| Icon | Restriction | Definition |
 | 90 Day Generic | Select generics may be dispensed at a retail pharmacy for a 90 day supply. |
 | Age Limit Restriction | Coverage of this drug may be based on member age. |
 | Behavioral Health | For members with Community Care Services (CCS), certain drugs must be
billed to Ohana Health Plan CCS. |
 | Clinical Criteria | Click on the link for additional coverage details. |
 | Dosing Limit | There are limits on the amount of medicine covered within a certain amount of time. |
 | Generic Indicator | Generics are simply copies of brand-name drugs. Brand-name and generic
drugs have the same active ingredients, strength and dose. And the FDA requires
that generic drugs meet the same high safety standards for purity, quality,
safety and strength. |
 | Hansen's Disease Program | If used for Hansen's Disease (or Leprosy) refer to the Department of
Health's Hansen's Disease Program. |
 | Limited Distribution | Limited distribution drugs are those that are available only through select pharmacies or wholesalers as determined by the manufacturer. |
 | Medical Benefit | Product is covered under the Medical Benefit. |
 | Over The Counter | Over the counter medication available with a prescription. (Prescribers
please indicate OTC on the prescription). |
 | Prescriber Note | Additional notes for the prescriber. |
 | Prior Authorization | Prior authorization is the process of obtaining approval of benefits
before certain prescriptions may be filled. |
 | Quantity Limit | Certain prescription drugs have specific quantity limits per
prescription or per month. |
 | Specialty Pharmacy | Specialty drugs are used to treat difficult,
long term conditions. You may need to get this drug through a specialty
pharmacy. |
 | State Carve Out | State Carve Out drug. |
 | Step Therapy | You may need to use one medication before benefits for the use of
another medication can be authorized. |