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New Agency FAQs May Require Changes to Health Plan Pharmacy Coverage of Preventive Care Services (PDF)
BuckLink to more items from this source
[Guidance Overview]
May 28, 2015
"A plan may use cost-sharing to encourage the use of generic pharmacy items rather than brand name items. But if a plan does impose cost-sharing or medical management techniques, it must have an accessible, transparent and expedient exceptions process. Also, if a provider recommends a particular contraceptive service or item based on medical necessity, the plan must defer to the provider's determination and cover it without cost sharing."

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