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Performance Drug List Scrip World, powered by 1.866.475.7589 Participating pharmacies CVS/caremark Customer Service www.meritain.com Mail service

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Please note: if you’re having difficulty filling a prescription, or any other sort of issue, simply call the number listed on your ID Card.

Meritain Health | 8 CVS Health National Network Participating

Retail Pharmacies

The following list shows the major chain pharmacies that accept your members’ prescription ID card. In addition to these, many independent pharmacies also take part in the prescription program. If your members need to find out if a pharmacy not listed here accepts their card, they should call the pharmacy directly.

A E I A & P Pharmacy Eaton Apothecary IHC Health Center Accredo Health Group, Inc. Ingles Pharmacy ACME Pharmacy F Albertson’s Pharmacy Fairview Pharmacy J Ameridrug Pharmacy Farm Fresh Pharmacy Jewel-Osco Pharmacy Aurora Pharmacy Food City Pharmacy Food Lion Pharmacy K B Fred Meyer’s Pharmacy Kerr Drug Baker’s Pharmacy Fred’s Pharmacy Kessel Pharmacy Bartell Drugs Fresh Market King Sooper’s Pharmacy Bel Air Pharmacy Pharmacy Kinney Drugs Bi-Lo Pharmacy Fruth Pharmacy Klein’s Pharmacy Bi-Mart Pharmacy Fry’s Food and Drug Klingensmith’s Drug Brookshire Pharmacy Kmart Pharmacy G Knight Drug C Gerbes Pharmacy Kroger Pharmacy Carrs-Gottstein Foods Pharmacy Giant Eagle Pharmacy Kroger Sav-on Pharmacy Cashwise Pharmacy Giant Pharmacy City Market Pharmacy Group Health Pharmacy L Coborn’s Pharmacy Lincare Infusion Services Copps Pharmacy H Long’s Drugs Coram Healthcare Pharmacy Haggen Pharmacy Costco Pharmacy Hannaford Food & Drug M Critical Care Systems Harmons Pharmacy Marianos Pharmacy Cub Pharmacy Harps Pharmacy Marsh Drug Store CVS Pharmacy Harris Teeter Pharmacy Martin’s Pharmacy CVS Pharmacy in Target stores Harveys Supermarket Pharmacy Maxor Pharmacy CVS Specialty HealthPartners Pharmacy May’s Drug Store H-E-B Pharmacy Med-Fast Pharmacy D Hen House Pharmacy Medicap Pharmacy Dierbergs Pharmacy Henry Ford Medical Center Medicine Shoppe Pharmacy Dillon Pharmacy Pharmacy Meijer Pharmacy Discount Drug Mart Homeland Pharmacy Metro Market Pharmacy Doc’s Drugs Horton & Converse Pharmacy Drug Warehouse Humana Pharmacy Duane Reade Hy-Vee Pharmacy

CVS Caremark® reserves the right to review and update the National Network Participating Retail Pharmacies List. www.caremark.com ©2016 CVS Caremark. All rights reserved. 106-29293A 110716 National Network Participating Retail Pharmacies (cont.)

N S W Navarro Discount Pharmacy Safeway Pharmacy Wal-Mart Pharmacy NCS Healthcare Pharmacy Sam’s Club Pharmacy Walgreens Pharmacy Neighborcare Pharmacy Sav-Mor Pharmacy Wegman’s Pharmacy Nob Hill Pharmacy Save Mart Pharmacy Weis Pharmacy North Florida Pharmacy Sav-On Pharmacy White Drug Schnucks Pharmacy Winn-Dixie Pharmacy O Scolari’s Pharmacy Omnicare Pharmacy Scott’s Pharmacy Oncology Pharmacy Shaw’s Pharmacy Option Care Pharmacy Shop ‘n Save Pharmacy Osco Pharmacy Shopko Pharmacy Shoppers Pharmacy P ShopRite Pharmacy Pavilions Pharmacy Smith’s Pharmacy Pick N Save Pharmacy St John Pharmacy PrescribeIT Rx Pharmacy Stop & Shop Pharmacy Price Chopper Pharmacy Super 1 Pharmacy Price Cutter Pharmacy Super D Drugs Publix Pharmacy Super One Pharmacy Super RX Pharmacy Q QFC Pharmacy T Quick Chek Pharmacy Texas Oncology Pharmacy Thrifty White Pharmacy R Times Pharmacy Raley’s Drug Center Tom Thumb Pharmacy Ralphs Pharmacy Tops Pharmacy Randall’s Pharmacy Recept Pharmacy U Rite Aid Pharmacy United Market Street Pharmacy Ritzman Pharmacy United Pharmacy USA Drug UW Health Pharmacy Services V Vons Pharmacy

CVS Caremark reserves the right to review and update the National Network Participating Retail Pharmacies List. www.caremark.com ©2016 CVS Caremark. All rights reserved. 106-29293A 110716 Formulary Drug List January 2017

Performance Drug List

The CVS Caremark® Performance Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition. These preferred brand-name medicines are listed to help identify products that are clinically appropriate and cost-effective. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.

PLAN MEMBER HEALTH CARE PROVIDER Your benefit plan provides you with a prescription benefit program Your patient is covered under a prescription benefit plan administered by CVS Caremark. Ask your doctor to consider administered by CVS Caremark. As a way to help manage health prescribing, when medically appropriate, a preferred medicine from care costs, authorize generic substitution whenever possible. If you this list. Take this list along when you or a covered family member believe a brand-name product is necessary, consider prescribing a sees a doctor. brand name on this list. Please note: Please note:

• Your specific prescription benefit plan design may not cover • Generics should be considered the first line of prescribing. certain products or categories, regardless of their appearance in The member's prescription benefit plan design may alter this document. Products recently approved by the U.S. Food • 1 and Drug Administration (FDA) may not be covered upon coverage of certain products or vary copay amounts based on release to the market. the condition being treated. This drug list represents a summary of prescription coverage. • Your prescription benefit plan design may alter coverage of • certain products or vary copay 1 amounts based on the condition It is not all-inclusive and does not guarantee coverage. The being treated. member’s specific prescription benefit plan design may not cover certain products or categories, regardless of their • You may be responsible for the full cost of non-formulary appearance in this document. Products recently approved by products that are removed from coverage. the FDA may not be covered upon release to the market. For specific information regarding your prescription benefit • 1 • The member's prescription benefit plan may have a different coverage and copay information, please visit copay 1 for specific products on the list. www.caremark.com or contact a CVS Caremark Customer Care representative. • Unless specifically indicated, drug list products will include all dosage forms. • CVS Caremark may contact your doctor after receiving your 1 prescription to request consideration of a drug list product or • Log in to www.caremark.com to check coverage and copay generic equivalent. This may result in your doctor prescribing, information for a specific medicine. when medically appropriate, a different brand-name product or generic equivalent in place of your original prescription.

• In most instances, a brand-name drug for which a generic product becomes available will be designated as a non- preferred option upon release of the generic product to the market.

ANALGESICS COLCRYS HYSINGLA ER § ERYTHROMYCINS / § TETRACYCLINES ULORIC NUCYNTA MACROLIDES doxycycline hyclate § NSAIDs NUCYNTA ER azithromycin minocycline § OPIOID ANALGESICS diclofenac sodium OPANA ER clarithromycin tetracycline codeine-acetaminophen meloxicam OXYCONTIN clarithromycin ext-rel fentanyl transdermal § ANTIFUNGALS naproxen SUBSYS erythromycins fentanyl transmucosal DIFICID fluconazole § NSAIDs, COMBINATIONS VISCOSUPPLEMENTS lozenge itraconazole diclofenac sodium- hydrocodone-acetaminophen GEL-ONE § FLUOROQUINOLONES terbinafine tablet misoprostol hydromorphone HYALGAN ciprofloxacin ANTIRETROVIRAL AGENTS hydromorphone ext-rel SUPARTZ FX ciprofloxacin ext-rel § NSAIDs, TOPICAL methadone levofloxacin § ANTIRETROVIRAL diclofenac sodium solution ANTI-INFECTIVES morphine moxifloxacin COMBINATIONS VOLTAREN GEL morphine ext-rel ANTIBACTERIALS ATRIPLA morphine suppository § PENICILLINS § COX-2 INHIBITORS § CEPHALOSPORINS COMPLERA oxycodone amoxicillin EPZICOM celecoxib oxycodone-acetaminophen cefdinir amoxicillin-clavulanate EVOTAZ cefprozil § GOUT tramadol dicloxacillin PREZCOBIX tramadol ext-rel cefuroxime axetil penicillin VK allopurinol STRIBILD BUTRANS cephalexin colchicine tablet TRIUMEQ FENTORA SUPRAX probenecid TRUVADA

Your specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. For specific information, visit www.caremark.com or contact a CVS Caremark Customer Care representative.

INTEGRASE INHIBITORS § ACE INHIBITOR / PCSK9 INHIBITORS PROSTAGLANDIN venlafaxine ISENTRESS DIURETIC COMBINATIONS REPATHA VASODILATORS venlafaxine ext-rel capsule TIVICAY fosinopril-hydrochlorothiazide ORENITRAM PRISTIQ § BETA-BLOCKERS lisinopril-hydrochlorothiazide § NUCLEOSIDE REVERSE SOLUBLE GUANYLATE § MISCELLANEOUS quinapril-hydrochlorothiazide atenolol AGENTS TRANSCRIPTASE carvedilol CYCLASE STIMULATORS INHIBITORS § ANGIOTENSIN II metoprolol succinate ext-rel ADEMPAS bupropion abacavir RECEPTOR ANTAGONISTS / metoprolol tartrate bupropion ext-rel § MISCELLANEOUS lamivudine DIURETIC COMBINATIONS nadolol mirtazapine candesartan / candesartan- propranolol RANEXA trazodone PROTEASE INHIBITORS hydrochlorothiazide propranolol ext-rel CENTRAL NERVOUS § ANTIPARKINSONIAN NORVIR eprosartan BYSTOLIC AGENTS PREZISTA irbesartan / irbesartan- COREG CR SYSTEM amantadine REYATAZ hydrochlorothiazide § ANTICONVULSANTS losartan / losartan- § CALCIUM CHANNEL carbidopa-levodopa ANTIVIRALS BLOCKERS carbamazepine carbidopa-levodopa ext-rel hydrochlorothiazide carbamazepine ext-rel § CYTOMEGALOVIRUS telmisartan / telmisartan- amlodipine carbidopa-levodopa- 2 diazepam rectal gel entacapone AGENTS hydrochlorothiazide diltiazem ext-rel divalproex sodium valganciclovir valsartan / valsartan- nifedipine ext-rel entacapone divalproex sodium ext-rel pramipexole hydrochlorothiazide verapamil ext-rel § HEPATITIS C AGENTS ethosuximide ropinirole BENICAR / BENICAR HCT gabapentin ribavirin § CALCIUM CHANNEL ropinirole ext-rel lamotrigine EPCLUSA (genotypes 2, 3) § ANGIOTENSIN II BLOCKER / ANTILIPEMIC selegiline lamotrigine ext-rel HARVONI (genotypes 1, 4, 5, 6) RECEPTOR ANTAGONIST / COMBINATIONS AZILECT CALCIUM CHANNEL amlodipine-atorvastatin levetiracetam MIRAPEX ER § HERPES AGENTS BLOCKER COMBINATIONS levetiracetam ext-rel NEUPRO § DIGITALIS GLYCOSIDES oxcarbazepine acyclovir amlodipine-telmisartan phenobarbital ANTIPSYCHOTICS valacyclovir amlodipine-valsartan digoxin phenytoin § ATYPICALS INFLUENZA AGENTS AZOR DIRECT RENIN INHIBITORS / phenytoin sodium extended aripiprazole DIURETIC COMBINATIONS RELENZA § ANGIOTENSIN II primidone clozapine TAMIFLU RECEPTOR ANTAGONIST / TEKTURNA / tiagabine olanzapine

CALCIUM CHANNEL TEKTURNA HCT topiramate quetiapine § MISCELLANEOUS BLOCKER / DIURETIC valproic acid risperidone clindamycin § DIURETICS COMBINATIONS zonisamide ziprasidone ivermectin furosemide amlodipine-valsartan- FYCOMPA ARISTADA metronidazole hydrochlorothiazide hydrochlorothiazide OXTELLAR XR LATUDA nitrofurantoin metolazone TRIBENZOR QUDEXY XR SEROQUEL XR sulfamethoxazole- spironolactone- TROKENDI XR trimethoprim ANTILIPEMICS hydrochlorothiazide VIMPAT § ATTENTION DEFICIT ALBENZA § BILE ACID RESINS torsemide HYPERACTIVITY DISORDER SIVEXTRO triamterene- § ANTIDEMENTIA cholestyramine amphetamine- XIFAXAN 550 MG hydrochlorothiazide donepezil WELCHOL dextroamphetamine galantamine NEPRILYSIN INHIBITOR / mixed salts ANTINEOPLASTIC CHOLESTEROL galantamine ext-rel ANGIOTENSIN II RECEPTOR amphetamine- AGENTS ABSORPTION INHIBITORS memantine ANTAGONIST dextroamphetamine rivastigmine HORMONAL ZETIA COMBINATIONS mixed salts ext-rel rivastigmine transdermal ANTINEOPLASTIC AGENTS guanfacine ext-rel ENTRESTO § FIBRATES NAMENDA XR methylphenidate § ANTIANDROGENS fenofibrate § NITRATES methylphenidate ext-rel bicalutamide ANTIDEPRESSANTS fenofibric acid APTENSIO XR ZYTIGA nitroglycerin lingual spray § SELECTIVE SEROTONIN QUILLIVANT XR § HMG-CoA REDUCTASE NITROLINGUAL REUPTAKE INHIBITORS STRATTERA § KINASE INHIBITORS INHIBITORS / NITROSTAT (SSRIs) VYVANSE imatinib mesylate COMBINATIONS NITRATE / VASODILATOR citalopram BOSULIF FIBROMYALGIA atorvastatin COMBINATIONS escitalopram SPRYCEL fluvastatin fluoxetine LYRICA BIDIL § MISCELLANEOUS lovastatin paroxetine SAVELLA pravastatin PULMONARY ARTERIAL paroxetine ext-rel VISTOGARD § HUNTINGTON'S DISEASE rosuvastatin HYPERTENSION sertraline AGENTS CARDIOVASCULAR simvastatin ENDOTHELIN RECEPTOR FLUOXETINE 60 MG VYTORIN TRINTELLIX tetrabenazine ANTAGONISTS § ACE INHIBITORS VIIBRYD § NIACINS LETAIRIS HYPNOTICS fosinopril TRACLEER § SEROTONIN lisinopril niacin ext-rel § NONBENZODIAZEPINES NOREPINEPHRINE quinapril eszopiclone § OMEGA-3 FATTY ACIDS § PHOSPHODIESTERASE REUPTAKE INHIBITORS ramipril INHIBITORS zolpidem (SNRIs) omega-3 acid ethyl esters zolpidem ext-rel sildenafil VASCEPA duloxetine

TRICYCLICS § BIGUANIDES SUPPLIES estropipate ENDOMETRIN

SILENOR metformin BD ULTRAFINE PREMARIN § SELECTIVE ESTROGEN metformin ext-rel INSULIN SYRINGES MIGRAINE § TRANSDERMAL RECEPTOR MODULATORS AND NEEDLES § SELECTIVE SEROTONIN § BIGUANIDE / DEXCOM CONTINUOUS estradiol raloxifene AGONISTS SULFONYLUREA GLUCOSE DIVIGEL OSPHENA COMBINATIONS EVAMIST naratriptan MONITORING SYSTEM § THYROID SUPPLEMENTS MINIVELLE glipizide-metformin ONETOUCH ULTRA rizatriptan 3 levothyroxine sumatriptan STRIPS AND KITS DIPEPTIDYL PEPTIDASE-4 VAGINAL SYNTHROID zolmitriptan ONETOUCH VERIO (DPP-4) INHIBITORS 3 ESTRACE CREAM RELPAX STRIPS AND KITS GASTROINTESTINAL JANUVIA PREMARIN CREAM ZOMIG NASAL SPRAY TRADJENTA ANTIOBESITY VAGIFEM § ANTIEMETICS SELECTIVE SEROTONIN INJECTABLE ESTROGEN / PROGESTINS dronabinol AGONIST / NONSTEROIDAL DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR / SAXENDA § ORAL granisetron ANTI-INFLAMMATORY meclizine DRUG (NSAID) BIGUANIDE COMBINATIONS ORAL estradiol-norethindrone metoclopramide COMBINATIONS JANUMET PREMPHASE BELVIQ ondansetron JANUMET XR PREMPRO TREXIMET CONTRAVE prochlorperazine JENTADUETO TRANSDERMAL promethazine § MULTIPLE SCLEROSIS JENTADUETO XR CALCIUM REGULATORS trimethobenzamide AGENTS § BISPHOSPHONATES COMBIPATCH INCRETIN MIMETIC AGENTS DICLEGIS glatiramer alendronate ESTROGEN / SELECTIVE SANCUSO TRULICITY AUBAGIO ibandronate ESTROGEN RECEPTOR VARUBI VICTOZA BETASERON risedronate MODULATOR COPAXONE 40 MG INSULINS ATELVIA COMBINATIONS § H2 RECEPTOR

