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555-555-0199@example.comUsed as an alternative to retail pharmacies, members can order and refill their prescriptions via postal mail, Internet, fax, or telephone. Once filled, the prescriptions are mailed directly to the member’s home.
555-555-0199@example.comAlso known as a formulary, this is a list of certain brand name and covered generic prescription drugs. The preferred drug list was developed and is maintained by the CareFirst BlueCross BlueShield Pharmacy and Therapeutics Committee, which is made up of a group of physicians and pharmacists that practice in the CareFirst BlueCross BlueShield region. CareFirst BlueCross BlueShield may change this list from time to time to provide the most cost-effective and complete prescription drug options to members.
555-555-0199@example.comA medication that is anticipated to be taken regularly for several months to treat a chronic condition such as diabetes, high blood pressure and asthma.
555-555-0199@example.comA term that describes procedures performed on structures of the body to improve or restore bodily function or to correct deformity resulting from disease, trauma or previous therapeutic intervention.
555-555-0199@example.comA benefit option in which a member pays a lower copay for generic drugs (Tier 1), a higher copay for preferred brand name drugs (Tier 2) and the highest copay for non-preferred brand name drugs (Tier 3).
555-555-0199@example.comThis is a list of brand name and generic prescription drugs developed and maintained by CareFirst BlueCross BlueShield and used by providers and pharmacists when writing and filling prescriptions. Prior Authorization is used to insure the appropriate use of medications that have specific indications, safety concerns, or have a high potential for overuse.
555-555-0199@example.comWhen an FDA-approved generic equivalent (Tier 1) is substituted for a non-preferred brand name drug (Tier 3).
555-555-0199@example.comThose services that include occupational, physical and speech therapy and select oral health care for the treatment of children with certain congenital or genetic birth defects, to enhance the child's ability to function. These services are directed at developing skills that were never present.
555-555-0199@example.comPrograms for members with chronic health conditions. Services range from quarterly mailings to case management with 24-hour access by phone to a support nurse.
555-555-0199@example.comDescribes the use of a service or supply which does not meet the criteria for determining medical necessity.
555-555-0199@example.comA term that describes the use of a service or supply which is provided with the primary intent of improving appearance, not restoring bodily function or correcting deformity resulting from disease, trauma or previous therapeutic intervention.
555-555-0199@example.comHealth insurance coverage extended to the spouse or partner and unmarried children of the primary insured member. Certain age restrictions on the coverage of children may apply.
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