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• <br /> ::::':••.:-, •.. ,, .7 :........ <br /> - . . -• <br /> . , . . • . <br /> • , 2-28 • • <br /> . . ... - --_ . <br /> . . <br /> . . . <br /> . . <br /> . . <br /> Prescription Drug Blder . <br /> . . <br /> i prescription requires a 55.00 or 25% copayment, whichever is . <br /> ater fOr up to a 34-day supply prescribed by a Participating <br /> an and filled by a Participating Pharmacy• You must dhow your <br /> In Membership Card before obtaining a prescription. <br /> • <br /> -escription drugs through CPBP are available only at RS,±-t--P-C19.1 . <br /> Lores with over 60 locations in the service area. <br /> General Esclusious/Limitations . . : <br /> . . . . <br /> . . . <br /> Any Medical Supplies (i.e. , Bandages, Syringes) . <br /> Over The Counter (OTC) Medications <br /> Any new dregs/products approved by the FDA after January 1, 1965 without <br /> prior approval by the Plan. Any drugs/products that are used for <br /> DP approved purposes• . .. <br /> r <br /> Specific BsclusionsLimitations . . -... . <br /> and <br /> Contro <br /> Birth l Pills Devices . . <br /> Fertility DrUg0 . <br /> Injectable Prescriptions <br /> Insulin and Oral An ti-Diabetic Medications <br /> Vitamins (Children and Pre-Natal) <br /> 0169 . . . <br />