GILENYA † ANTAGONISTS BASAGLAR § CALCITONINS DUAVEE REBIF ranitidine HUMULIN R U-500 TECFIDERA calcitonin-salmon FERTILITY REGULATORS LEVEMIR INFLAMMATORY BOWEL GNRH / LHRH § MUSCULOSKELETAL NOVOLIN 70/30 PARATHYROID HORMONES DISEASE THERAPY AGENTS NOVOLIN N ANTAGONISTS FORTEO § ORAL AGENTS NOVOLIN R cyclobenzaprine CETROTIDE balsalazide NOVOLOG § CARNITINE DEFICIENCY NARCOLEPSY NOVOLOG MIX 70/30 AGENTS § OVULATION STIMULANTS, budesonide capsule GONADOTROPINS sulfasalazine NUVIGIL TRESIBA levocarnitine FOLLISTIM AQ sulfasalazine delayed-rel POSTHERPETIC § INSULIN SENSITIZERS CONTRACEPTIVES OVIDREL APRISO NEURALGIA pioglitazone § MONOPHASIC LIALDA § GLUCOCORTICOIDS PENTASA GRALISE ethinyl estradiol- § INSULIN SENSITIZER / dexamethasone UCERIS drospirenone PSYCHOTHERAPEUTIC - BIGUANIDE COMBINATIONS methylprednisolone ethinyl estradiol- § RECTAL AGENTS MISCELLANEOUS pioglitazone-metformin prednisone norethindrone acetate § OPIOID ANTAGONISTS hydrocortisone enema § INSULIN SENSITIZER / BEYAZ GLUCOSE ELEVATING mesalamine rectal naloxone injection SULFONYLUREA LO LOESTRIN FE AGENTS suspension NARCAN NASAL SPRAY COMBINATIONS MINASTRIN 24 FE GLUCAGEN HYPOKIT CANASA SAFYRAL § PARTIAL OPIOID AGONIST / pioglitazone-glimepiride GLUCAGON CORTIFOAM

OPIOID ANTAGONIST EMERGENCY KIT § MEGLITINIDES § TRIPHASIC § IRRITABLE BOWEL COMBINATIONS nateglinide ethinyl estradiol-norgestimate HUMAN GROWTH SYNDROME buprenorphine-naloxone repaglinide ORTHO TRI-CYCLEN LO HORMONES AMITIZA sublingual tablet HUMATROPE LINZESS SUBOXONE FILM SODIUM-GLUCOSE FOUR PHASE NORDITROPIN LOTRONEX NATAZIA CO-TRANSPORTER 2 VASOMOTOR SYMPTOM VIBERZI (SGLT2) INHIBITORS § PHOSPHATE BINDER AGENTS § EXTENDED CYCLE FARXIGA AGENTS § LAXATIVES BRISDELLE ethinyl estradiol- JARDIANCE calcium acetate lactulose levonorgestrel PHOSLYRA peg 3350-electrolytes ENDOCRINE AND SODIUM-GLUCOSE RENVELA MOVIPREP METABOLIC CO-TRANSPORTER 2 § TRANSDERMAL ethinyl estradiol- VELPHORO SUPREP § ANDROGENS (SGLT2) INHIBITOR / BIGUANIDE COMBINATIONS norelgestromin PROGESTINS OPIOID-INDUCED ANDRODERM CONSTIPATION AXIRON XIGDUO XR VAGINAL § ORAL MOVANTIK NUVARING medroxyprogesterone ANTIDIABETICS § SULFONYLUREAS progesterone, micronized glimepiride PANCREATIC ENZYMES AMYLIN ANALOGS ESTROGENS MEGACE ES glipizide CREON SYMLINPEN § ORAL glipizide ext-rel VAGINAL VIOKACE estradiol CRINONE ZENPEP

§ PROTON PUMP dipyridamole ext-rel-aspirin § CYSTIC FIBROSIS imiquimod sulfacetamide INHIBITORS BRILINTA tobramycin inhalation PICATO tobramycin esomeprazole EFFIENT solution ZYCLARA BESIVANCE lansoprazole BETHKIS MOXEZA IMMUNOLOGIC § ANTIFUNGALS omeprazole VIGAMOX AGENTS § LEUKOTRIENE RECEPTOR ciclopirox pantoprazole ANTAGONISTS clotrimazole § ANTI-INFECTIVE / DEXILANT ALLERGENIC EXTRACTS ANTI-INFLAMMATORY montelukast econazole GRASTEK COMBINATIONS § STEROIDS, RECTAL zafirlukast ketoconazole ORALAIR PROCTOFOAM-HC nystatin neomycin-polymyxin B- RAGWITEK § NASAL ANTIHISTAMINES JUBLIA bacitracin-hydrocortisone § ULCER THERAPY BIOLOGIC DISEASE- azelastine LUZU neomycin-polymyxin B- COMBINATIONS 6 olopatadine NAFTIN dexamethasone MODIFYING AGENTS PYLERA tobramycin-dexamethasone ENBREL § ANTIPSORIATICS § NASAL STEROIDS / TOBRADEX OINTMENT HUMIRA GENITOURINARY COMBINATIONS acitretin TOBRADEX ST flunisolide calcipotriene ZYLET § BENIGN PROSTATIC § DISEASE-MODIFYING fluticasone methoxsalen HYPERPLASIA ANTIRHEUMATIC DRUGS mometasone ANTI-INFLAMMATORIES (DMARDs) CORTICOSTEROIDS alfuzosin ext-rel triamcinolone § Nonsteroidal doxazosin RASUVO § Low Potency DYMISTA bromfenac dutasteride NUTRITIONAL / desonide diclofenac finasteride PHOSPHODIESTERASE-4 SUPPLEMENTS hydrocortisone ketorolac tamsulosin INHIBITORS PROLENSA terazosin § ELECTROLYTES DALIRESP § Medium Potency CARDURA XL hydrocortisone butyrate § Steroidal potassium chloride liquid PULMONARY FIBROSIS RAPAFLO mometasone dexamethasone AGENTS VITAMINS AND MINERALS triamcinolone ERECTILE DYSFUNCTION ALREX § PRENATAL VITAMINS ESBRIET CLODERM DUREZOL ALPROSTADIL AGENTS OFEV LOCOID LOTION LOTEMAX prenatal vitamins MUSE

CITRANATAL STEROID / BETA AGONIST § High Potency BETA-BLOCKERS PHOSPHODIESTERASE COMBINATIONS RESPIRATORY desoximetasone § Nonselective INHIBITORS ADVAIR fluocinonide timolol maleate solution CIALIS ANAPHYLAXIS TREATMENT BREO ELLIPTA

§ Very High Potency BETIMOL AGENTS DULERA § URINARY EPIPEN clobetasol cream, foam, gel, Selective § STEROID INHALANTS ANTISPASMODICS lotion, ointment, shampoo EPIPEN JR BETOPTIC S oxybutynin budesonide inhalation oxybutynin ext-rel § ANTICHOLINERGICS suspension § IMMUNOMODULATORS § CARBONIC ANHYDRASE tolterodine SPIRIVA ASMANEX tacrolimus INHIBITORS FLOVENT DISKUS ELIDEL tolterodine ext-rel dorzolamide trospium ANTICHOLINERGIC / BETA FLOVENT HFA § ROSACEA AZOPT trospium ext-rel AGONIST COMBINATIONS PULMICORT FLEXHALER MYRBETRIQ § SHORT ACTING QVAR metronidazole § CARBONIC ANHYDRASE

TOVIAZ ipratropium-albuterol FINACEA INHIBITOR / BETA- TOPICAL ORACEA VESICARE inhalation solution BLOCKER COMBINATIONS SOOLANTRA dorzolamide-timolol COMBIVENT RESPIMAT DERMATOLOGY HEMATOLOGIC § ACNE MOUTH / THROAT / COSOPT PF LONG ACTING § ANTICOAGULANTS adapalene DENTAL AGENTS ANORO ELLIPTA CARBONIC ANHYDRASE warfarin benzoyl peroxide PROTECTANTS BEVESPI AEROSPHERE INHIBITOR / ELIQUIS clindamycin solution EPISIL SYMPATHOMIMETIC XARELTO BETA AGONISTS, clindamycin-benzoyl MUGARD COMBINATIONS

INHALANTS peroxide HEMATOPOIETIC GROWTH SIMBRINZA erythromycin solution OPHTHALMIC FACTORS § SHORT ACTING erythromycin-benzoyl § ANTIALLERGICS DRY EYE DISEASE albuterol inhalation solution ARANESP peroxide PROAIR HFA azelastine RESTASIS PROCRIT tretinoin PROAIR RESPICLICK cromolyn sodium XIIDRA ZARXIO ACANYA olopatadine § PROSTAGLANDINS HEMOPHILIA AGENTS LONG ACTING ATRALIN PATADAY Hand-held Active Inhalation BENZACLIN PAZEO latanoprost KOGENATE FS DIFFERIN travoprost KOVALTRY ARCAPTA EPIDUO § ANTI-INFECTIVES TRAVATAN Z NOVOEIGHT SEREVENT RETIN-A MICRO ciprofloxacin ZIOPTAN NUWIQ

Nebulized Passive Inhalation TAZORAC erythromycin § SYMPATHOMIMETICS gentamicin § PLATELET AGGREGATION PERFOROMIST § ACTINIC KERATOSIS INHIBITORS levofloxacin brimonidine fluorouracil cream 5% ofloxacin ALPHAGAN P clopidogrel fluorouracil solution

SYMPATHOMIMETIC / BETA- BLOCKER COMBINATIONS COMBIGAN

OTIC § ANTI-INFECTIVE / ANTI-INFLAMMATORY COMBINATIONS CIPRODEX

QUICK REFERENCE DRUG LIST

A B cefuroxime axetil diclofenac sodium- ethinyl estradiol- celecoxib misoprostol levonorgestrel abacavir balsalazide cephalexin dicloxacillin ethinyl estradiol- ACANYA BASAGLAR † CETROTIDE DIFFERIN norelgestromin acitretin BD ULTRAFINE cholestyramine DIFICID ethinyl estradiol- acyclovir INSULIN SYRINGES CIALIS digoxin norethindrone acetate adapalene AND NEEDLES ciclopirox diltiazem ext-rel 2 ethinyl estradiol-norgestimate ADEMPAS BELVIQ CIPRODEX dipyridamole ext-rel-aspirin ethosuximide ADVAIR BENICAR ciprofloxacin divalproex sodium EVAMIST ALBENZA BENICAR HCT ciprofloxacin ext-rel divalproex sodium ext-rel EVOTAZ albuterol inhalation solution BENZACLIN citalopram DIVIGEL alendronate benzoyl peroxide CITRANATAL donepezil F alfuzosin ext-rel BESIVANCE clarithromycin dorzolamide FARXIGA allopurinol BETASERON clarithromycin ext-rel dorzolamide-timolol fenofibrate ALPHAGAN P BETHKIS clindamycin doxazosin fenofibric acid ALREX BETIMOL clindamycin solution doxycycline hyclate fentanyl transdermal amantadine BETOPTIC S clindamycin-benzoyl dronabinol fentanyl transmucosal AMITIZA BEVESPI AEROSPHERE peroxide DUAVEE lozenge amlodipine BEYAZ clobetasol cream, foam, gel, DULERA FENTORA amlodipine-atorvastatin bicalutamide lotion, ointment, shampoo duloxetine FINACEA amlodipine-telmisartan BIDIL CLODERM DUREZOL finasteride amlodipine-valsartan BOSULIF clopidogrel dutasteride FLOVENT DISKUS amlodipine-valsartan- BREO ELLIPTA clotrimazole DYMISTA FLOVENT HFA hydrochlorothiazide BRILINTA clozapine fluconazole amoxicillin brimonidine E codeine-acetaminophen flunisolide amoxicillin-clavulanate BRISDELLE colchicine tablet econazole fluocinonide amphetamine- bromfenac COLCRYS EFFIENT fluorouracil cream 5% dextroamphetamine budesonide capsule COMBIGAN ELIDEL fluorouracil solution mixed salts budesonide inhalation COMBIPATCH ELIQUIS fluoxetine amphetamine- suspension dextroamphetamine buprenorphine-naloxone COMBIVENT RESPIMAT ENBREL FLUOXETINE 60 MG COMPLERA ENDOMETRIN fluticasone mixed salts ext-rel sublingual tablet CONTRAVE entacapone fluvastatin ANDRODERM bupropion COPAXONE 40 MG ENTRESTO FOLLISTIM AQ ANORO ELLIPTA bupropion ext-rel COREG CR EPCLUSA FORTEO APRISO BUTRANS CORTIFOAM EPIDUO fosinopril APTENSIO XR BYSTOLIC COSOPT PF EPIPEN fosinopril-hydrochlorothiazide ARANESP CREON EPIPEN JR furosemide ARCAPTA C CRINONE EPISIL FYCOMPA aripiprazole calcipotriene cromolyn sodium eprosartan ARISTADA calcitonin-salmon cyclobenzaprine EPZICOM G ASMANEX calcium acetate erythromycin gabapentin ATELVIA CANASA D erythromycin solution galantamine atenolol candesartan DALIRESP erythromycin-benzoyl atorvastatin candesartan- galantamine ext-rel desonide peroxide GEL-ONE ATRALIN hydrochlorothiazide desoximetasone erythromycins gentamicin ATRIPLA carbamazepine dexamethasone ESBRIET GILENYA AUBAGIO carbamazepine ext-rel DEXCOM CONTINUOUS escitalopram glatiramer AXIRON carbidopa-levodopa GLUCOSE esomeprazole glimepiride azelastine carbidopa-levodopa ext-rel MONITORING SYSTEM ESTRACE CREAM AZILECT carbidopa-levodopa- glipizide DEXILANT estradiol glipizide ext-rel azithromycin entacapone diazepam rectal gel estradiol-norethindrone glipizide-metformin AZOPT CARDURA XL DICLEGIS estropipate GLUCAGEN HYPOKIT AZOR carvedilol diclofenac eszopiclone GLUCAGON cefdinir diclofenac sodium ethinyl estradiol- EMERGENCY KIT cefprozil diclofenac sodium solution drospirenone GRALISE

granisetron losartan NORVIR PREZCOBIX SPIRIVA GRASTEK losartan-hydrochlorothiazide NOVOEIGHT PREZISTA spironolactone- guanfacine ext-rel LOTEMAX NOVOLIN 70/30 primidone hydrochlorothiazide LOTRONEX NOVOLIN N PRISTIQ SPRYCEL H lovastatin NOVOLIN R PROAIR HFA STRATTERA HARVONI LUZU NOVOLOG PROAIR RESPICLICK STRIBILD HUMATROPE LYRICA NOVOLOG MIX 70/30 probenecid SUBOXONE FILM

