2024-BenefitsGuide-V14-Final

Prescription Drug Benefits

Important Features of the Prescription Drug Policy

Maintenance Choice Mail Order Service This CVS Caremark service can provide valuable savings on certain maintenance medications that can be mailed directly to your home or picked up at your local CVS pharmacy (not allowed in OK and MN). AUTOMATIC ENROLLMENT After two regular fills, you will be automatically enrolled in the CVS Caremark Maintenance Choice Mail Order Service and your maintenance medication will be mailed directly to your home. You can request to pick up your maintenance medications at a local CVS pharmacy by going to www.caremark.com or contacting CVS Caremark Customer Service at 877-494-9519. OPTING OUT By opting out of the CVS Caremark Maintenance Choice Mail Order Service program, you will be able to get your medications at any network pharmacy, but the supply will be limited to 30 days, and the standard copay will apply. This is a more expensive option for you and Reliance Rewards. You may opt out of the CVS Caremark Maintenance Choice Mail Order Service by contacting CVS Caremark Customer Service at 877-494-9519. Reliance Rewards utilizes a step therapy program for prescription drugs associated with rheumatoid arthritis or osteoarthritis. The step therapy preferred drug strategy encourages the use of safe, equally effective, and less expensive drugs before “stepping up” to a more expensive brand-name therapeutic alternative. You will be required to try the preferred drug before a brand-name drug is dispensed. If the brand-name drug is dispensed before approved as part of the step therapy program, you will be required to pay 100% of the drug cost. STEP THERAPY PROGRAM FOR RHEUMATOID ARTHRITIS OR OSTEOARTHRITIS

DISPENSE AS WRITTEN POLICY A generic medicine is a Food and Drug Administration (FDA) approved copy of a brand-name drug. The FDA reviews each generic medicine to ensure that it is the same as the brand-name drug in safety, effectiveness, quality, and performance (how it works in the body). The generic version is available for the same use (high blood pressure, allergies, etc.) and in the same form (pill, liquid, cream, etc.) as its brand-name equivalent. Under the Dispense as Written Policy, if you or your doctor requests a brand-name drug when a generic is available, you are responsible for the difference in cost between the brand-name and generic drug, plus the applicable generic copay. PRIOR AUTHORIZATION REQUIRED Certain prescription drug classes require authorization from CVS Caremark prior to dispensing. These drugs have the potential for serious side effects or inappropriate use. The best way to avoid inconvenience is to have your physician call the CVS Caremark Prior Authorization department at 800-294-5979 to determine whether the drug will be covered. SPECIALTY MEDICATION GUIDELINE MANAGEMENT This is a comprehensive program to help ensure specialty medication use is appropriate, safe, and effective. By working with the physician, this program confirms appropriate use prior to dispensing a specialty medication, according to evidence-based medicine standards. In addition, there will be continual monitoring throughout treatment to assure appropriate use within clinical guidelines. The coordination of the program is usually handled between CVS Caremark and your physician. No action is required by you. PRUDENTRX (PPO ONLY) This is a prescription manufacturer copay assistance programwhich offers enrolled members a $0 copay for selected specialty medications. Participation in this program is voluntary and requires enrollment in PrudentRx. PrudentRx sends enrollment instructions to newmembers in the plan.

Reliance Rewards plans include comprehensive prescription drug benefits through CVS Caremark. The CVS Caremark prescription drug benefits are the SAME for the High PPO and Low PPO plans. You share in the cost of the prescription drugs through copays and/or a percentage of the costs each time you fill a prescription. The CVS Caremark prescription drug benefits for the Saver Plan are treated as any other medical expense – subject to the annual deductible and plan coinsurance (no copays). Preventive drugs (for the treatment of high blood pressure, diabetes, etc.) covered at the plan coinsurance without being subject to the plan’s deductible. Prescription drugs are the fastest rising cost of healthcare today, affecting all employers and plans, including Reliance Rewards. You have the ability to help manage our costs by always asking your doctor if there is an equivalent generic prescription drug available. You can also save money if you utilize the CVS Caremark Maintenance Choice Mail Order Service for your maintenance prescriptions (not allowed in OK and MN).

CVS/CAREMARK MAINTENANCE CHOICE MAIL ORDER SERVICE* Up to a 90-day supply

RETAIL PHARMACY Up to a 30-day supply

HIGH PPO/LOW PPO

SAVER PLAN

HIGH PPO/LOW PPO

SAVER PLAN

$20 Copay

$10 Copay

Generic Drugs

You Pay 20% Coinsurance $60 minimum and $120 maximum You Pay 35% Coinsurance $100 minimum and $200 maximum

You Pay 25%Coinsurance $30minimumand $50 maximum You Pay 40%Coinsurance $50minimumand $80 maximum

In-Network 20% Coinsurance Out-of-Network 40% Coinsurance***

In-Network 20% Coinsurance*** Out-of-Network 40% Coinsurance***

Preferred Brand- Name Drugs**

With PrudentRx: $0 Copay Without PrudentRx: You Pay 30%

PrudentRx Specialty Medication

Healthcare Reform Preventive Drugs

$0 copay** for contraceptives, aspirin, and folic acid. If a generic equivalent is available, then the copay or coinsurance amount above will apply to obtain the brand name version of the medication.

* Discounted pricing for mail order prescriptions is not allowed in OK or MN ** If a generic equivalent is available and either you or your doctor requests a brand-name drug, you’ll pay the applicable generic copay amount (if any) plus the difference in cost between the brand-name drug and its generic equivalent *** After you meet your Saver Plan medical deductible

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