Accumulators
On this plan, there is no deductible, and the Individual In-Network MOOP is $4,500
Silver Plan
These medical devices are used to administer medications such as Cyanocobalamin (Vitamin B2) and Testosterone.
Syringes
These medications belong to a fairly newer FDA-Approved category, GLP-1, known for improving medical conditions such as Obstructive Sleep Apnea, pre-diabetes, and high blood pressure.
Weightloss Medications
What list of medications does this client NOT have?
Safe Harbor Drug List
On this plan, there is no deductible, and the Individual In-Network MOOP is $4,000
Gold Plan
A 14-year-old child will have no problem getting this medication, but his 20-year-old brother will need prior authorization.
CNS Stimulants
This medication category is used for the medical condition of erectile dysfunction.
Impotence: Non-oral and oral agents
This client is not enrolled in this process, and rejections regarding this issue are expected and appropriate.
COB (Coordination of Benefits)
This plan has an Individual In-Network Deductible of $1,900
High Deductible Health Plan
These medications are included in this plan, but if a member is over 26 years old, prior authorization will be required.
Topical Tretinoins and Isotretinoins
This medication category includes all injectables and non-injectables used to aid in family-building procedures
Fertility Medications
These medications, while covered by Rightway and with the prior authorization process handled by Rightway, will not be filled by the usual preferred pharmacy; instead, they will be carved out.
Specialty Medications
This plan(s) has an Integrated deductible with its medical benefits
All plans
This inclusion will require prior authorization if the total amount paid exceeds $300. The makeup of this inclusion should always be checked, though, because it may not be covered even with prior authorization.
Compounds
This medication category includes forms of synthetic testosterone to treat hormone conditions or assist with performance and image enhancement
Anabolic Steroids
For specialty medications, this program will have to be contacted in order to fulfill the member's order
GBS Rx
This plan(s) has an Embedded MOOP
All plans!
This medication is given to an Rh-negative mother to prevent the formation of Rh antibodies that could harm a future Rh-positive baby.
Rhogam
This category includes medications used for cosmetic treatments, examples are Rogaine and Finasteride
Hair Loss Medications
This device is NOT included in either pharmacy or medical coverage, and will require a warm transfer to the member's medical benefit provider for an alternative solution.
Disposable Insulin Pumps