HUMIRA NUCYNTA prochlorperazine SUBSYS M HUMULIN R U-500 NUCYNTA ER PROCRIT sulfacetamide HYALGAN meclizine NUVARING PROCTOFOAM-HC sulfamethoxazole- hydrochlorothiazide medroxyprogesterone NUVIGIL progesterone, micronized trimethoprim hydrocodone-acetaminophen MEGACE ES NUWIQ PROLENSA sulfasalazine hydrocortisone meloxicam nystatin promethazine sulfasalazine delayed-rel hydrocortisone butyrate memantine propranolol sumatriptan O hydrocortisone enema mesalamine rectal propranolol ext-rel SUPARTZ FX hydromorphone suspension OFEV PULMICORT FLEXHALER SUPRAX hydromorphone ext-rel metformin ofloxacin PYLERA SUPREP

HYSINGLA ER metformin ext-rel olanzapine SYMLINPEN methadone olopatadine Q SYNTHROID

I methoxsalen omega-3 acid ethyl esters QUDEXY XR T ibandronate methylphenidate omeprazole quetiapine imatinib mesylate methylphenidate ext-rel ondansetron QUILLIVANT XR tacrolimus imiquimod methylprednisolone ONETOUCH ULTRA quinapril TAMIFLU ipratropium-albuterol metoclopramide STRIPS AND KITS 3 quinapril-hydrochlorothiazide tamsulosin inhalation solution metolazone ONETOUCH VERIO QVAR TAZORAC 3 irbesartan metoprolol succinate ext-rel STRIPS AND KITS TECFIDERA irbesartan- metoprolol tartrate OPANA ER R TEKTURNA hydrochlorothiazide metronidazole ORACEA RAGWITEK TEKTURNA HCT ISENTRESS MINASTRIN 24 FE ORALAIR raloxifene telmisartan itraconazole MINIVELLE ORENITRAM ramipril telmisartan- ivermectin minocycline ORTHO TRI-CYCLEN LO RANEXA hydrochlorothiazide MIRAPEX ER OSPHENA ranitidine terazosin J mirtazapine OVIDREL RAPAFLO terbinafine tablet JANUMET mometasone oxcarbazepine RASUVO tetrabenazine JANUMET XR montelukast OXTELLAR XR REBIF tetracycline JANUVIA morphine oxybutynin RELENZA tiagabine JARDIANCE morphine ext-rel oxybutynin ext-rel RELPAX timolol maleate solution JENTADUETO morphine suppository oxycodone RENVELA TIVICAY JENTADUETO XR MOVANTIK oxycodone-acetaminophen repaglinide TOBRADEX OINTMENT JUBLIA MOVIPREP OXYCONTIN REPATHA TOBRADEX ST

MOXEZA RESTASIS tobramycin P K moxifloxacin RETIN-A MICRO tobramycin inhalation ketoconazole MUGARD pantoprazole REYATAZ solution ketorolac MUSE paroxetine ribavirin tobramycin-dexamethasone

KOGENATE FS MYRBETRIQ paroxetine ext-rel risedronate tolterodine

KOVALTRY PATADAY risperidone tolterodine ext-rel N PAZEO rivastigmine topiramate L nadolol peg 3350-electrolytes rivastigmine transdermal torsemide TOVIAZ lactulose NAFTIN penicillin VK rizatriptan naloxone injection PENTASA ropinirole TRACLEER lamivudine NAMENDA XR PERFOROMIST ropinirole ext-rel TRADJENTA lamotrigine naproxen phenobarbital rosuvastatin tramadol lamotrigine ext-rel naratriptan phenytoin tramadol ext-rel lansoprazole NARCAN NASAL SPRAY phenytoin sodium extended S TRAVATAN Z latanoprost NATAZIA PHOSLYRA travoprost LATUDA SAFYRAL trazodone LETAIRIS nateglinide PICATO SANCUSO TRESIBA LEVEMIR neomycin-polymyxin B- pioglitazone SAVELLA tretinoin levetiracetam bacitracin-hydrocortisone pioglitazone-glimepiride SAXENDA TREXIMET levetiracetam ext-rel neomycin-polymyxin B- pioglitazone-metformin selegiline triamcinolone levocarnitine dexamethasone potassium chloride liquid SEREVENT triamterene- levofloxacin NEUPRO pramipexole SEROQUEL XR hydrochlorothiazide levothyroxine niacin ext-rel pravastatin sertraline TRIBENZOR LIALDA nifedipine ext-rel prednisone sildenafil trimethobenzamide LINZESS nitrofurantoin PREMARIN SILENOR TRINTELLIX lisinopril nitroglycerin lingual spray PREMARIN CREAM SIMBRINZA TRIUMEQ lisinopril-hydrochlorothiazide NITROLINGUAL PREMPHASE simvastatin NITROSTAT PREMPRO TROKENDI XR LO LOESTRIN FE SIVEXTRO NORDITROPIN prenatal vitamins trospium LOCOID LOTION SOOLANTRA

trospium ext-rel valproic acid VIGAMOX X ziprasidone TRULICITY valsartan VIIBRYD zolmitriptan XARELTO TRUVADA valsartan-hydrochlorothiazide VIMPAT zolpidem XIFAXAN 550 MG VARUBI VIOKACE zolpidem ext-rel XIGDUO XR U VASCEPA VISTOGARD ZOMIG NASAL SPRAY XIIDRA UCERIS VELPHORO VOLTAREN GEL zonisamide ULORIC venlafaxine VYTORIN Z ZYCLARA venlafaxine ext-rel capsule VYVANSE ZYLET zafirlukast V verapamil ext-rel ZYTIGA W ZARXIO VAGIFEM VESICARE ZENPEP valacyclovir VIBERZI warfarin ZETIA valganciclovir VICTOZA WELCHOL ZIOPTAN PREFERRED OPTIONS LIST DRUG NAME(S) PREFERRED OPTION(S)* DRUG NAME(S) PREFERRED OPTION(S)* ABILIFY aripiprazole, clozapine, olanzapine, quetiapine, ASCENSIA STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 3, risperidone, ziprasidone, LATUDA, ONETOUCH VERIO STRIPS AND KITS 3 SEROQUEL XR ATACAND, ATACAND HCT candesartan, candesartan-hydrochlorothiazide, ABSTRAL fentanyl transmucosal lozenge, FENTORA, eprosartan, irbesartan, irbesartan- SUBSYS hydrochlorothiazide, losartan, losartan- hydrochlorothiazide, telmisartan, telmisartan- 4 3 ACCU-CHEK STRIPS AND KITS ONETOUCH ULTRA STRIPS AND KITS , hydrochlorothiazide, valsartan, valsartan- 3 ONETOUCH VERIO STRIPS AND KITS hydrochlorothiazide, BENICAR, BENICAR HCT ACTOS pioglitazone ATROVENT HFA SPIRIVA ADDERALL XR amphetamine-dextroamphetamine mixed salts, AVONEX glatiramer, AUBAGIO, BETASERON, amphetamine-dextroamphetamine mixed salts COPAXONE 40 MG, GILENYA, REBIF, ext-rel, guanfacine ext-rel, methylphenidate, TECFIDERA methylphenidate ext-rel, APTENSIO XR, QUILLIVANT XR, STRATTERA, VYVANSE AXERT naratriptan, rizatriptan, sumatriptan nasal spray, ADRENACLICK EPIPEN, EPIPEN JR sumatriptan tablet, zolmitriptan, RELPAX, ADVICOR atorvastatin, fluvastatin, lovastatin, pravastatin, ZOMIG NASAL SPRAY rosuvastatin, simvastatin, VYTORIN AZELEX adapalene, benzoyl peroxide, AEROSPAN ASMANEX, FLOVENT DISKUS, clindamycin solution, clindamycin- FLOVENT HFA, PULMICORT FLEXHALER, benzoyl peroxide, erythromycin solution, QVAR erythromycin-benzoyl peroxide, tretinoin, ACANYA, ATRALIN, BENZACLIN, DIFFERIN, ALCORTIN A hydrocortisone EPIDUO, RETIN-A MICRO, TAZORAC ALLISON MEDICAL INSULIN SYRINGES 5 BD ULTRAFINE INSULIN SYRINGES BECONASE AQ flunisolide, fluticasone, mometasone, triamcinolone, DYMISTA ALOQUIN hydrocortisone BENZAC AC, BENZAC W adapalene, benzoyl peroxide, ALORA estradiol, DIVIGEL, EVAMIST, MINIVELLE clindamycin solution, clindamycin- ALTOPREV atorvastatin, fluvastatin, lovastatin, pravastatin, benzoyl peroxide, erythromycin solution, rosuvastatin, simvastatin, VYTORIN erythromycin-benzoyl peroxide, tretinoin, ACANYA, ATRALIN, BENZACLIN, DIFFERIN, ALVESCO ASMANEX, FLOVENT DISKUS, EPIDUO, RETIN-A MICRO, TAZORAC FLOVENT HFA, PULMICORT FLEXHALER, QVAR BENZIQ adapalene, benzoyl peroxide, clindamycin solution, clindamycin- AMRIX cyclobenzaprine benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, ANDROGEL ANDRODERM, AXIRON ACANYA, ATRALIN, BENZACLIN, DIFFERIN, ANGELIQ estradiol-norethindrone, PREMPHASE, EPIDUO, RETIN-A MICRO, TAZORAC PREMPRO BREEZE 2 STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 3, ANTARA fenofibrate, fenofibric acid ONETOUCH VERIO STRIPS AND KITS 3 APEXICON E desoximetasone, fluocinonide butalbital-acetaminophen-caffeine capsule naratriptan, rizatriptan, sumatriptan, zolmitriptan, RELPAX, ZOMIG NASAL SPRAY APIDRA NOVOLOG BYDUREON TRULICITY, VICTOZA ARMOUR THYROID levothyroxine, SYNTHROID BYETTA TRULICITY, VICTOZA ARTHROTEC celecoxib; diclofenac sodium, meloxicam or naproxen WITH esomeprazole, lansoprazole, CARAC fluorouracil cream 5%, fluorouracil solution, omeprazole, pantoprazole or DEXILANT imiquimod, PICATO, ZYCLARA ASACOL HD balsalazide, sulfasalazine, CARDIZEM diltiazem ext-rel sulfasalazine delayed-rel, APRISO, LIALDA, (except generic CARDIZEM LA) PENTASA, UCERIS CARDIZEM CD diltiazem ext-rel (except generic CARDIZEM LA)

DRUG NAME(S) PREFERRED OPTION(S)* DRUG NAME(S) PREFERRED OPTION(S)* CARDIZEM LA (and its generics) diltiazem ext-rel EXTAVIA glatiramer, AUBAGIO, BETASERON, (except generic CARDIZEM LA) COPAXONE 40 MG, GILENYA, REBIF, TECFIDERA CARNITOR levocarnitine FEMRING ESTRACE CREAM, PREMARIN CREAM, CARNITOR SF levocarnitine VAGIFEM CLIMARA PRO COMBIPATCH FETZIMA duloxetine, venlafaxine, CLINDAGEL erythromycin solution venlafaxine ext-rel capsule, PRISTIQ clobetasol spray clobetasol foam FIORICET CAPSULE naratriptan, rizatriptan, sumatriptan, zolmitriptan, RELPAX, ZOMIG NASAL SPRAY CLOBEX SPRAY clobetasol foam FIRST TESTOSTERONE ANDRODERM, AXIRON CONTOUR NEXT STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 3, ONETOUCH VERIO STRIPS AND KITS 3 fluorouracil cream 0.5% fluorouracil cream 5%, fluorouracil solution, imiquimod, PICATO, ZYCLARA CONTOUR STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 3, ONETOUCH VERIO STRIPS AND KITS 3 FORTAMET metformin, metformin ext-rel CRESTOR atorvastatin, fluvastatin, lovastatin, pravastatin, FORTESTA ANDRODERM, AXIRON rosuvastatin, simvastatin, VYTORIN FOSAMAX PLUS D alendronate, ibandronate, risedronate, CYMBALTA duloxetine, venlafaxine, ATELVIA venlafaxine ext-rel capsule, PRISTIQ FOSRENOL calcium acetate, PHOSLYRA, RENVELA, DAKLINZA EPCLUSA (genotypes 2, 3), VELPHORO HARVONI (genotypes 1, 4, 5, 6) FREESTYLE STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 3, DELZICOL balsalazide, sulfasalazine, ONETOUCH VERIO STRIPS AND KITS 3 sulfasalazine delayed-rel, APRISO, LIALDA, FROVA naratriptan, rizatriptan, sumatriptan nasal spray, PENTASA, UCERIS sumatriptan tablet, zolmitriptan, RELPAX, DETROL LA oxybutynin ext-rel, tolterodine, ZOMIG NASAL SPRAY tolterodine ext-rel, trospium, trospium ext-rel, GELNIQUE oxybutynin ext-rel, tolterodine, MYRBETRIQ, TOVIAZ, VESICARE tolterodine ext-rel, trospium, trospium ext-rel, DEXPAK dexamethasone, methylprednisolone, MYRBETRIQ, TOVIAZ, VESICARE prednisone GENOTROPIN HUMATROPE, NORDITROPIN DIOVAN, DIOVAN HCT candesartan, candesartan-hydrochlorothiazide, GLEEVEC imatinib mesylate, BOSULIF, SPRYCEL eprosartan, irbesartan, irbesartan- hydrochlorothiazide, losartan, losartan- GLUMETZA metformin, metformin ext-rel hydrochlorothiazide, telmisartan, telmisartan- hydrochlorothiazide, valsartan, valsartan- HELIXATE FS KOGENATE FS, KOVALTRY, NOVOEIGHT, hydrochlorothiazide, BENICAR, BENICAR HCT NUWIQ DORAL eszopiclone, zolpidem, zolpidem ext-rel, HUMALOG NOVOLOG SILENOR HUMALOG MIX 50/50 NOVOLOG MIX 70/30 DUTOPROL metoprolol succinate ext-rel WITH HUMALOG MIX 75/25 NOVOLOG MIX 70/30 hydrochlorothiazide HUMULIN NOVOLIN EDARBI, EDARBYCLOR candesartan, candesartan-hydrochlorothiazide, eprosartan, irbesartan, irbesartan- INCRUSE ELLIPTA SPIRIVA hydrochlorothiazide, losartan, losartan- hydrochlorothiazide, telmisartan, telmisartan- INNOPRAN XL atenolol, carvedilol, metoprolol succinate ext- hydrochlorothiazide, valsartan, valsartan- rel, metoprolol tartrate, nadolol, propranolol, hydrochlorothiazide, BENICAR, BENICAR HCT propranolol ext-rel, BYSTOLIC, COREG CR EDLUAR eszopiclone, zolpidem, zolpidem ext-rel, INTERMEZZO eszopiclone, zolpidem, zolpidem ext-rel, SILENOR SILENOR ENABLEX oxybutynin ext-rel, tolterodine, INTUNIV amphetamine-dextroamphetamine mixed salts, tolterodine ext-rel, trospium, trospium ext-rel, amphetamine-dextroamphetamine mixed salts MYRBETRIQ, TOVIAZ, VESICARE ext-rel, guanfacine ext-rel, methylphenidate, methylphenidate ext-rel, APTENSIO XR, ENJUVIA estradiol, estropipate, PREMARIN QUILLIVANT XR, STRATTERA, VYVANSE ESTRING ESTRACE CREAM, PREMARIN CREAM, INVOKAMET XIGDUO XR VAGIFEM INVOKANA FARXIGA, JARDIANCE EUFLEXXA GEL-ONE, HYALGAN, SUPARTZ FX ISTALOL timolol maleate solution, BETIMOL EVZIO naloxone injection, NARCAN NASAL SPRAY JALYN dutasteride or finasteride WITH EXFORGE amlodipine-telmisartan, amlodipine-valsartan, alfuzosin ext-rel, doxazosin, tamsulosin, AZOR terazosin or RAPAFLO EXFORGE HCT amlodipine-valsartan-hydrochlorothiazide, KAZANO JANUMET, JANUMET XR, JENTADUETO, TRIBENZOR JENTADUETO XR KLOR-CON/25 potassium chloride liquid

