Benchmark plan Complex periodontal procedures (osseous surgery including flap and closure and mucogingivoplastic surgery) limited to once per Member per quadrant in a five-year period; Benchmark plan Debridement limited to once per Member in a period; and Benchmark plan Gingivectomy and gingivoplasty limited to once per Member per quadrant in a three-year period. Pharmacy This section applies only to that cover prescription drugs. If the plan does not cover prescription drugs, you can skip this section and go on to the next section, Preventive Services. No RCW 48.44.465 An HCSC may not retract an authorization issued by any on a Retracting pharmacy claim. Authorization Statement WAC Contract must include “Your Right to Safe and Effective Pharmacy Required Services” statement. Allowed Cost WAC Prescription benefit may include cost control measures, including Control requiring preferred drug substitution in a therapeutic class, if Measures the restriction is for a less expensive, equally therapeutic alternative product available to treat the condition. Pharmacy WAC A carrier may include elements in its prescription drug benefit (Cont’d) design that, where clinically feasible, create incentives for the use of generic drugs, e.g. step therapy protocols, use of drug tiering, or otherwise limiting the benefit to the use of a generic drug in lieu of brand name drugs, subject to a substitution process. WAC Required Carrier must establish a process for a provider and enrollee (or their drug designee) to request a substitution for a covered prescribed therapy, drug or medication that is not on the formulary.
Benchmark plan Complex periodontal procedures (osseous surgery including flap and closure and mucogingivoplastic surgery) limited to once per Member per quadrant in a five-year period; Benchmark plan Debridement limited to once per Member in a period; and Benchmark plan Gingivectomy and gingivoplasty limited to once per Member per quadrant in a three-year period. Pharmacy Pharmacy (Cont’d) This section applies only to that cover prescription drugs. If the plan does not cover prescription drugs, you can skip this section and go on to the next section, Preventive Services. No Retracting Authorization RCW 48.44.465 An HCSC may not retract an authorization issued by any on a pharmacy claim. Statement Required WAC Contract must include “Your Right to Safe and Effective Pharmacy Services” statement. Allowed Cost Control Measures WAC Prescription benefit may include cost control measures, including requiring preferred drug substitution in a therapeutic class, if the restriction is for a less expensive, equally therapeutic alternative product available to treat the condition. WAC A carrier may include elements in its prescription drug benefit design that, where clinically feasible, create incentives for the use of generic drugs, e.g. step therapy protocols, use of drug tiering, or otherwise limiting the benefit to the use of a generic drug in lieu of brand name drugs, subject to a substitution process. Required drug WAC Carrier must establish a process for a provider and enrollee (or their designee) to request a substitution for a covered prescribed therapy, drug or medication that is not on the formulary.