Page 8 - Hospice Benefits Enrollments Guide

Prescription Drug Plans

Policy# 7076

 You will have a penalty applied if you elect the Brand name when a generic is
available (if the Provider has not indicated dispense as written).

 Program does include Prior Authorization and Step Therapy requirements.

 You can obtain a 90 day supply of your medication for 3 times the retail
copayment.

 Preventive OTC Medications (with prescription) and Contraceptive Drugs and
Devices, per HCR, are covered at 100%.

7 |