DRUG NAME(S) PREFERRED OPTION(S)* DRUG NAME(S) PREFERRED OPTION(S)* KOMBIGLYZE XR JANUMET, JANUMET XR, JENTADUETO, ONGLYZA JANUVIA, TRADJENTA JENTADUETO XR OPSUMIT LETAIRIS, TRACLEER LANTUS BASAGLAR †, LEVEMIR, TRESIBA ORTHOVISC GEL-ONE, HYALGAN, SUPARTZ FX LASTACAFT azelastine, cromolyn sodium, olopatadine, PATADAY, PAZEO OSENI JANUMET, JANUMET XR, JENTADUETO, JENTADUETO XR LESCOL XL atorvastatin, fluvastatin, lovastatin, pravastatin, 5 rosuvastatin, simvastatin, VYTORIN OWEN MUMFORD NEEDLES BD ULTRAFINE NEEDLES LEVITRA CIALIS OXYTROL oxybutynin ext-rel, tolterodine, tolterodine ext-rel, trospium, trospium ext-rel, LIPITOR atorvastatin, fluvastatin, lovastatin, pravastatin, MYRBETRIQ, TOVIAZ, VESICARE rosuvastatin, simvastatin, VYTORIN PANCREAZE CREON, VIOKACE, ZENPEP LIPTRUZET atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, VYTORIN PENNSAID diclofenac sodium, diclofenac sodium solution, meloxicam, naproxen, VOLTAREN GEL LIVALO atorvastatin, fluvastatin, lovastatin, pravastatin, 5 rosuvastatin, simvastatin, VYTORIN PERRIGO NEEDLES BD ULTRAFINE NEEDLES LUMIGAN latanoprost, travoprost, TRAVATAN Z, PERTZYE CREON, VIOKACE, ZENPEP ZIOPTAN PEXEVA citalopram, escitalopram, fluoxetine, paroxetine, LUNESTA eszopiclone, zolpidem, zolpidem ext-rel, paroxetine ext-rel, sertraline, SILENOR FLUOXETINE 60 MG, TRINTELLIX, VIIBRYD Matzim LA diltiazem ext-rel PLAVIX clopidogrel, BRILINTA, EFFIENT (except generic CARDIZEM LA) PLEGRIDY glatiramer, AUBAGIO, BETASERON, MENEST estradiol, estropipate, PREMARIN COPAXONE 40 MG, GILENYA, REBIF, TECFIDERA MENOSTAR estradiol PRADAXA warfarin, ELIQUIS, XARELTO MICARDIS, MICARDIS HCT candesartan, candesartan-hydrochlorothiazide, eprosartan, irbesartan, irbesartan- PRALUENT REPATHA hydrochlorothiazide, losartan, losartan- PRECISION XTRA STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 3, hydrochlorothiazide, telmisartan, telmisartan- ONETOUCH VERIO STRIPS AND KITS 3 hydrochlorothiazide, valsartan, valsartan- hydrochlorothiazide, BENICAR, BENICAR HCT PRED MILD dexamethasone, DUREZOL, LOTEMAX MILLIPRED dexamethasone, methylprednisolone, PREFERAOB generic prenatal vitamins, CITRANATAL prednisone PREFEST estradiol-norethindrone, PREMPHASE, MONOVISC GEL-ONE, HYALGAN, SUPARTZ FX PREMPRO NAPRELAN celecoxib, diclofenac sodium, meloxicam, PRENATAL PLUS generic prenatal vitamins, CITRANATAL naproxen PREVACID esomeprazole, lansoprazole, omeprazole, NATESTO ANDRODERM, AXIRON pantoprazole, DEXILANT NESINA JANUVIA, TRADJENTA PROTONIX esomeprazole, lansoprazole, omeprazole, pantoprazole, DEXILANT NEUPOGEN ZARXIO PROTOPIC tacrolimus, ELIDEL NEXIUM esomeprazole, lansoprazole, omeprazole, pantoprazole, DEXILANT PROVENTIL HFA PROAIR HFA, PROAIR RESPICLICK NILANDRON bicalutamide, ZYTIGA QNASL flunisolide, fluticasone, mometasone, triamcinolone, DYMISTA NITROMIST nitroglycerin lingual spray, NITROLINGUAL, NITROSTAT QSYMIA BELVIQ, CONTRAVE, SAXENDA NORITATE metronidazole, FINACEA, SOOLANTRA RAYOS dexamethasone, methylprednisolone, prednisone NORVASC amlodipine RELION INSULIN NOVOLIN INSULIN NOVACORT hydrocortisone RELISTOR MOVANTIK NOVO NORDISK NEEDLES 5 BD ULTRAFINE NEEDLES RHINOCORT AQUA flunisolide, fluticasone, mometasone, NUTROPIN AQ HUMATROPE, NORDITROPIN triamcinolone, DYMISTA OLEPTRO trazodone RIOMET metformin, metformin ext-rel OLUX-E clobetasol foam ROZEREM eszopiclone, zolpidem, zolpidem ext-rel, OLYSIO EPCLUSA (genotypes 2, 3), SILENOR HARVONI (genotypes 1, 4, 5, 6) SAIZEN HUMATROPE, NORDITROPIN OMNARIS flunisolide, fluticasone, mometasone, STRIANT ANDRODERM, AXIRON triamcinolone, DYMISTA SURE-TEST STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 3, OMNITROPE HUMATROPE, NORDITROPIN ONETOUCH VERIO STRIPS AND KITS 3

DRUG NAME(S) PREFERRED OPTION(S)* DRUG NAME(S) PREFERRED OPTION(S)* SYMBICORT ADVAIR, BREO ELLIPTA, DULERA VALCYTE valganciclovir SYNVISC, SYNVISC-ONE GEL-ONE, HYALGAN, SUPARTZ FX VALTREX acyclovir, valacyclovir TANZEUM TRULICITY, VICTOZA venlafaxine ext-rel tablet (except 225 mg) duloxetine, venlafaxine, venlafaxine ext-rel capsule, PRISTIQ TASIGNA imatinib mesylate, BOSULIF, SPRYCEL VENLAFAXINE EXT-REL TABLET duloxetine, venlafaxine, TECHNIVIE EPCLUSA (genotypes 2, 3), (except 225 mg) venlafaxine ext-rel capsule, PRISTIQ HARVONI (genotypes 1, 4, 5, 6) VENTOLIN HFA PROAIR HFA, PROAIR RESPICLICK TESTIM ANDRODERM, AXIRON VERAMYST flunisolide, fluticasone, mometasone, 7 testosterone gel 1% ANDRODERM, AXIRON triamcinolone, DYMISTA TEVETEN, TEVETEN HCT candesartan, candesartan-hydrochlorothiazide, VIAGRA CIALIS eprosartan, irbesartan, irbesartan- hydrochlorothiazide, losartan, losartan- VIEKIRA PAK EPCLUSA (genotypes 2, 3), hydrochlorothiazide, telmisartan, telmisartan- HARVONI (genotypes 1, 4, 5, 6) hydrochlorothiazide, valsartan, valsartan- hydrochlorothiazide, BENICAR, BENICAR HCT VITAFOL-ONE generic prenatal vitamins, CITRANATAL TOBI tobramycin inhalation solution, BETHKIS VOGELXO ANDRODERM, AXIRON TOBI PODHALER tobramycin inhalation solution, BETHKIS XENAZINE tetrabenazine TOUJEO BASAGLAR †, LEVEMIR, TRESIBA XOPENEX HFA PROAIR HFA, PROAIR RESPICLICK TRICOR fenofibrate, fenofibric acid XTANDI bicalutamide, ZYTIGA TRIGLIDE fenofibrate, fenofibric acid ZEGERID esomeprazole, lansoprazole, omeprazole, pantoprazole, DEXILANT TRILIPIX fenofibrate, fenofibric acid ZEPATIER EPCLUSA (genotypes 2, 3), TRIVIDIA INSULIN SYRINGES 5 BD ULTRAFINE INSULIN SYRINGES HARVONI (genotypes 1, 4, 5, 6) TRUETEST STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 3, ZETONNA flunisolide, fluticasone, mometasone, ONETOUCH VERIO STRIPS AND KITS 3 triamcinolone, DYMISTA TRUETRACK STRIPS AND KITS 4 ONETOUCH ULTRA STRIPS AND KITS 3, ZUBSOLV buprenorphine-naloxone sublingual tablet, ONETOUCH VERIO STRIPS AND KITS 3 SUBOXONE FILM TUDORZA SPIRIVA ZYFLO, ZYFLO CR montelukast, zafirlukast ULTIMED INSULIN SYRINGES 5 BD ULTRAFINE INSULIN SYRINGES ULTIMED NEEDLES 5 BD ULTRAFINE NEEDLES

You may be responsible for the full cost of certain non-formulary products that are removed from coverage. Please check with your plan sponsor for more information.

FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This drug list represents a summary of prescription coverage. It is not all-inclusive and does not guarantee coverage. New-to-market products and new variations of products already in the marketplace will not be added to the formulary until the product has been evaluated, determined to be clinically appropriate and cost-effective, and approved by the CVS Caremark Pharmacy and Therapeutics Committee (or other appropriate reviewing body). In most instances, a brand- name drug for which a generic product becomes available will be designated as a non-preferred option upon release of the generic product to the market. Specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. The member's prescription benefit plan may have a different copay 1 for specific products on the list. Unless specifically indicated, drug list products will include all dosage forms. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. Generics listed in therapeutic categories are for representational purposes only. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use where listed. Log in to www.caremark.com to check coverage and copay 1 information for a specific medicine.

An exception process may exist for specific clinical or regulatory circumstances that may require coverage of an excluded medication.

* The preferred options in this list are a broad representation within therapeutic categories of available treatment options and do not necessarily represent clinical equivalency. § Generics are available in this class and should be considered the first line of prescribing. † Expected Availability 12/15/16 1 Copayment, copay or coinsurance means the amount a member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. 2 Listing does not include generic CARDIZEM LA. 3 A ONETOUCH blood glucose meter may be provided at no charge by the manufacturer to those individuals currently using a meter other than ONETOUCH. For more information on how to obtain a blood glucose meter, call: 1-800-588-4456. 4 ONETOUCH brand test strips are the only preferred options. 5 BD ULTRAFINE syringes and needles are the only preferred options. 6 Coverage may be altered or copay 1 amounts may vary based on the condition being treated (e.g. psoriasis). 7 Listing reflects the authorized generics for TESTIM and VOGELXO.

Plan member privacy is important to us. Our employees are trained regarding the appropriate way to handle members' private health information. CVS Caremark may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable.

The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission.

Sample Member Formulary Letter

Avoid paying full price for the medicine listed below. Act by [DATE] before your current one is no longer on the drug list. City, State Zip>

Dear :

The CVS/caremark pharmacy staff continually reviews drugs, products and prices for your plan sponsor. This allows your plan sponsor to make sure cost-effective medicines that work well become part of your plan’s drug list.

As of [DATE], your medicine listed below will not be covered on your plan’s drug list. This means you will pay the full price if you continue to use this medicine.

Be sure to choose a new covered medicine:

Your current non-covered drug: Your new covered options:

To learn more about these drug options and costs, visit www.caremark.com/druglist. Remember: in general, generic medicines usually have the lowest copay* on your benefit plan.

Your next steps: • Talk to your doctor directly about choosing a less costly medicine, as listed above. • If you are using a retail pharmacy: have your doctor call in the prescription to your local pharmacy. • If you are using mail service: your doctor can call in the new prescription toll-free to [xxx-xxx-xxxx]. Or you can call us toll-free at [1-xxx-xxx-xxxx] and we will contact your doctor for you. • Your doctor may consult www.druglist.com for more options. However, if your doctor chooses a non-covered drug, your plan may require you to pay the full cost. • You can check for the latest updates on drug prices throughout the year by visiting www.caremark.com.

Sincerely,

Your Pharmacy Team

*Copayment, copay or coinsurance means the amount a plan member is required to pay for a prescription in accordance with a plan. This may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, to be paid by the plan sponsor. This document contains references to brand name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS/caremark.

CVS/caremark does not operate www.druglist.com, nor is it responsible for the availability or reliability of its content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS/caremark. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

106-24033b 100511 TDD: 1-800-863-5488 Prior Authorization What Is Prior Authorization?

A Prior Authorization (PA) is a safety and cost-saving feature of your prescription benefit plan designed to prevent improper prescribing or use of certain drugs that may not be the best choice for a health condition. PAs may be provided in conjunction with quantity limits or step therapy protocols, all of which are designed for the health and safety of members and the good of the plan.

How it works

The pharmacist enters the prescription information into the Caremark system at the point of sale. If the client- approved plan design requires a PA for the drug, the pharmacist will receive an alert and may ask the member to contact the prescriber or may have the prescriber contact the CVS/caremark Prior Authorization Department for a consultation. Once the incoming information has been assessed, a decision is made. The decision can be an approval, a denial or may be auto-closed due to lack of information. If authorization is granted, the prescription will be filled. If authorization is not granted at the retail pharmacy, there are two choices: 1. The member may still have the prescription filled by paying the entire retail cost of the drug. 2. The member may ask the prescriber for an alternate drug covered by your benefit, if available. Please remember to allow more time for the PA process: in most circumstances, approximately two business days for standard prior authorization and approximately one business day for an urgent prior authorization request.

PAs for Medical Necessity

The P&T Committee has approved exception criteria that allow the member to make a request for access to a non- formulary drug when it is determined to be the only safe and effective treatment. The member must submit the following supporting documentation for consideration:

 A physician statement with the name and strength of the alternatives tried or considered

 Evidence the formulary alternatives were unsafe and ineffective, or have known interactions with other drugs the member is taking Once the information is reviewed, a decision is made to approve for a period of one year, or to deny. This type of request may incur an additional charge per request. For specific drug coverage information, visit www.caremark.com or contact a CVS/caremark Customer Care representative at 1.866.475.7589.

90-day grace period for exclusions

New client groups with members currently taking excluded medications are given a 90-day period to transition to a formulary product, during which they can continue to obtain the excluded medication. Members will receive a formulary mailing informing them of the new process.

CLINICAL PRIOR AUTHORIZATION CRITERIA REQUEST FORM

Please complete this form and fax it to CVS Caremark at 1-888-836-0730 to receive a DRUG SPECIFIC CRITERIA FORM for prior authorization. Once received, a DRUG SPECIFIC CRITERIA FORM will be faxed to the specific physician along with patient specific information, appropriate criteria for the request and questions that must be answered. Once received, reviewed and approved an override will be processed and the pharmacist can resubmit the claim for payment. If the request is denied, the physician and patient will be sent a notification and reason for the denial.

ALL fields must be completed before faxing. Please fax the completed form to CVS Caremark at 1-888-836-0730.

SECTION I: PATIENT INFORMATION LAST NAME, FIRST NAME (PLEASE PRINT) DOB (MM/DD/YYYY)

STREET ADDRESS PHONE NUMBER

CITY STATE

CARDHOLDER ID # ZIP CODE

SECTION II: DRUG INFORMATION DRUG NAME (PLEASE PRINT) DRUG STRENGTH

SECTION III: PHYSICIAN INFORMATION PHYSICIAN NAME (PLEASE PRINT)

PHYSICIAN ADDRESS (STREET, CITY, STATE, ZIP CODE)

PHYSICIAN PHONE NUMBER PHYSICIAN FAX NUMBER

SIGNATURE DATE

DISCLAIMER: Incomplete or illegible forms and missing fields may delay the processing of your request. Please complete all fields to ensure appropriate processing.

CONFIDENTIALITY NOTICE: This communication and any attachments may contain confidential and/or privileged information for the use of the designated recipients named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution, or copying of it or its contents is prohibited. If you have received this communication in error, please notify the sender immediately by telephone and destroy all copies of this communication and any attachments.

PRIVACY DISCLAIMER: Plan participant privacy is important to us. Our employees are trained regarding the appropriate way to handle plan participants’ private health information.

5274-13630A Mail Order Prescriptions Mail Service—Prescriptions Made Easy

Your prescription plan allows members to fill prescriptions through CVS/caremark’s Mail Service Pharmacy. With CVS/caremark, members can set up and manage new prescriptions at home so they don’t have to waste time with trips to the pharmacy. Members should use mail service for 90-day prescriptions to treat a chronic condition that requires long-term drug therapy. Helpful tip: when members are ordering through mail service for the first time, they should make sure they have a 30-day supply of a medication on hand to meet their needs until the mail service prescriptions can be delivered.

