form. MedsYourWay™ (“MedsYourWay”) may lower Your out-of-pocket costs for select Covered Drugs purchased at select in-network retail pharmacies. MedsYourWay is a program that automatically compares available drug discount card prices and prices under Your benefit plan for select Covered Drugs and establishes Your out-of-pocket cost to the lower price available. At the time You submit or pick up Your Prescription, present Your BCBSTX Identification Card to the pharmacist. This will identify You as a participant in MedsYourWay and allow You the lower price available for select Covered Drugs. The amount You pay for your Prescription will be applied, if applicable, to Your out-of-pocket maximum. Available select Covered Drugs and drug discount card pricing through MedsYourWay may change occasionally. Certain restrictions may apply and certain Covered Drugs or drug discount cards may not be available for the MedsYourWay program. You may experience a different out-of-pocket amount for select Covered Drugs depending upon which retail pharmacy is utilized. For additional information regarding MedsYourWay, please contact a Customer Service Representative at the toll-free telephone number on the back of Your Identification Card. Participation in MedsYourWay is not mandatory and You may choose not to participate in the program at any time by contacting Your Customer Service Representative at the toll-free telephone number on the back of your Identification ▇▇▇▇.▇▇ the event MedsYourWay fails to provide, or continue to provide, the program as stated, there will be no impact to You. In such an event, You will pay the plan’s pharmacy benefit copay.

Mail Order Program. If You elect to use the mail-order service, You must mail Your Prescription Order to the address provided on the mail-order prescription form and send in Your payment for each prescription filled or refilled. Each prescription or refill is subject to the Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS and any applicable pricing differences, payable by Member directly to the mail order Pharmacy. Some drugs may not be available through the mail-order program. If You have any questions about this mail-order program, need assistance in determining the amount of Your payment, or need to obtain the mail-order prescription claim form, access the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇ or contact customer service at the toll-free number on Your identification card. Mail the completed form, Your Prescription Order(s) and payment to the address indicated on the form. The HMO Specialty Pharmacy Program delivery service offers: • coordination of coverage between You, Your Health Care Practitioner and HMO; • educational materials about the patient’s particular condition and information about managing potential medication side effects; • syringes, sharps containers, alcohol swabs and other supplies with every shipment for FDA approved self- injectable medications; and • access to a pharmacist for urgent medication issues 24 hours a day, 7 days a week, 365 days each year. The Drug List which includes these Specialty Drugs is available by accessing the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇/▇▇▇▇▇▇▇▇▇▇▇▇-▇▇▇▇-▇▇▇▇-▇▇▇▇▇▇▇▇▇▇▇/▇▇▇▇-▇▇▇▇▇ or by contacting customer service at the toll-free number on Your identification card. Your cost will be the applicable Copayment shown in the Schedule of Copayments and Benefit Limits SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS as well as any applicable pricing differences. Prescription Drugs Purchased Outside of the Service Area. HMO will reimburse You for the Allowable Amount of the prescription drugs less the Out-of-Area Drug Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS, for covered prescription drugs which You purchase outside of the Service Area. You must submit a completed claim form to HMO, within ninety (90) days of the date of purchase to qualify for reimbursement under the PHARMACY BENEFITS. You may access the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇/▇▇▇▇▇/▇▇▇▇▇▇▇▇▇▇ to obtain a prescription drug claim form. MedsYourWay™ (“MedsYourWay”) may lower Your out-of-pocket costs for select Covered Drugs purchased at select in-network retail pharmacies. MedsYourWay is a program that automatically compares available drug discount card prices and prices under Your benefit plan for select Covered Drugs and establishes Your out-of-pocket cost to the lower price available. At the time You submit or pick up Your Prescription, present Your BCBSTX Identification Card to the pharmacist. This will identify You as a participant in MedsYourWay and allow You the lower price available for select Covered Drugs. The amount You pay for your Prescription will be applied, if applicable, to Your out-of-pocket maximum. Available select Covered Drugs and drug discount card pricing through MedsYourWay may change occasionally. Certain restrictions may apply and certain Covered Drugs or drug discount cards may not be available for the MedsYourWay program. You may experience a different out-of-pocket amount for select Covered Drugs depending upon which retail pharmacy is utilized. For additional information regarding MedsYourWay, please contact a Customer Service Representative at the toll-free telephone number on the back of Your Identification Card. Participation in MedsYourWay is not mandatory and You may choose not to participate in the program at any time by contacting Your Customer Service Representative at the toll-free telephone number on the back of your Identification ▇▇▇▇.▇▇ the event MedsYourWay fails to provide, or continue to provide, the program as stated, there will be no impact to You. In such an event, You will pay the plan’s pharmacy benefit copay.

Mail Order Program. If You elect to use the mail-order service, You must mail Your Prescription Order to the address provided on the mail-order prescription form and send in Your payment for each prescription filled or refilled. Each prescription or refill is subject to the Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS and any applicable pricing differences, payable by Member directly to the mail order Pharmacy. Some drugs may not be available through the mail-order program. If You have any questions about this mail-order program, need assistance in determining the amount of Your payment, or need to obtain the mail-order prescription claim form, access the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇ or contact customer service at the toll-free number on Your identification card. Mail the completed form, Your Prescription Order(s) and payment to the address indicated on the form. The HMO Specialty Pharmacy Program delivery service offers: • coordination  Coordination of coverage between You, Your Health Care Practitioner and HMO; • educational ,  Educational materials about the patient’s particular condition and information about managing potential medication side effects; • syringes,  Syringes, sharps containers, alcohol swabs and other supplies with every shipment for FDA approved self- self-injectable medications; , and • access  Access to a pharmacist for urgent medication issues 24 hours a day, 7 days a week, 365 days each year. The Drug List which includes these Specialty Drugs is available by accessing the website at ▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇.▇▇▇/member/▇▇▇▇▇▇prescription-drug-plan-information/▇▇▇▇▇▇▇▇▇▇▇▇drug-▇▇▇▇-▇▇▇▇-▇▇▇▇▇▇▇▇▇▇▇/▇▇▇▇-▇▇▇▇▇ lists or by contacting customer service at the toll-free number on Your identification card. Your cost will be the applicable Copayment shown in the Schedule of Copayments and Benefit Limits SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS as well as any applicable pricing differences. Prescription Drugs Purchased Outside of the Service Area. HMO will reimburse You for the Allowable Amount of the prescription drugs less the Out-of-Area Drug Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS, for covered prescription drugs which You purchase outside of the Service Area. You must submit a completed claim form to HMO, within ninety (90) days of the date of purchase to qualify for reimbursement under the PHARMACY BENEFITS. You may access the website at ▇▇▇.▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇/▇▇▇▇▇/▇▇▇▇▇_▇▇▇▇▇ to obtain a prescription drug claim form.