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<br />3.2 <br /> <br />The quantity of Prescription Drugs dispensed pursuant to a <br />Prescription Order or refill shall not exceed that required for <br />thirty-four (34) consecutive days with the following exceptions: a) <br />up to a three-month supply of oral contraceptives may be dispensed; <br />and b) one vial of insulin may be dispensed. <br /> <br />4. <br /> <br />EXCLUSIONS <br /> <br />4.1 <br /> <br />Drugs which do not by Federal law require a prescription (except <br />insulin) and all other drugs and over-the-counter medicationst even if <br />written on a Prescription Ordert are excludd fom coverage. Non- <br />durable disposable medical supplies and items such as specified under <br />4.4 of EXCLUSIONS. <br /> <br />4.2 <br /> <br />Administration or injection of any drugs except as specified as a <br />basic benefit in the THP Group Master Contract/Certificate. <br /> <br />4.3 <br /> <br />Vitamins, even those which by law require a Prescription Order, except <br />as otherwise indicated by Health Plan Drug Formulary. <br /> <br />4.4 <br /> <br />Devices or su~~lies of any ty~e, even though such devi~es may require <br />a Prescription Ordert such ast but not limited to, therapeutic <br />devices, artificial appliancest hypodermic needles, syringes, support <br />garments or other devices regardless of their inte~ded use, except as <br />specified as a basic benefit in the THP Master Group <br />Contract/Certificate. <br /> <br />4.5 <br /> <br />Experimental drugs and agents. <br /> <br />4.6 <br /> <br />Prescriptions issued by <br />specified in Section 2. <br /> <br />non-participating <br /> <br />THP Physicians except as <br /> <br />4.7 <br /> <br />Drugs dispensed by non-participating Pharmacies except as specified in <br />Sectio~ 2, Part 2.2. <br /> <br />5. <br /> <br />CONDITIONS UNDER WHICH SERVICE SHALL 'BE RENDERED <br /> <br />5.1 <br /> <br />The Covered Person's Identificatio~ Card shall be presented to the <br />Pharmacy whe~ a Covered Person applies for benefits under this Rider; <br />furthermore, the Covered Person must be eligible to receive covered <br />benefits at the time the Prescriptio~ is filled or refilled. <br /> <br />5.2 <br /> <br />As a condition precedent to the approval of claims hereunder, each <br />Covered Person authorizes and directs any other Pharmacy which <br />furnishes benefits hereunder to make available to THP information <br />relating to all Prescription Orders, copies thereof a~d other records <br />as needed by THP. THP shall in every case hold such information and <br />records as confidential. <br /> <br />5.3 <br /> <br />THP shall not be liable for any claimst i~jury, demand or judgment <br />based o~ tort or other grounds (including warranty of drugs), arising <br />out of or in connection with the sale, compounding, dispensing, <br />manufacturing, or use 'of any Prescription Drug or insulin whether or <br />~ot covered under this Rider. <br /> <br />THPRX 10/87 <br /> <br />-3- <br />