It’s easy with FastStart®!

Members can sign up for mail service with FastStart®. They have several options to get started:

By Internet 1. Members should log in to www.caremark.com or register, if necessary. 2. Then, they should click on Start a New Prescription, and then click FastStart®. 3. They’ll need to fill in the member information.

By Phone 1. Members can call FastStart® toll free at 1.800.875.8067, Monday through Friday, 7 a.m. to 7 p.m. (CST). 2. This lets the representative know the member wishes to fill prescriptions through mail service. 3. The member will need to provide the information on their ID Card, the names of long-term medicines, the prescriber’s name and phone number, the member’s payment information and the mailing address.

ReadyFill Program

The ReadyFill Program adds ease and convenience for members by automatically refilling select prescriptions so it’s easier to stay healthy. Once members enroll, ReadyFill can help them to:

 Save time—there’s no need to call in or drop off refills requests.

 Reduce effort—CVS/caremark will call a member when refills are ready and contact his or her prescriber when the prescription runs out.

 Stay on track—ReadyFill helps ensure members don’t run out of medication so they can keep taking it as prescribed. When ready for ReadyFill, members should register an account at www.caremark.com, go to the Prescription Center and look for Time-Saving Suggestions to see which prescriptions are eligible. Members can opt out of ReadyFill later if they no longer need the prescription. Convenience. Enjoy easy refills Ready when you are. Members give When you enroll qualified prescriptions in ReadyFill at Mail, we will automatically refill your prescriptions Cost-savings. and the extra at the appropriate time, unless you cancel. We will us high marks also contact your doctor to renew a prescription once convenience of the last refill is up or the prescription is about to expire. for service. Delivered to you. Each year, close to five million people choose the automatic refills. ReadyFill at Mail stays in contact. convenience and cost savings of CVS Caremark Mail Service Pharmacy to fill their long-term You can select which prescription(s) to include and You can refill your mail order prescription prescriptions. A recent survey**of members using CVS Caremark Mail your preferred method of communication (automated in three simple ways: mail service revealed that: phone call, email or text message) to receive notices Service Pharmacy about them. If you select automated phone calls or • 98 percent are very satisfied overall option 1 text messages, you may also receive notice by email • 97 percent think mail service is convenient or U.S. mail. • 96 percent would recommend mail service to Online at www.caremark.com their family and friends Enroll in • 95 percent think mail service is easy to use option 2 If you have questions or need help with your ReadyFill at Mail mail-service order, simply call the toll-free number Call us at the number on the on your prescription ID card. back of your prescription ID card 1 Register or sign in to Caremark.com, then go to the option 3 Manage Rx page. Select the eligible prescriptions you want Mail in a completed order form to enroll and follow the steps. (there’s one included in your prescription ReadyFill at Mail is available for most common maintenance OR medications for chronic conditions or long-term therapy. Not all mail delivery) service prescriptions are eligible. Medications such as controlled substances, specialty drugs and prescriptions covered by certain government payers, including Medicare Part B, are not part of ® 2 Call the toll-free Customer Care Save time when you sign up for ReadyFill at Mail . this program. Your privacy is important to us. Our employees are This automatic prescription refill and renewal number on your prescription trained regarding the appropriate way to handle your private health information. program is a no-cost service provided by ID card. *Copay, copayment or coinsurance means the amount a plan CVS Caremark Mail Service Pharmacy. We do all of participant is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription the refill ordering work for you. No need to fill out price, or a fixed amount or other charge, with the balance, if any, forms, make calls or go online to order refills. If a paid by the Plan. **CVS Caremark Mail Service Pharmacy 2009 Member Satisfaction copay* is required, you will ONLY be charged when Survey. your prescription ships. ©2013 Caremark. All rights reserved. 49-28346a 082613 TDD: 1-800-863-5488 Lower prescription costs: Most 90-day When you call, be sure to have: So many benefits, prescriptions ordered through mail service cost • The ID number from your prescription card less compared to getting three 30-day supplies • Your doctor’s first and last name and at a retail pharmacy. Visit the Savings Center at no extra cost. phone number Your prescription benefit plan offers a way for www.caremark.com to see how much you can save. you to save both time and money on long-term • Your payment information and mailing address Personal service: Speak with a registered prescriptions. For medicines you or your family pharmacist by calling the 24-hour, toll-free members take regularly, the CVS Caremark Mail number on your prescription card when you 2 Log onto www.caremark.com/faststart Service Pharmacy will deliver them to you – at no Going online is a quick and easy way to start have questions about your prescriptions. extra cost. Mail service is available for prescriptions using mail service. Once you provide the used to treat conditions such as high cholesterol, Secure delivery: Your medicines are sent in plain requested information, we’ll contact your doctor asthma, arthritis, diabetes, heart disease and high packaging to protect your privacy. The package for a 90-day prescription. If you haven’t blood pressure. is tamper-proof and, if necessary, temperature- registered yet on Caremark.com, be sure to controlled to protect certain medications and for have your prescription card with your ID number CVS Caremark Mail Service your safety. You can even track delivery on your handy when you register for the first time. Pharmacy offers many benefits, own through Caremark.com, or call us at the number on your prescription ID card and we can 3 Fill out and send a mail service order form • You can also pay by check, electronic check, Bill including: do it for you. If you already have a 90-day prescription, you Me Later® or money order (Cash is NOT accepted) Greater convenience: Order 90-day supplies of can send it to us with a completed mail service • Your original prescription from your doctor for up your medicine through mail service, and enjoy order form. Please have the following information It’s easy to start using mail to a 90-day supply no-cost, dependable and regular delivery of with you when you complete the form: service. Choose ONE of the prescriptions to your home or location of choice. • The ID number from your prescription ID card If you need your prescription filled right away, ask This saves you a trip to the retail pharmacy following three ways: your doctor to write two prescriptions for your every 30 days. • Your complete mailing address, including ® long-term medicine: 1 Call the FastStart toll-free number on your zip code prescription ID card • Your doctor’s first and last name and phone • One for a short-term supply (30 days or less) that can be filled at a retail pharmacy participating in A representative will let you know which of number the CVS Caremark Retail Pharmacy Network your prescriptions can be filled through • A list of your allergies and other health CVS Caremark Mail Service Pharmacy. We conditions AND will then contact your doctor for a 90-day prescription and will mail your medication • Your credit or debit card number if you prefer • One for the maximum days supply allowed by to you. that method of payment your plan (usually 90 days), with up to three refills. Enclose this prescription along with the mail service order form you send in. Mail Service Order Form

Mail this form to:

CVS CAREMARK PO BOX 94467 PALATINE, IL 60094-4467 Enter ID # below if not shown or if different from above

Prescription Plan Sponsor or Company Name

Please use blue or black ink, capital letters, and fill in both sides of this form. New Prescriptions - Mail your new prescriptions with this form. Number of New prescriptions: Refills - Order by Web, phone, or write in Rx number(s) below. Number of Refill prescriptions: FOR FASTEST SERVICE, order refills at www.caremark.com or call the number on your prescription benefit ID Card. A Shipping Address. To ship to an address different from the one printed above, please make changes here. Last Name First Name MI Suffix (JR, SR)

Street Name Apt./Suite # Use this address for this order only. City State ZIP Code

Daytime Phone #: - - Evening Phone #: - -

B Reﬁlls. To order mail service refills, enter your prescription number(s) here.

1) 2) 3) 4)

5) 6) 7) 8)

We may package all of these prescriptions together unless you tell us not to.

1st person with a reﬁll or new prescription. This person needs: Easy open caps Spanish forms and labels Suffix (JR,SR)

Gender: MF Date of Birth: Your E-Mail: Date new prescription written:

Doctor’s Last Name Doctor’s First Name Doctor’s Phone # Tell us about new allergies or health information for this person. Only tell us about new information. Allergies: None Aspirin Cephalosporin Codeine Erythromycin Peanuts Penicillin Sulfa Other: Health Information: Arthritis Asthma Diabetes Acid Reflux Glaucoma Heart Problem High Blood Pressure High Cholesterol Migraine Osteoporosis Prostate Issues Thyroid Other: 2nd person with a reﬁll or new prescription. This person needs: Easy open caps Spanish forms and labels Suffix (JR,SR)

Gender: MF Date of Birth: Your E-Mail: Date new prescription written:

E How would you like to pay for this order? Fill in the oval to choose a payment. Electronic Check. Pay from your bank account. First time users register online or call Customer Care. Bill Me Later®. Works like a credit card. First time users register online or call Customer Care. Credit or Debit Card. (VISA®, MasterCard®, Discover®, or American Express®) Fill in this oval to use your card on file. Fill in this oval to use a new card or to update your card expiration date. Exp. Date Credit Card Holder Signature/Date Check or Money Order. Amount: $ . • Make check or money order out to CVS Caremark. Regular delivery is free and will take 7 to 10 days from the day you send this form. • Write your prescription benefit ID number on your If you want faster delivery, choose: check or money order. 2nd Business Day ($17) Business days • If your check is returned, we will charge you up to $40. are only Next Business Day ($23) Monday-Friday Payment for Balance Due and Future Orders: If you chose Electronic Check, Bill Me Later®, or a Credit or Debit Card, • Faster delivery charges may change. we will also use it to pay for any balance that you owe and • Faster delivery is for shipping time, not processing time. • Faster delivery can only be sent to a street address, for future orders. not a PO box. Fill in this oval if you DO NOT want to use this payment method for future orders. MTP-MOF-2010 Mail Service Means One Less Thing for You to Do Mail Service Your prescription benefit offers you the convenient option to get 90-day* supplies of your long-term** medications delivered to you by mail. When you use the CVS Caremark Mail Service Pharmacy to fill your prescriptions, you’ll enjoy the many benefits it provides: Your medicine will be delivered within 10 days • Added value – 24/7 access to pharmacists, alert messages by e-mail, text or phone from the time your • Cost savings – one 90-day supply may cost less than three 30-day supplies at a retail pharmacy order is placed. • Greater convenience – at-home delivery at no extra cost, easy refills online or by phone • Quality and safety – dedicated pharmacists checking each and every order

Let us handle the legwork of filling your long-term prescriptions so you don’t have to. See the back side to learn how to get started.

To learn more, visit www.caremark.com or call the number on your Prescription Card.

*Actual quantity may vary depending on your plan. **A long-term medication is taken regularly for chronic conditions, such as high blood pressure, high cholesterol or diabetes, or long-term therapy. Get Started with CVS Caremark Mail Service Mail Service It’s quick and easy!

If you have a prescription, choose one of two ways to submit it: FastStart is quick, convenient • Mail your prescription and a completed order form to CVS Caremark and saves you a trip to the • Ask your doctor to call in your prescription toll-free at 1-800-378-5697 doctor’s oﬃce for a new prescription. If you need a prescription, choose from two FastStart® options to get started: • Phone – Call FastStart toll-free at 1-800-875-0867* from 7 a.m. to 7 p.m. (CT) Monday-Friday • Online – Log on to www.caremark.com/faststart and sign in or register, if necessary Have your Prescription Card number, the names of your medicines, your doctor’s information and your payment information ready. We’ll handle the rest.

*For TDD assistance, please dial toll-free 1-800-231-4403.

FastStart® A Head Start to Mail Service

Caremark offers a unique program–FastStart–to assist you and your plan Options Include: participants in promoting the utilization of the mail service benefit. Although you may have implemented the mail service benefit for your plan participants, FastStart for Plan Participants! having them use that option can often be challenging. Some plan participants Getting prescriptions mailed directly to plan continue to fill maintenance medications at local participating retail pharmacies, participants is simple with FastStart. Easy instead of using the mail service offering which can help reduce the cost of long- as 1-2-3! term medications.

1 Plan participants call FastStart toll-free at FastStart is a direct-to-plan participant program designed to increase awareness 1-800-875-0867 (TDD assistance, please call and usage of the mail service benefit. The program is offered at no additional 1-800-231-4403). charge and is appropriate for clients with the mail service benefit and cost-effective 2 The plan participant lets the representative plan participant co-pays*. know they wish to fill their prescription through mail service. Getting Started With FastStart Here’s how it works…plan participants who purchase their maintenance 3 The plan participant provides the medications through participating retail pharmacies and have not used the information on their benefit ID card, the mail service benefit in the last six months are selected to receive a letter. The names of the long-term medications they letter advises plan participants of easy options to make the first time use of the take, their prescribing physician’s name and mail service benefit fast, simple and convenient. phone number, and their mailing address. Continued

FastStart for Prescribing Physicians! A prescribing physician’s office can also call FastStart toll-free using our physician number: 1-800-378-5697. To expedite processing, the plan participant provides the prescribing physician the information from their benefit ID card along with their mailing address. FASTSTART®

Additional Features Include: Available Today Targeted plan participant mailings – Promotional mail campaign encouraging plan participants to take advantage of the convenience, value, quality, and safety that is provided when ordering maintenance prescriptions through Caremark Mail Service Pharmacy. About Caremark Automated outbound calls – Enhanced automated outbound messages with inbound transactional capabilities assist plan participants with starting or moving Caremark is a leading provider of their maintenance medication prescriptions to Caremark Mail Service Pharmacy. fully integrated pharmacy benefit management, specialty pharmacy The automated system will generate a prompt to the plan participant requesting services and disease management that they respond by indicating their preference to transfer directly to a FastStart programs to more than 2,000 representative, who will contact their doctor on their behalf to facilitate getting clients nationwide. started at mail. www.caremark.com Enhancements in 2008 Web capability – Enhanced web technology allows plan participants to access FastStart To learn if FastStart can assist you benefit online. and your plan participants in mail FastStart also includes other tools and resources that you and your plan participants service utilization, talk with your can use, such as brochures and posters. Caremark account representative. Benefits for Plan Sponsors FastStart helps you add value to your prescription benefit portfolio through: • Potentially lowering your overall drug spend • Improved formulary compliance rates • Increasing plan participant satisfaction and convenience • Faster adoption of generic medications • Higher compliance with utilization and safety rules Caremark analyses show that plan participants who use their mail service benefit tend to have increased adherence and lower total healthcare costs. Benefits for Plan Participants With FastStart, plan participants will benefit as well with: • Convenience – Free standard shipping • Potential reduced out-of-pocket expenses – One co-pay for up to a 90-day supply of medications • Time savings – Refills can be made by phone or online 24 hours a day, seven days a week • Quality and safety – A dedicated team of pharmacists ensures that plan participants receive the right medication, the right way, at the right price

* While the standard FastStart program is no charge to employers, fees may apply for modified or custom program.

www.caremark.com

What are specialty drugs?

Specialty pharmaceuticals are a relatively new and rapidly growing category of drugs that are the result of continued advances in drug development technology and design. They are created to target and treat very specific medical conditions and include bioengineered proteins, blood-driven products and complex molecules.

Specialty pharmaceuticals:

 Are used in the management of specific chronic or genetic conditions.

 Are often injectable or infused medicines, but may also include oral medicines.

 Require additional education of a member and close monitoring in collaboration with his or her doctor.

 May require special handling, delivery and/or special medical devices to administer the medicine.

 May only be available only from specialty pharmacies.

Specialty pharmacy costs continue to outpace traditional pharmacy trend and managing specialty pharmacy trend appropriately is a priority for many of our clients. The CVS/caremark Specialty Guideline Management program is designed to prevent inappropriate utilization of these highly specialized and expensive medications outside of approved guidelines and indications.

Specialty Guideline Management (SGM)

To effectively manage specialty medications, CVS/caremark offers a robust SGM program that includes:

 Bases authorization for specialty drugs on currently accepted medical guidelines for appropriate use.

 Evaluating patient progress to determine whether expected outcomes are being met and appropriate therapeutic endpoints are being reached.

 Evidence-based programs designed to consistently manage specialty pharmacy utilization in accordance with current standards of care.

 Flexibility in choosing levels of intensity ( indications for use vs. more comprehensive algorithms).

 Comprehensive management that goes beyond the capabilities of a traditional prior authorization (PA) program, and includes: - Utilization management components. - Outcomes management reporting components. - Flexible implementation.

