Common use of NON-NETWORK Clause in Contracts

NON-NETWORK. If a member chooses to use a non-network pharmacy, s/he will be required to pay the full cost of the prescrip- tion and then file a claim with the PBM. The PBM will reimburse the cost of the drug based on the network discounted amount as determined by the PBM, less the applicable deductible or coinsurance. A. Preferred formulary generic drug: Forty percent (40%) coinsurance after deductible has been met for up to a thirty- one- (31-) day supply for a generic drug on the formulary. B. Preferred formulary brand drug: Forty percent (40%) coinsurance after deductible has been met for up to a thirty- one- (31-) day supply for a brand drug on the formulary. C. Non-preferred formulary drug and approved excluded drug: Fifty percent (50%) coinsurance after deductible has been met for up to a thirty-one- (31-) day supply for a drug not on the formulary. D. Diabetic drug (as designated by the PBM) coinsurance: Fifty percent (50%) of the applicable non-network coinsurance after deductible has been met.

NON-NETWORK. If a member chooses to use a non-network pharmacy, s/he will be required to pay the full cost of the prescrip- tion and then file a claim with the PBM. The PBM will reimburse the cost of the drug based on the network discounted amount as determined by the PBM, less the applicable deductible or coinsurance. A. Preferred formulary generic drug: Forty percent (40%) coinsurance after deductible has been met for up to a thirty- one- (31-) day supply for a generic drug on the formulary. B. Preferred formulary brand drug: Forty percent (40%) coinsurance after deductible has been met for up to a thirty- one- (31-) day supply for a brand drug on the formulary. C. Non-preferred formulary drug and approved excluded drug: Fifty percent (50%) coinsurance after deductible has been met for up to a thirty-one- (31-) day supply for a drug not on the formulary. D. Diabetic drug (as designated by the PBM) coinsurance: Fifty fifty percent (50%) of the applicable non-network coinsurance after deductible has been met.

NON-NETWORK. If a member chooses to use a non-network pharmacy, s/he will be required to pay the full cost of the prescrip- tion and then file a claim with the PBM. The PBM will reimburse the cost of the drug based on the network discounted amount as determined by the PBM, less the applicable deductible or coinsurance. A. Preferred formulary generic drug: Forty percent (40%) coinsurance after deductible has been met for up to a thirty- one- (31-) day supply for a generic drug on the formulary. B. Preferred formulary brand drug: Forty percent (40%) coinsurance after deductible has been met for up to a thirty- thirty-one- (31-) day supply for a brand drug on the formularyfor- mulary. C. Non-preferred formulary drug and approved excluded drug: Fifty percent (50%) coinsurance after deductible has been met for up to a thirty-one- (31-) day supply for a drug not on the formulary. D. Diabetic drug (as designated by the PBM) coinsurance: Fifty percent (50%) of the applicable non-network coinsurance after deductible has been met.