Benefits at a Glance 2020 Prescription Benefits Summary for FCPS Members Enrolled in

Aetna/Innovation Health and CareFirst BlueChoice Advantage Health Plans

Your Prescription Drug Plan CVS Caremark provides convenient access to retail and mail service delivery options to help ensure you receive the prescriptions you need. Your prescription drug plan includes access to:  A nationwide network of more than 68,000 participating retail pharmacies (both CVS and non-CVS pharmacies).  The CVS Caremark Mail Service pharmacy, for convenient delivery of your medication to your home address.  The CVS Specialty pharmacy, for participants who take specialty medications for treatment of rare or complex conditions.

Your Coinsurance or Copayments* The amount you pay for your covered medications depends on the type of medication (generic, brand, or specialty) and where you fill your prescriptions.

Acute and Maintenance Obtained at CVS Retail Pharmacy Obtained at a Participating Non-CVS Medications Locations or CVS Mail Service Pharmacy Retail Pharmacy Locations Up to 30-day supply Generic: $7 Brand Name: 20% of cost of drug (maximum $75) 31 to 60-day supply Generic: $14 Brand Name: 20% of cost of drug (maximum $150) 61 to 90-day supply Generic: $14 Generic: $21 Brand Name: 20% of cost of drug Brand Name: 20% of cost of drug (maximum $150) (maximum $225) Specialty Medications CVS Specialty Pharmacy Up to 30-day supply Generic: $7 Brand Name: 20% of cost of drug (maximum $75)

Note: Specialty medicines must be filled through CVS Specialty Pharmacy after the initial fill at a participating retail pharmacy. *If the cost of the medication is less than the minimum copayment, you will pay the lower amount.

Maximum Out-of-Pocket Once your out-of-pocket expense reaches the specified levels below, the Plan will pay covered charges at 100% for the remainder of the calendar year. Individual: $1,500 Family: $3,000

Formulary Your coverage under CVS Caremark is based on a formulary—a preferred list of covered medications. Your formulary offers a wide selection of clinically-sound, cost-effective generic and brand-name prescription drugs. To view the current formulary, visit https://info.caremark.com/fcps.

Preventive Medications To promote good health and help prevent the need for costly care, your plan offers coverage for a number of preventive medications at $0 copayment. These include women’s contraceptives and several over-the-counter drugs recommended for coverage by the U.S. Preventive Services Task Force. Coverage of these drugs requires a prescription (even for over the counter items) and are subject to certain age and gender criteria.

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Generics Preferred Program (Automatic Generic Substitution) If your doctor prescribes a brand-name drug when equivalent generic drugs are available, you will automatically receive an FDA-approved generic drug* unless:  Your doctor writes “dispense as written” (DAW) on the prescription; or  You request the brand-name drug at the time you fill your prescription * When more than one generic drug is approved, CVS Caremark may fill your prescription with any approved generic equivalent.

If a generic is available, but you or your doctor request the brand-name drug, you will pay the generic copayment PLUS the full difference in cost between the brand-name drug and the generic equivalent. This difference in cost is referred to as the ancillary fee. The ancillary fee is in addition to the copayment, so the cost could exceed the copayment maximum.

If your doctor requests you take the brand name drug due to medical necessity, please refer to the Prior Authorization section.

Prior Authorization Prescriptions for certain medications require a prior authorization, also known as a coverage review, to ensure the drug is safe, clinically appropriate and cost effective for your condition. The review uses both formulary and clinical guidelines to determine if the plan will pay for certain medicines. If your prescription requires a prior authorization, your doctor must submit a request for coverage review for approval.

If, on the rare occasion you are not able to take the generic medicine, your doctor can request a prior authorization that may allow you to purchase the brand-name drug without paying the ancillary charge.

Step Therapy – Brands Requiring Use of Generics First Some brands require the use of clinically appropriate, cost-effective generic drugs before the Plan will cover higher-cost medications. With step therapy, you typically start with a generic drug before a brand-name drug is approved. If you are not able to use the generic drug, brand-name drugs may be covered in the second step.