To learn more about specialty pharmacy services and where these medications are best obtained according to the specific plan design, please visit CVS/caremark’s Specialty Pharmacy website at www.cvscaremarkspecialtyrx.com, or call a customer service representative at 1.866.475.7589. We Offer Specialty What to Look for Pharmacy Services for These Conditions in a Specialty and More* Pharmacy Provider • Asthma Specialty drugs can help you stay healthier but CVS Caremark • Crohn’s disease getting the most from them requires extra care. We • Cystic fibrosis help make it easier for you to manage your condition • Growth hormone and related disorders and enjoy better quality of life with the experienced Specialty • Hematopoietics support of our clinician-led teams. • Hemophilia, von Willebrand disease and Pharmacy related bleeding disorders We have more than 30 years experience helping • Hepatitis people with their specialty pharmacy • Hereditary Angioedema needs. Many of our specialty pharmacies are • HIV accredited by two independent health care • Hormonal therapies review groups – The Joint Commission and • Immune disorders URAC. The Joint Commission is the nation’s • Infertility major standards-setting and accrediting • Lysosomal storage disorders organization in health care. URAC establishes • Macular degeneration quality standards for the health care industry. • Multiple sclerosis • Oncology Their accreditation reflects our high • Osteoarthritis standards for quality and safety in health care. • Osteoporosis Personalized Pharmacy Care • Psoriasis We’ll help with your for Your Complex Condition • Pulmonary arterial hypertension specialty pharmacy needs. • Pulmonary disorders Call us toll-free: 1-800-237-2767 • Renal disorders • Rheumatoid arthritis • RSV prevention • Transplants

Not sure if your prescription is a specialty drug? Please ask your doctor.

CVS7245.indd 1 5/16/13 12:11 PM • Coordinating delivery of your refills Helping You • Understanding and managing your condition Helping You Stay Healthier • Taking your medicine correctly Save Time • Troubleshooting side effects Personalized Attention It’s faster and easier to get your specialty • Proper medicine storage When you choose CVS Caremark drugs from CVS Caremark. You’ll get In addition to regular calls to refill complimentary delivery by mail to your home, to provide your specialty drugs, your prescription, we’ll send you useful office or other location of your choice. Or, for you’ll get personalized support educational materials by mail. And certain therapies and locations, you can pick up your specialty drugs at the CVS/pharmacy from a team of clinical experts whenever you have questions, you’ll be able to reach a specialty pharmacist by nearest you*. trained in your condition. Your phone 24 hours a day, 365 days a year. To make it easier to get started on your You can also easily find information about team will be led by a pharmacist specialty drug, our benefits experts will your condition and medication at help manage your specialty pharmacy or nurse and can help you with: www.cvscaremarkspecialtyrx.com benefit coverage and get any prior authorizations needed. Convenient, Secure Shipping The quality of your medicine is maintained during shipping with our secure, temperature-controlled packaging.

To help protect your privacy, the outside of the shipping package is non-descriptive. We’ll include the supplies you need to take your medicines, such as syringes and alcohol swabs.

*Ask us if this service is available for your medication and CVS/pharmacy location. Based on the availability of CVS/pharmacy locations and subject to applicable laws and regulations.

CVS7245.indd 2 5/16/13 12:11 PM CHOOSE CVS CAREMARK SPECIALTY PHARMACY WE’RE ALWAYS WITHIN REACH

* Based on the availability of CVS/pharmacy® locations and subject to applicable laws and regulations. Services are also available at Long’s Drugs locations. Certain services are only accessed via calling CVS Caremark Specialty Pharmacy directly. For details, call toll-free at 1-866-846-3095. **In-store pick up is not available in Arkansas, Oklahoma and West Virginia. Some states require first fill prescriptions to be transmitted directly to the dispensing pharmacy. Other restrictions may apply. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. ©2014 CVS/caremark. All rights reserved. 75-32124a 091714 WE DO MORE WE OFFER WE ARE THAN FILL YOUR MORE CHOICES, COMMITTED SPECIALTY MEDICATION MORE CONVENIENCE TO YOUR HEALTH CVS Caremark Specialty Pharmacy delivers complete Enjoy easier, more flexible care with these services. Choose CVS Caremark Specialty Pharmacy for your care for all your complex health needs. Choose us as PRESCRIPTION DROP OFF AT CVS/PHARMACY unique health and medication needs. Our CareTeam your specialty pharmacy and gain greater access to Drop off or transfer your order at any CVS/pharmacy. is ready to help you get the most out of your your medication and the support you need to stay Or ask your doctor to send it to us. medication so you can stay healthier. on track. MEDICATION PICK UP OR DELIVERY SERVICES** Choose CVS Caremark Specialty Pharmacy— We provide you personalized health advice from a Pick up your order at any CVS/pharmacy or have it WE’RE ALWAYS WITHIN REACH. CareTeam of specially-trained pharmacists and delivered—you’re in control. nurses–available by phone 24/7. INSURANCE GUIDANCE MAKING THE CHANGE IS SIMPLE We can help you manage your benefits, including And we understand caring for your condition filing claims and minimizing costs. Just drop off or transfer your prescription to takes extra planning and effort. To help, we offer any CVS/pharmacy. services to assist with your condition at any 24/7 PERSONALIZED CARE Questions? Call us toll-free at 1-866-846-3095. CVS/pharmacy® location.* Our CareTeam is always ready to answer your questions, remind you to refill and help you manage side effects. Specialty CONNECT

One in three members attempts to fill their specialty medications at a traditional retail Convenient Access to pharmacy. Twenty-five percent of them will be told their medication cannot be filled at that Specialty Pharmacy Services pharmacy, which can lead to therapy delay or abandonment.1, 2 Members who are served through a traditional retail store may not receive the clinical support or outcomes seen with a specialty pharmacy. When members don’t get the right care and monitoring, it adds Enhanced benefit for members with open up to extra expense for them and their employers. The evidence? Seven to ten percent network plans lower adherence at retail and 20 percent fewer members on therapy after one year, leading to risk of preventable inpatient events like hospitalizations.3 Plan members taking high-cost specialty medications have special needs; their diagnosis and complicated Choice of Access with the Same Clinical Quality drug regimens can make them feel overwhelmed. These members benefit from the services of a specialty Prescription is dropped off pharmacy. They have access to disease state specialists or sent to any CVS/pharmacy who can help them understand their diagnosis and the Patient receives same high-quality clinical complexities of injectable and infused drugs and their support from our Specialty CareTeam disruptive side effects.

Please contact your CVS Caremark Account Representative to learn more about how we can help you improve member satisfaction and outcomes. Delivery to CVS/pharmacy, patient Doctor sends prescription home or location of choice* to specialty mail pharmacy

We understand that specialty conditions are complex and can be personal in nature. *Where allowed by law. 1. CVS Caremark Enterprise Analytics, 2012. 2. 2011 New England Opinion focus group of specialty patients, That’s why clinical support is provided by specialty pharmacy CareTeams, who focus on calls to 150 retail pharmacies (CVS and competitors) on January 13-15, 2012 3. CVS Caremark Enterprise Analytics, 2013 specific therapies and conditions. This ensures members have access to the right level of 4. CVS Caremark Enterprise Analytics, March 2012 care to manage their medication and condition from the privacy of their own homes. 5. Enterprise Analytics, 2013. Optimal adherence defined as MPR of at least 80% ©2013 Caremark. All Rights Reserved. 75-29524c 102213 Specialty CONNECT

Our specialty members are 36% more likely to remain on the The clinical services that are offered through our drugs they are prescribed.4 CareTeams help members stay on therapy, experience With the specialty service model, members are starting therapy sooner, and they value better health outcomes and lower overall health care the option of having their medications sent to a CVS/pharmacy or location of their choice. costs no matter where they choose to access their Whether they access specialty pharmacy services at a CVS/pharmacy or through specialty specialty benefit. Provided by specialty pharmacy mail, members enjoy optimal adherence rates that are virtually the same. These outcomes clinicians with up-to-date knowledge on evidence- are possible because retail patients now have access to the same specialty pharmacy based protocols, CareTeams help improve member services through our enhanced model. adherence by educating them about taking their medications correctly, reviewing proper medication storage and handling and troubleshooting medication side effects.

Mean MPR5 Percentage of Patients with Dedicated CareTeams form long lasting relationships Optimal Adherence5 with the member and their family caregiver – they know POSTand PERIODunderstand them. This familiarity leads to care that 92.3% 6.7% 90.2% 90.8% is personalized to meet members’ unique needs. { PRE PERIOD 86.1% 86.1% 85.6% 85.9% 84.4% For members who require their medications to be 82.3% infused, our nursing services provide high-quality 16% and timely infusion nursing care in the most effective settings. Physician outreach supports members by 71.8% 71.4% helping ensure they start therapy on time, and stay 69.9%{ on therapy.

You can opt-in to our robust communication support RETAIL PILOT CVS CAREMARK RETAIL PILOT CVS CAREMARK during implementation, to help members understand CONTROL STORES SPECIALTY CONTROL STORES SPECIALTY PHARMACY PHARMACY the program and the valuable services they will receive.

PRE PERIOD POST PERIOD October 2016

Specialty Pharmacy Drug List Providing one of the broadest offerings of specialty pharmaceuticals in the industry

The Specialty Pharmacy Drug List is a guide of medications available through CVS Specialty™. Our goal is to help make your life better. With nearly 40 years of experience, CVS Specialty provides quality care and service. We have a network of pharmacies that includes those with Joint Commission and URAC accreditation. The Joint Commission and URAC are nationally-recognized symbols of quality that reflect an organization’s commitment to meet high standards of quality and safety. This list represents brand-name products in CAPS and generic products in lowercase italics.

Please note: If you are a plan member or a health care provider, please visit CVSspecialty.com, fax 1-800-323-2445 or call 1-800-237-2767 for specific information regarding medications available through CVS Specialty. e-Prescribe specialty prescription(s) to CVS Specialty Pharmacy.

ACROMEGALY KYLEENA*† GROWTH HORMONE & IXINITY† HEREDITARY octreotide acetate MIRENA*† RELATED DISORDERS KOATE-DVI ANGIOEDEMA (SANDOSTATIN)† NEXPLANON*† Growth Hormone Disorders KOGENATE FS BERINERT*† SANDOSTATIN LAR† SKYLA*† GENOTROPIN KOVALTRY CINRYZE*† SOMATULINE DEPOT*† HUMATROPE MONOCLATE-P FIRAZYR*† SOMAVERT*† CRYOPYRIN-ASSOCIATED NORDITROPIN MONONINE KALBITOR*† PERIODIC SYNDROMES NUTROPIN NOVOEIGHT* RUCONEST*† ALCOHOL/OPIOID ARCALYST*† † OMNITROPE NOVOSEVEN RT DEPENDENCY ILARIS* SAIZEN NUWIQ HIV MEDICATIONS † VIVITROL SEROSTIM*† OBIZUR* EGRIFTA*† CYSTIC FIBROSIS † TEV-TROPIN PROFILNINE SD FUZEON ALLERGEN BETHKIS* † ZOMACTON RECOMBINATE IMMUNOTHERAPY KALYDECO* HORMONAL THERAPIES ORALAIR*† KITABIS PAK*† ZORBTIVE RIASTAP † AVEED* † RIXUBIS ORKAMBI* IGF-1 Deficiency ELIGARD† ALLERGIC ASTHMA † STIMATE PULMOZYME † † † INCRELEX* FIRMAGON CINQAIR* † TRETTEN* † † TOBI PODHALER* leuprolide acetate (LUPRON) NUCALA* VONVENDI † † tobramycin nebulizer HEMATOPOIETICS LUPANETA PACK XOLAIR* (TOBI*) MOZOBIL*† WILATE † LUPRON DEPOT NEUMEGA XYNTHA † ALPHA-1 ANTITRYPSIN NATPARA* DUPUYTREN’S DEFICIENCY HEPATITIS C SUPPRELIN LA*† † CONTRACTURE HEMOPHILIA, † ARALAST NP* † DAKLINZA TRELSTAR XIAFLEX* VON WILLEBRAND † GLASSIA*† EPCLUSA VANTAS † DISEASE & RELATED † † ZOLADEX ZEMAIRA* ELECTROLYTE DISORDERS BLEEDING DISORDERS HARVONI INCIVEK SAMSCA ADVATE IMMUNE DEFICIENCIES & ANEMIA INFERGEN ADYNOVATE RELATED DISORDERS† ARANESP GASTROINTESTINAL MODERIBA AFSTYLA BIVIGAM* EPOGEN DISORDERS-OTHER OLYSIO PROCRIT † ALPHANATE CARIMUNE NF GATTEX* PEGASYS † † ALPHANINE SD CUVITRU OCALIVA* PEGINTRON BOTULINUM TOXINS † ALPROLIX CYTOGAM † SOLESTA* REBETOL SOLUTION BOTOX BEBULIN FLEBOGAMMA † RIBAPAK DYSPORT GOUT BEBULIN VH FLEBOGAMMA DIF † RIBASPHERE MYOBLOC KRYSTEXXA† BENEFIX GAMASTAN S/D † RIBATAB XEOMIN* CORIFACT* GAMMAGARD LIQUID ribavirin caps (REBETOL) ELOCTATE GAMMAGARD S/D COAGULATION ribavirin tabs (COPEGUS) FEIBA NF GAMMAKED DISORDERS SOVALDI † FEIBA VH GAMMAPLEX* CEPROTIN* TECHNIVIE HELIXATE FS GAMUNEX-C VICTRELIS HEMOFIL M HEPAGAM B CONTRACEPTIVES VIEKIRA PAK † HUMATE-P HIZENTRA* IMPLANON* IDELVION† ZEPATIER HYPERHEP B

Products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document. *Indicates Limited Distribution products distributed by CVS Specialty. †Indicates the therapy class or product is part of the CVS Specialty Select offering. Call 1-800-237-2767 for specific medications available through CVS Specialty. This document contains confidential and proprietary information of CVS Caremark and may not be reproduced, distributed or printed without written permission from CVS Specialty. Listing is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy. ©2016 CVS Specialty. All rights reserved. 75-CTC14953A October 2016 v10012016 Specialty Pharmacy Drug List Page 1 of 2 October 2016

HYPERRHO S/D MYOZYME* COTELLIC*† PHENYLKETONURIA SIMPONI HYQVIA NAGLAZYME* ERIVEDGE*† KUVAN*† SIMPONI ARIA MICRHOGAM VIMIZIM* FARYDAK*† XELJANZ † PRE-TERM BIRTH NABI-HB VPRIV* HYCAMTIN* † OCTAGAM IBRANCE*† MAKENA*

PRIVIGEN MIGRAINE imatinib mesylate (GLEEVEC) SEIZURE DISORDERS PSORIASIS † † † H. P. ACTHAR GEL* RHOGAM ZECUITY* INLYTA* † COSENTYX* † RHOPHYLAC IRESSA*† SABRIL* ENBREL WINRHO SDF MOVEMENT DISORDERS JAKAFI*† † HUMIRA SYSTEMIC LUPUS APOKYN* † MEKINIST* † NORTHERA*† INFLECTRA ERYTHEMATOSUS IMMUNE (IDIOPATHIC) MUGARD † † † OTEZLA* BENLYSTA NUPLAZID* † THROMBOCYTOPENIC NEXAVAR* † OTREXUP PURPURA tetrabenazine NINLARO*† UREA CYCLE DISORDERS † RASUVO † (XENAZINE* ) † NPLATE POMALYST* REMICADE† phenylbutyrate sodium † † PROMACTA* REVLIMID* STELARA† (BUPHENYL) MULTIPLE SCLEROSIS † SPRYCEL † RAVICTI* † TALTZ* AMPYRA* † INFECTIOUS DISEASE STIVARGA* † ACTIMMUNE*† AUBAGIO* LONSURF*† PULMONARY ARTERIAL AVONEX ODOMZO*† HYPERTENSION† INFERTILITY BETASERON PURIXAN*† ADCIRCA BRAVELLE EXTAVIA SUTENT ADEMPAS* CETROTIDE GILENYA TAFINLAR*† epoprostenol sodium* chorionic gonadotropin glatiramer acetate TAGRISSO*† LETAIRIS* (NOVAREL, PREGNYL) (COPAXONE, GLATOPA) † † TARCEVA* OPSUMIT* FOLLISTIM AQ LEMTRADA* TARGRETIN ORENITRAM* ganirelix acetate PLEGRIDY* TASIGNA REMODULIN* GONAL-F REBIF temozolomide (TEMODAR) sildenafil citrate (REVATIO) MENOPUR TECFIDERA*† † THALOMID TRACLEER* OVIDREL TYSABRI* † † TYKERB* TYVASO* REPRONEX ZINBRYTA* VOTRIENT*† UPTRAVI*† † INFLAMMATORY NEUTROPENIA XALKORI* VELETRI* XTANDI*† VENTAVIS* BOWEL DISEASE GRANIX † CIMZIA LEUKINE ZELBORAF* ENTYVIO† NEULASTA ZOLINZA PULMONARY DISORDERS- ZYKADIA* OTHER HUMIRA NEUPOGEN † † † ZYTIGA ESBRIET* INFLECTRA ZARXIO † REMICADE† OFEV*

