Prescription drug benefits

CVS Caremark Mail Order

• You can get up to a 90-day supply of covered medication.

• You pay a $10.00 co-payment for generic drugs.

• You pay a $10.00 co-payment for brand-name drugs.

• If you request a brand-name drug when a generic equivalent is available, you are responsible for the $10.00 brand-name co-payment plus the cost difference between the brand-name drug and generic drug.

• Standard shipping and handling is free.

Maintenance Choice Retail Pharmacy Service

• You can get up to 2 fills of covered maintenance medication at a retail pharmacy

• You pay a $5.00 co-payment for generic drugs for a 34 day supply

• You pay a $7.50 co-payment for brand-name drugs for a 34 day supply

You pay a $10.00 co-payment for drugs for a 90 day supply

• If you purchase a brand-name drug when a generic drug is available you will pay the brand co- payment, plus the difference in cost between the brand-name drug and the generic drug.

• For a prescription you take on a long-term basis (3 months or more), you may use a participating retail pharmacy for your initial prescription and one refills (for a total of two fills), for up to a 90-day supply each time. If you remain on that medication, you must order subsequent refills through the CVS Caremark Mail Order program or a CVS Retail Pharmacy.

Your Preferred Prescriptions ® Formulary

Your prescription drug benefit includes a formulary, which is a list of generic and brand-name drugs that are preferred by your plan. This list includes a wide selection of medications and is preferred because it offers you choice while helping to keep the cost of your prescription drug benefit affordable. Every drug on the formulary is Food and Drug Administration (FDA) approved, and reviewed by an independent group of doctors and pharmacists for safety and efficacy. CVS Caremark may remind your doctor when a formulary medication is available for a drug that is not on your formulary. This may result in a change in your prescription. However, your doctor will always make the final decision on your medication. For more information, visit www.caremark.com or call 1-888-752-7229

CVS Caremark Mail Order Program

Offering you convenience and potential cost savings.

For your long-term prescription needs, if you need medication on an ongoing basis, such as to treat asthma, diabetes or other chronic conditions, you can ask your doctor to prescribe up to a 90-day supply for home delivery, plus refills for up to 1 year (as appropriate). You will pay just one co-payment for each prescription or refill. Since you can get a larger supply of medication through the CVS Caremark Mail Order Program than at a participating retail pharmacy, you may save money.

With the Mail Order Service:

• Your medications are dispensed by one of the pharmacists at a CVS Caremark network of home delivery pharmacies.

• Medications are shipped to you by standard delivery at no additional cost to you. (Express shipping is available for an added charge.)

• You can track your prescriptions online at www.caremark.com, or by calling Member Services toll-free at 1-888-752-7229.

• Registered pharmacists are available around-the-clock for medication consultations.

Refilling your prescription

You can easily refill your home delivery prescriptions online, by telephone, or by mail. Have your Member ID number (which is on your prescription ID card) and your prescription number for the medication handy. If you choose to pay by credit card, please have that number available as well.

• Online—Each time registered users log in to www.caremark.com, available prescription refills will be displayed in the personalized "order center," as well as within your prescription history. From the order center, simply check the box next to the items you want to order and follow the on-screen instructions to check out.

• By telephone—Call 1-888-752-7229 to use the automated refill system.

• By mail—Use the refill order form that will accompany your prescription. Mail them with your co-payment to CVS Caremark in the return envelope.

Coverage Management and Prior Authorization

Some medications are covered by your plan only for certain uses or in certain quantities. Your plan sets all coverage parameters. For example, a drug may not be covered when it is used for cosmetic purposes. Also, the quantity covered may be limited to certain amounts over certain time periods. In these cases, your doctor may need to provide more information. The pharmacy will let you know if additional information is required by your plan. You or the pharmacy can then ask your doctor to call a special toll-free number. This call will initiate a review that typically takes 1 to 2 business days. Once the review is complete, CVS Caremark will notify you and your doctor of the decision. If the review is approved, the letter will tell you the length of your coverage approval. If the review is denied, the letter will include the reason for coverage denial and instructions on how to submit an appeal.