Filling Your Prescriptions There are several ways to fill your prescriptions depending on your needs.

Filling a short-term prescription medicine: For short-term medicine needs, such as antibiotics for strep throat or pain relievers for an injury, filling your prescription at a participating local pharmacy is optimal. Simply visit any participating retail pharmacy and present your CVS Caremark member ID card and written prescription to your pharmacist. See page 1 for your copayment/coinsurance amounts.

Filling maintenance medicines: For medications you take regularly to treat ongoing conditions (such as drugs used to treat high-blood pressure or diabetes), the CVS Caremark Mail Service Pharmacy and CVS retail pharmacy chains offer the best value. You also have the option of filling your prescriptions at a non-CVS participating local pharmacy. However, higher copayments may apply (see page 1 for copayment/coinsurance amounts). Note: You are not required to use CVS retail pharmacies for filling your maintenance medications. If you choose to use a CVS retail pharmacy or CVS Caremark Mail Service, you will pay lower copayments than if you use other network retail pharmacies.

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Filling specialty medications: For specialty medicines (drugs used to treat complex conditions, such as cancer or multiple sclerosis), you must use the CVS Specialty pharmacy. Specialty medications are conveniently delivered to your home address, or you may choose to pick up at your local CVS pharmacy. For more information about CVS Specialty Pharmacy, contact a CVS Specialty representative at 1-800-237-2767 or register online at https://CVSspecialty.com.

For more information For more information about estimated medication costs, participating pharmacies, covered drugs and more, visit https://info.caremark.com/fcps or call CVS Caremark toll-free at 1-888-217-4161.

A No-Cost Program to Help You Manage Your Diabetes

Testing and tracking your blood glucose levels is a crucial component of successful diabetes management, but it can sometimes be a time-consuming, manual process. Now, there’s a better way. Your pharmacy benefits include the CVS Caremark® Transform Diabetes Care (TDC) program. The program* offers no-cost tools, services and extra support to help participants effectively manage their diabetes, including an optional glucometer via Livongo. Every time you test your blood glucose levels with Livongo, your numbers will be automatically sent to a secure online account.*

With Livongo, you can easily:  Track your levels, see trends and share your data with whomever you choose**  Get unlimited test strips and lancets delivered to your door at no out-of-pocket cost  Receive personalized tips in real-time to help you stay on track and make informed choices

Two ways to get started today (use registration code: FAIRFAX)  ONLINE – visit join.livongo.com/FAIRFAX  PHONE – call your dedicated Livongo Team at 1-800-945-4355

Additional TDC benefits include:  Two diabetes monitoring visits per year at any MinuteClinic® location (at no out-of-pocket cost to you) to help prevent diabetes-related conditions and include: A1c testing, foot exams, body mass index (BMI) assessments, diet consultation, and blood pressure and cholesterol checks. No appointment is necessary; simply bring the program voucher with you to any MinuteClinic location. Program vouchers will be included in your Welcome Kit mailed to your home address.  Personalized, one-on-one coaching with a pharmacist. Need help managing your diabetes medications? If you pick up prescriptions at a CVS Pharmacy, you may stop in and speak to a pharmacist. If you receive your prescriptions by mail, you may call the number on your CVS member ID card to speak with a CVS Caremark pharmacist.

*Your employer offers this program at no cost to you. Program availability is subject to change. You will be notified if the program is no longer available. This program is not a substitute for medical care provided by your doctor and is not a replacement for the advice or treatment you may be receiving from your doctor for your diabetes. In the event of a medical emergency, contact 9-1-1. **By participating in this program, you are consenting to Livongo sharing your personal information, including health information such as your glucose readings, with CVS Caremark to help you manage your diabetes. Information shared with CVS Caremark is protected by HIPAA and may result in a CVS Caremark pharmacist reaching out to you. CVS Caremark may also coordinate with your health care provider.

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