SIMPONI ONCOLOGY-INJECTABLE OSTEOARTHRITIS † RENAL DISEASE TYSABRI*† BELEODAQ*† EUFLEXXA † SENSIPAR † GEL-ONE BENDEKA* † IRON OVERLOAD † GELSYN-3 † BLINCYTO* † RESPIRATORY SYNCYTIAL deferoxamine (DESFERAL) † GENVISC 850* † DARZALEX* † VIRUS EXJADE* † HYALGAN † † EMPLICITI* † SYNAGIS JADENU* KEYTRUDA*† HYMOVIS* † KYPROLIS*† MONOVISC RETINAL DISORDERS LIPID DISORDERS ORTHOVISC† EYLEA*† † melphalan hydrochloride KYNAMRO* † † (EVOMELA*)† SUPARTZ ILUVIEN* † † OPDIVO*† SYNVISC LUCENTIS* LIPID DISORDERS - PCSK9 † † † SYNVISC ONE MACUGEN* INHIBITORS TECENTRIQ* † † THYROGEN* PRALUENT* † XGEVA† OSTEOPOROSIS VISUDYNE* REPATHA YONDELIS*† FORTEO † RHEUMATOID ARTHRITIS † PROLIA zoledronic acid (ZOMETA) † LYSOSOMAL STORAGE zoledronic acid (RECLAST)† ACTEMRA* DISORDERS† CIMZIA ONCOLOGY-ORAL/TOPICAL ALDURAZYME* PAROXYSMAL ENBREL CERDELGA* AFINITOR HUMIRA † NOCTURNAL ALECENSA* † CEREZYME* HEMOGLOBINURIA INFLECTRA bexarotene (TARGRETIN) † CYSTAGON* † ORENCIA BOSULIF SOLIRIS* ELAPRASE* † OTREXUP FABRAZYME* CABOMETYX* RASUVO LUMIZYME* capecitabine (XELODA) REMICADE†

Scrip World has partnered with CVS/caremark to provide members with the Diabetic Meter Program. This program offers cost savings and convenience to plan members.

Regular blood glucose testing is essential for people with diabetes. The Diabetic Meter Program can provide your members with tools to monitor their blood glucose levels and better manage their health.

What is the Diabetic Meter program?

Members who qualify can receive a OneTouch® blood glucose meter kit, which includes a starter supply of test strips and lancets, at no cost, as part of their CVS/caremark Mail Service Pharmacy benefits. This program can save members $65 to $90 over the retail price of blood glucose meter kits, in addition to the money they can save by ordering their diabetes testing supplies through CVS/caremark Mail Service Pharmacy.

Who qualifies for the program?

Members can receive a blood glucose meter kit if they:

 Have diabetes.

 Have CVS/caremark Mail Service prescription benefits.

 Have a prescription for OneTouch® test strips. If members don’t already have a prescription for strips, we may be able to get one from their doctor . Please note: additional requirements or limitations may be applied by the manufacturer.

How does the program work?

Members may call the CVS/caremark Diabetic Meter Team toll-free at 1.800.588.4456 weekdays 6 a.m. to 4 p.m. (MT). Customer Care Representatives can help them choose one of four available meters. For added convenience, a representative can contact members’ physicians to request and process prescriptions.

Meter kits will be shipped directly from the manufacturer to members within 7 to 10 days of the order. Test strips and lancets can be shipped from CVS/caremark within 10 to 14 days. Members may receive no more than one meter kit as part of their pharmacy benefits every year. Meters are provided by LifeScan (OneTouch®). Maintenance Choice Maintenance Choice

Maintenance Choice® from CVS/caremark is a unique option that combines cost savings, access and quality through their 90-day mail pricing plan design. Maintenance Choice can help improve member adherence by leveraging mail service and retail capabilities. It provides members a choice in how they receive a 90-day supply of maintenance medication. Members can choose to receive their maintenance medications through mail service or at a CVS/pharmacy at the mail pricing and copay.

Benefits of this unique 90-day solution include:

 Cost savings. Implementing the Maintenance Choice Mandatory solution can help you achieve up to four percent savings on your gross pharmacy spend.

 Improved health outcomes and quality. Clients who implemented Maintenance Choice have experienced consistent quality and generic dispensing metrics at mail service and CVS pharmacies. In addition, up to 39 percent more members have become optimally adherent with Maintenance Choice compared to traditional mandatory mail plan designs.

 Increased member satisfaction, convenience and flexibility. Members will enjoy lower copays and increased convenience through home delivery or fewer trips to the retail pharmacy (both of which are shown to help improve adherence). The ability to move prescriptions between mail and CVS/pharmacy when needed creates flexibility for members. Easy-to-use online and mobile tools offer members more control in managing and tracking their medications.

The option to offer the Maintenance Choice Program is not only a key differentiator for Script World, it is also one of the most popular programs among our clients. For more information, contact your Script World account manager toll free at 1.800.830.2310.

Two Ways to Save on Your Maintenance Choice® Long-Term Medications Introducing Maintenance Choice, a program that offers you choice and savings. Now you and your To get started, log on to family can receive 90-day* supplies of long-term www.caremark.com. medication(s) through CVS Caremark Mail Service You may also call us Pharmacy or at a CVS/pharmacy. Either way, toll-free using the number on the back of your your copay will be the same. Prescription Card. Choose which option works best for you, and we’ll handle the rest.

*Actual quantity may vary depending on your plan. Count on CVS Caremark for Quality Pharmacy Service Maintenance Choice®

With Maintenance Choice, you get the same quality service and savings whether you choose delivery or retail pick-up at a CVS/pharmacy. CVS Caremark Mail Service Pharmacy: CVS/pharmacy: • Enjoy convenient home delivery • Pick up your medication at a time that • Receive your medications in private, is convenient for you tamper-resistant and (when needed) • Enjoy same-day prescription availability temperature-controlled packaging • Talk with a pharmacist face-to-face • Talk to a pharmacist by phone

To get started, log on to www.caremark.com. You may also call us toll-free using the number on the back of your Prescription Card.

©2009 Caremark. All rights reserved. 5287-17768k www.caremark.com Maintenance Choice oﬀ ers you SAVINGS when it comes to ﬁ lling long-term* prescriptions. Now, you have two ways to SAVE. CVS Caremark Mail Service Pharmacy: CVS/pharmacy: • Enjoy convenient, reliable delivery to the location of • Pick up your medication at a time that is your choice convenient for you • Receive your medications in unmarked, • Enjoy same-day prescription availability tamper-resistant and (when needed) temperature- • Talk with a pharmacist face-to-face controlled packaging • Talk to a pharmacist by phone toll-free, 24/7, from the privacy of your home

Plus, you can easily order reﬁ lls and manage your prescriptions anytime from your computer or mobile device at www.caremark.com.

Get Started If you would like to… Then…

Continue with mail service You don’t have to do anything: • We’ll continue to send your medications to your location of choice

Pick up at CVS/pharmacy Please let us know by one of the three ways below: • Sign in or register at Caremark.com. Then, select a CVS/pharmacy location for pick up • Visit your local CVS/pharmacy and talk to the pharmacist • Call using the toll-free number on your Prescription Beneﬁ t ID Card, and we’ll handle the rest

Sign up for mail service You can do easily online or by phone: for the rst time • Visit www.caremark.com/faststart and sign in or register to start a prescription • Call FastStart® toll-free at 1-800-875-0867. We’ll handle the rest

Learn more Call us using the toll-free number on your Prescription Bene t ID card

Before you reach your 30-day ﬁ ll limit and your out-of-pocket cost increases, we will contact you to help you get started with Maintenance Choice. We’ll then help you get a 90-day** prescription from your doctor so you can choose to ﬁ ll it through the CVS Caremark Mail Service Pharmacy or at a CVS/pharmacy.

*A long-term medication is taken regularly for chronic conditions or long-term therapy. A few examples include medications for managing high blood pressure, asthma, diabetes or high cholesterol. **Actual quantity may vary depending on your plan.

MC Flyer.indd 1 9/9/11 11:09 AM Compound Management

Coverage Strategy for Compounds: Ingredient Exclusion List

CVS/caremark recommends exclusion of these ingredients when present in a compound drug.

Category Examples Rationale Proprietary PCCA Lipoderm Base, PCCA Custom Lipo-Max Cream, Select bases associated with very Bases Versabase Cream, Versapro Cream, PCCA Pracasil Plus high per gram costs and lack of Base, Spirawash Gel Base, Versabase Gel, Lipopen Ultra high- quality clinical evidence to Cream, Lipo Cream Base, Pentravan Cream/Cream Plus, support benefit for use in VersaPro Gel, Versatile Cream Base, PLO Transdermal compounds. Cream, Transdermal Pain Base Cream, PCCA Emollient Cream Base, Penderm, Salt Stable LS Advanced Cream, Ultraderm Cream, Base Cream Liposome, Mediderm Cream Base, Salt Stable Cream.

Drug Specific Muscle relaxants (e.g., baclofen, carisoprodol, Included routinely in topical Bulk Powders cyclobenzaprine) compounds. Bulk powder forms of Analgesics (e.g., sodium salicylate, aspirin) these drug chemicals have not Antidepressants (e.g., trazodone HCl, desipramine HCl) been adequately studied for Anti-inflammatory agents (e.g., fenoprofen Ca, flurbiprofen) transdermal administration. Efficacy Opioids (e.g., codeine phosphate, fentanyl citrate, morphine) and safety are unknown. FDA Neuropathic Agents (e.g., droperidol, chlorpromazine HCl, approved drugs for transdermal lithium carbonate, phenobarbital, caffeine) administration are available for Antiadrenergics (e.g., clonidine) some drugs in these therapeutic classes. Hormone & Androgens (e.g., danazol, methyltestosterone) Hormone replacement therapy Adrenal Bulk Estrogens (e.g., estriol micronized, estradiol) (including those with bio-identical Powders Progestins (e.g., norethindrone acetate, progesterone) hormones) is commonly formulated Corticosteroids (e.g., betamethasone Na phosphate, into a variety of compound dosage cortisone acetate) forms. Insufficient clinical evidence exists for safety or effectiveness of compounded HRT. Bulk Nutrients Vitamins (e.g., thiamine HCl, niacin) Commercial enteral nutritional Minerals, Electrolytes (e.g., sodium acetate, calcium products are available when carbonate) needed for specific dietary Amino Acids (e.g., calcium amino acid chelate 20%, zinc management of certain diseases or amino acid chelate 20%) conditions (e.g., low protein products for renal failure patients). Bulk Surfactants (e.g., polyoxyl 50 stearate) Ingredients commonly used in Compounding Vehicles (e.g., ethyl alcohol 100%, alcohol gel base, sorbitol topical formulations to promote Agents solution, cellulose gum oral thickening powder packet, absorption, tolerance or palatability acacia syrup, fixed oil suspension vehicle-liquid) as seen with compounds for Alkalizing Agents (e.g., trolamine liquid) cosmetic uses. Antiseptics, Disinfectants (e.g., glutaral, phenol) Pigments (e.g., methoxsalen, hydroquinone)

Misc. Bulk Chelating Agents (e.g., penicillamine) Additional ingredients found in Ingredients Digestive Enzymes (e.g., pepsin) various compounds for which there Keratolytics (e.g., cantharidin, podophyllum resin) is insufficient clinical evidence of Anesthetics (e.g., benzocaine, cocaine HCl, ketamine) safety or effectiveness. Neuropathic Agents (e.g., gabapentin)

This list is not intended to be all inclusive and is subject to change. It is representative of the ingredients used in compounded prescriptions that CVS/caremark recommends excluding from coverage. 106-31557a 080514 About Compounded Medications

Scrip World’s goal is for members to receive the best medication for positive outcomes, while managing costs and safety concerns. For this reason, the Scrip World clinical team has collaborated with our Pharmacy Benefits Management (PBM) partners to develop a strategy for managing compounded medications. Scrip World implemented this new strategy beginning September 2014.

Background Scrip World’s strategy A compounding pharmacy is defined as a practice in which a licensed pharmacist combines mixes or alters ingredients in response to a To proactively manage the high cost prescription. This creates a medication tailored to the medical needs of and appropriate use of compound a patient. medication, Scrip World has created the Today, compounded medications provide greater flexibility and following strategy: individualization in treating patients when like-manufactured products l Any compound medications costing are not commercially available. Pharmacies sometimes make more than $300 require a prior compounded medications when a patient has an allergy and needs authorization mediation without a certain dye, preservative or other inactive l Compound drugs must meet the ingredient. A pharmacy may also make these medications when a standard utilization management patient has trouble swallowing a capsule or tablet and needs medicine in criteria for treating a condition. liquid form that is not currently available. l Medications must not include bulk Cost, safety and effectiveness compounding powders (chemicals Scrip World believes that, though compounded medications can be that do not have FDA approval, or an useful in prescription therapy, in most cases there are safe and effective indication for use in treating certain lower-cost alternatives. Often, compounded medications are more costly disease states). than FDA-approved products for the same condition. When making best-practice prescription choices, FDA-approved, commercially manufactured and lower-cost medications should always be the first treatment consideration.

Impact to members Scrip World will notify any members affected by the change in compound management within 60 days of the program implementation. Plans with unmanaged high-cost compound utilization may experience potentially significant cost savings from this new strategy.

If you have any questions, we can help. Please email Scrip World at [email protected].

ACA (Affordable Care Act) preventive definition

This is the list of drugs that are required for coverage under the ACA at a $0 copay and bypass deductible (if applicable). The drugs on the list comply with the preventive drug list that has been identified by the U.S. Department of Health and Human Services (HHS) as a preventive service.

ACA preventive—what’s required?

 This is required on all nongrandfathered plans.

 All drugs on the list must be provided at $0 to the member(s).

 All drugs on the list are not subject to deductible.

HDHP/HSA preventive definition

The list is used to promote preventive medications by allowing them to skip the deductible and are usually offered at regular copays (although sometimes $0). The makeup of the list is based on the guidelines for Preventive Care Safe Harbor from the IRS and vendor clinicians. This drug list is not compliant with the ACA requirements and was not intended to be. This drug list provides guidelines for inclusion for groups choosing to implement a HDHP/HSA benefit plan.

HDHP/HSA preventive—what’s required?

 This is not required on HDHP/HSA plans.

 If plans offer it, the drugs on the list can be offered at $0 or another copay determined by the client.

