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SERVICE SCOPE OF BENEFIT (ANNUAL) Including but not limited to: Value Add Services Services/equipment which are not in the State Plan but are cost effective, improve health and clinically appropriate. C. EOHHS policy affects the access to and/or the scope and amount of several benefits as follows: 1. Prescriptions: Generic Policy. For RHP enrolled members, prescription benefits must be for generic drugs. Exceptions for limited brand coverage for certain therapeutic classes may be granted if approved by EOHHS, or the MCO acting in compliance with their contractual agreements with EOHHS, and in accordance with the criteria described below: a. Availability of suitable within-class generic substitutes or out-of- class alternatives. b. Drugs with a narrow therapeutic range that are regarded as the standard of care for treating specific conditions. c. Relative disruptions in care that may be brought on by changing treatment from one drug to another. d. Relative medical management concerns for drugs that can only be used to treat patients with specific co-morbidities. e. Relative clinical advantages and disadvantages of drugs within a therapeutic class. f. Cost differentials between brand and generic alternatives. g. Drugs that are required under Federal and State Regulations. h. Demonstrated medical necessity and lack of efficacy on a case by case basis. 2. Non-emergency medical transportation (NEMT) policy. Responsibility for transportation services rests first with the member. If the member's condition, place of residence, or the location of medical provider does not permit the use of bus transportation, NEMT for the Medicaid enrollee may be arranged for by EOHHS or its agent for transportation to a Medicaid covered service from a Medicaid participating provider, including medical,