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  • Drugs furnished at no cost to the patient by

the local, state, or federal government

  • More than the recommended daily dosage

  • Drugs paid for any Workers’

Compensation coverage

  • Drugs considered not medically necessary

Coordination of Benefits When a participant has other health insurance coverage which is primary, a claim may be filed for secondary coverage under the Plan. To file a claim, a copy of the explanation of benefits from the primary insurance carrier along with a copy of the receipt from the pharmacy must be attached to a Direct Member Reimbursement (DMR) form. The form may be obtained from Catalyst Rx. The claim is processed by Catalyst Rx and reimbursement is made to the enrollee based upon the Plan’s allowable charge, less the amount paid by the primary carrier, less the applicable co- payment for that prescription drug.

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