High Deductible Health Plan (HDHP) - Health Savings Account (HSA)

Preventive Therapy Drug List (06/01/16) ANTICOAGULANTS/ CARBATROL sotalol AF CELONTIN Pacerone ANTIPLATELETS DEPAKENE BETAPACE ANTICOAGULANTS DEPAKOTE BETAPACE AF enoxaparin DEPAKOTE ER CORDARONE fondaparinux DILANTIN NORPACE warfarin FELBATOL NORPACE CR Jantoven FYCOMPA RYTHMOL ARIXTRA GABITRIL RYTHMOL SR COUMADIN KEPPRA SOTYLIZE COUMADIN INJECTION KEPPRA XR TIKOSYN ELIQUIS KLONOPIN FRAGMIN LAMICTAL NEPRILYSIN/ANGIOTENSIN II RECEPTOR IPRIVASK LAMICTAL XR ANTAGONIST COMBINATIONS LOVENOX LAMICTAL XR KIT ENTRESTO PRADAXA MYSOLINE SAVAYSA ONFI ORAL ANTIANGINAL AGENTS XARELTO OXTELLAR XR isosorbide dinitrate PEGANONE isosorbide mononitrate PLATELET AGGREGATION INHIBITORS PHENYTEK isosorbide mononitrate ext-rel clopidogrel POTIGA nitroglycerin dipyridamole QUDEXY XR nitroglycerin lingual spray dipyridamole ext-rel/aspirin SABRIL nitroglycerin sublingual aerosol AGGRENOX SPRITAM DILATRATE-SR BRILINTA STAVZOR ISORDIL DURLAZA TEGRETOL NITROLINGUAL EFFIENT TEGRETOL-XR NITROMIST PERSANTINE TOPAMAX PLAVIX TOPIRAMATE ER SL and chewable formulations are not included ZONTIVITY TRILEPTAL on this list. TROKENDI XR ANTICONVULSANTS VIMPAT TRANSDERMAL/TOPICAL ANTIANGINAL carbamazepine ZARONTIN AGENTS carbamazepine ext-rel ZONEGRAN nitroglycerin transdermal clonazepam Minitran divalproex sodium delayed-rel BOWEL PREPARATIONS NITRO-BID divalproex sodium ext-rel NITRO-DUR peg 3350/electrolytes ethosuximide Gavilyte felbamate COLYTE CORONARY ARTERY DISEASE lamotrigine GOLYTELY ANTIHYPERLIPIDEMICS lamotrigine ext-rel MOVIPREP atorvastatin levetiracetam NULYTELY cholestyramine levetiracetam ext-rel OSMOPREP colestipol oxcarbazepine PREPOPIK fenofibrate phenobarbital SUPREP fenofibric acid phenytoin fenofibric acid delayed-rel phenytoin sodium extended fluvastatin primidone CARDIOVASCULAR CONDITIONS - fluvastatin ext-rel tiagabine OTHER gemfibrozil topiramate ANTIARRHYTHMIC AGENTS lovastatin topiramate ext-rel amiodarone niacin ext-rel valproic acid disopyramide omega-3 acid ethyl esters zonisamide flecainide pravastatin Epitol propafenone rosuvastatin APTIOM propafenone ext-rel simvastatin BANZEL sotalol Niacor

Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.

Some strengths or dosage forms may not be included in the Preventive Therapy Drug List and certain products or categories may not be covered, regardless of their appearance in this document. Please check with your plan provider should you have any questions about coverage. Additional medications may be included in this list from time to time in compliance with Affordable Care Act requirements and/or U.S. Internal Revenue System (IRS) guidance. This list includes medications considered preventive by the IRS; it may not include all preventive medications.

This Preventive Therapy Drug List has been adopted by the referenced health plan. CVS/caremark® makes no representations regarding its compliance with applicable legal requirements. The Preventive Therapy Drug List should be modified as necessary or desired by the plan sponsor based on the advice of the plan sponsor’s counsel. 106-1038894B 060116

Prevalite SYMLINPEN SYNJARDY ALTOPREV TANZEUM TRADJENTA ANTARA TOUJEO XIGDUO XR COLESTID TRESIBA CRESTOR TRULICITY HEMATOLOGIC AGENTS FENOGLIDE VICTOZA ADVATE FIBRICOR ADYNOVATE JUXTAPID Over-the-Counter (OTC) products require a prescription. ALPHANATE Coverage may vary by plan. LESCOL XL ALPHANINE SD

LIPITOR ALPROLIX ORAL DIABETES AGENTS LIPOFEN BEBULIN acarbose LIVALO BENEFIX chlorpropamide LOCHOLEST/LOCHOLEST LIGHT CORIFACT glimepiride LOFIBRA ELOCTATE glipizide LOPID HELIXATE FS glipizide ext-rel LOVAZA HEMOFIL M glipizide/metformin MEVACOR HUMATE-P glyburide NIASPAN IDELVION glyburide, micronized PRAVACHOL IXINITY glyburide/metformin QUESTRAN/QUESTRAN LIGHT KOATE-DVI metformin TRICOR KOGENATE metformin ext-rel TRIGLIDE KOGENATE FS nateglinide TRILIPIX KOVALTRY pioglitazone VASCEPA MONOCLATE-P pioglitazone/glimepiride WELCHOL MONONINE pioglitazone/metformin ZETIA NOVOEIGHT repaglinide ZOCOR NUWIQ repaglinide/metformin PROFILNINE SD tolbutamide COMBINATION ANTIHYPERLIPIDEMICS RECOMBINATE ACTOPLUS MET amlodipine/atorvastatin RIXUBIS ACTOPLUS MET XR ADVICOR TRETTEN ACTOS CADUET XYNTHA AMARYL LIPTRUZET SIMCOR DUETACT VYTORIN FARXIGA HYPERTENSION FORTAMET ACE INHIBITORS/ANGIOTENSIN II RECEPTOR DIABETES GLUCOPHAGE ANTAGONISTS AND COMBINATION AGENTS GLUCOPHAGE XR amlodipine/benazepril DIAGNOSTIC AGENTS AND SUPPLIES GLUCOTROL benazepril BLOOD GLUCOSE MONITORS - ALL GLUCOTROL XL benazepril/hydrochlorothiazide BLOOD GLUCOSE STRIPS - ALL GLUCOVANCE candesartan CONTROL SOLUTIONS GLUMETZA candesartan/hydrochlorothiazide INSULIN SYRINGES, INFUSION SETS, GLYNASE captopril AND NEEDLES - ALL GLYSET captopril/hydrochlorothiazide KETONE BLOOD TEST STRIPS - ALL GLYXAMBI enalapril LANCETS, LANCET DEVICES INVOKAMET enalapril/hydrochlorothiazide OMNIPOD INVOKANA eprosartan URINE TESTING STRIPS - ALL JANUMET fosinopril V-GO JANUMET XR fosinopril/hydrochlorothiazide

JANUVIA irbesartan INHALED DIABETES AGENTS JARDIANCE irbesartan/hydrochlorothiazide AFREZZA JENTADUETO lisinopril

KAZANO lisinopril/hydrochlorothiazide INJECTABLE DIABETES AGENTS KOMBIGLYZE XR losartan APIDRA METAGLIP losartan/hydrochlorothiazide BYDUREON NESINA moexipril BYETTA ONGLYZA moexipril/hydrochlorothiazide HUMALOG OSENI perindopril HUMULIN PRANDIN quinapril LANTUS PRECOSE quinapril/hydrochlorothiazide LEVEMIR RIOMET ramipril NOVOLIN STARLIX telmisartan NOVOLOG

Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.

telmisartan/hydrochlorothiazide INDERAL LA MAXZIDE trandolapril KERLONE MICROZIDE trandolapril/verapamil ext-rel LEVATOL valsartan LOPRESSOR OTHER ANTIHYPERTENSIVE AGENTS valsartan/hydrochlorothiazide LOPRESSOR HCT amlodipine/telmisartan ACCUPRIL SECTRAL amlodipine/valsartan/ ACCURETIC TENORETIC hydrochlorothiazide ACEON TENORMIN clonidine ALTACE TOPROL-XL clonidine transdermal ATACAND TRANDATE guanabenz ATACAND HCT ZEBETA guanfacine AVALIDE ZIAC hydralazine AVAPRO methyldopa BENICAR CALCIUM CHANNEL BLOCKERS AND methyldopa/hydrochlorothiazide BENICAR HCT COMBINATION AGENTS minoxidil COZAAR amlodipine reserpine DIOVAN diltiazem Clorpres DIOVAN HCT diltiazem ext-rel AZOR EDARBI diltiazem XR CATAPRES EDARBYCLOR felodipine ext-rel CATAPRES-TTS EPANED isradipine EXFORGE HYZAAR nicardipine EXFORGE HCT LOTENSIN nifedipine TEKTURNA LOTENSIN HCT nifedipine ext-rel TEKTURNA HCT LOTREL nisoldipine ext-rel TENEX MAVIK verapamil TRIBENZOR MICARDIS verapamil ext-rel TWYNSTA MICARDIS HCT Afeditab CR PRESTALIA Cartia XT IMMUNIZING AGENTS PRINIVIL Dilt-XR ALLERGENIC EXTRACTS TARKA Matzim LA CERVARIX VASERETIC Nifediac CC CHOLERA VACCINE VASOTEC Nifedical XL COMBINATION VACCINES ZESTORETIC Taztia XT CYTOMEGALOVIRUS IMMUNE ZESTRIL ADALAT CC GLOBULIN CALAN DPT VACCINE BETA-BLOCKERS AND COMBINATION CALAN SR DT VACCINE AGENTS CARDIZEM DTaP VACCINE acebutolol CARDIZEM CD GARDASIL atenolol CARDIZEM LA GARDASIL 9 atenolol/chlorthalidone ISOPTIN SR GRASTEK betaxolol NORVASC HEPATITIS A VACCINE bisoprolol PROCARDIA HEPATITIS B IMMUNE GLOBULIN bisoprolol/hydrochlorothiazide PROCARDIA XL HEPATITIS B VACCINE carvedilol SULAR HIB VACCINE labetalol TIAZAC INFLUENZA VACCINE metoprolol VERELAN JAPANESE ENCEPHALITIS VACCINE metoprolol succinate ext-rel VERELAN PM MEASLES VACCINE metoprolol/hydrochlorothiazide MENINGOCOCCAL VACCINE nadolol DIURETICS MUMPS VACCINE nadolol/bendroflumethiazide amiloride/hydrochlorothiazide ORALAIR pindolol chlorothiazide PNEUMOCOCCAL VACCINE propranolol chlorthalidone POLIO VACCINE propranolol ext-rel hydrochlorothiazide PREVNAR 13 propranolol/hydrochlorothiazide indapamide RABIES IMMUNE GLOBULIN timolol maleate methyclothiazide RABIES VACCINE BYSTOLIC spironolactone/hydrochlorothiazide RAGWITEK COREG triamterene/hydrochlorothiazide RHO (D) IMMUNE GLOBULIN COREG CR ALDACTAZIDE ROTARIX CORGARD DIURIL ROTATEQ CORZIDE DYAZIDE RSV VACCINE DUTOPROL RUBELLA VACCINE

Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.

TETANUS IMMUNE GLOBULIN PROZAC raloxifene TYPHOID VACCINE PROZAC WEEKLY risedronate VARICELLA VACCINE REMERON ACTONEL VARICELLA-ZOSTER IMMUNE SURMONTIL ATELVIA GLOBULIN TOFRANIL BINOSTO YELLOW FEVER VACCINE VIIBRYD BONIVA ZOSTAVAX WELLBUTRIN BONIVA INJECTION WELLBUTRIN SR EVISTA MENTAL HEALTH WELLBUTRIN XL FORTICAL ANTIDEPRESSANTS ZOLOFT FOSAMAX amitriptyline FOSAMAX PLUS D amoxapine ANTIPSYCHOTICS MIACALCIN NASAL SPRAY bupropion aripiprazole PROLIA bupropion ext-rel chlorpromazine RECLAST citalopram clozapine clomipramine fluphenazine PREVENTIVE CARE SERVICES desipramine fluphenazine decanoate AGENTS FOR CHEMICAL DEPENDENCY doxepin haloperidol acamprosate calcium duloxetine delayed-rel loxapine buprenorphine sublingual escitalopram olanzapine buprenorphine/naloxone sublingual fluoxetine olanzapine orally disintegrating tabs disulfiram fluoxetine delayed-rel paliperidone naltrexone fluvoxamine perphenazine Depade imipramine HCl quetiapine ANTABUSE imipramine pamoate risperidone BUNAVAIL maprotiline thioridazine REVIA mirtazapine thiothixene SUBOXONE FILM nortriptyline trifluoperazine ZUBSOLV paroxetine HCl ziprasidone paroxetine HCl ext-rel ABILIFY ANTI-OBESITY AGENTS phenelzine ABILIFY MAINTENA benzphetamine protriptyline ARISTADA diethylpropion sertraline CLOZARIL diethylpropion ext-rel tranylcypromine EQUETRO phendimetrazine trazodone FANAPT phendimetrazine ext-rel trimipramine FAZACLO phentermine venlafaxine GEODON ADIPEX-P venlafaxine ext-rel HALDOL BELVIQ Irenka HALDOL DECANOATE CONTRAVE ANAFRANIL INVEGA QSYMIA APLENZIN INVEGA SUSTENNA REGIMEX BRINTELLIX INVEGA TRINZA SAXENDA CELEXA LATUDA SUPRENZA CYMBALTA REXULTI XENICAL EFFEXOR XR RISPERDAL ELAVIL RISPERDAL CONSTA SMOKING DETERRENTS EMSAM SAPHRIS bupropion ext-rel FETZIMA SEROQUEL nicotine polacrilex FORFIVO XL SEROQUEL XR nicotine transdermal IRENKA VERSACLOZ Buproban KHEDEZLA VRAYLAR CHANTIX LEXAPRO ZYPREXA NICODERM CQ MARPLAN ZYPREXA ZYDIS NICORETTE GUM NARDIL NICORETTE LOZENGE NORPRAMIN OBSESSIVE COMPULSIVE DISORDER NICOTROL INHALER OLEPTRO fluvoxamine ext-rel NICOTROL NS PAMELOR ZYBAN PARNATE OSTEOPOROSIS PAXIL alendronate Over-the-Counter (OTC) products require a prescription. PAXIL CR calcitonin Coverage may vary by plan. PEXEVA calcitonin/salmon PRISTIQ ibandronate

Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.

RESPIRATORY DISORDERS NULOJIX BIPHASIC PILLS RESPIRATORY AGENTS PROGRAF desogestrel/EE 0.15/20 budesonide suspension RAPAMUNE NECON 10/11 cromolyn sodium SANDIMMUNE montelukast ZORTRESS TRIPHASIC PILLS zafirlukast desogestrel/EE 0.1-0.025/ ACCOLATE MULTIPLE SCLEROSIS AGENTS 0.125-0.025/0.15-0.025 mg-mg ADVAIR glatiramer levonorgestrel/EE 0.05-30/ ADVAIR HFA AUBAGIO 0.075-40/0.125-30 mg-mcg AEROSPAN AVONEX norethindrone/EE 0.5-35/0.75-35/ ALVESCO BETASERON 1-35 mg-mcg ARNUITY ELLIPTA COPAXONE norethindrone/EE 0.5-35/1-35/ ASMANEX EXTAVIA 0.5-35 mg-mcg BREO ELLIPTA GILENYA norethindrone/EE 1-20/1-30/ DULERA LEMTRADA 1-35 mg-mcg FLOVENT DISKUS PLEGRIDY norgestimate/EE 0.18-25/0.215-25/ FLOVENT HFA REBIF 0.25-25 mg-mcg NUCALA TECFIDERA norgestimate/EE 0.18-35/0.215-35/ PULMICORT TYSABRI 0.25-35 mg-mcg QVAR SINGULAIR WOMEN'S HEALTH FOUR-PHASIC SYMBICORT ANTIESTROGENS NATAZIA SYNAGIS tamoxifen XOLAIR SOLTAMOX EXTENDED-CYCLE PILLS ZYFLO drospirenone/EE 3/20 ZYFLO CR AROMATASE INHIBITORS drospirenone/EE 3/30 anastrozole levonorgestrel/EE 0.1/20 SUPPLIES exemestane levonorgestrel/EE 0.15/30 SPACER DEVICES letrozole levonorgestrel/EE 0.15/30 and EE 10 SPACER SUPPLIES ARIMIDEX BEYAZ AROMASIN LO LOESTRIN FE FEMARA QUARTETTE VARIOUS CONDITIONS SAFYRAL ANTI-MALARIAL AGENTS CONTRACEPTIVES atovaquone/proguanil CONTINUOUS-CYCLE PILLS chloroquine EE = ethinyl estradiol ME = mestranol levonorgestrel/EE 0.09/20 mefloquine ARALEN LOW-DOSE MONOPHASIC PILLS PROGESTIN-ONLY PILLS MALARONE norethindrone 0.35 mg PRIMAQUINE desogestrel/EE 0.15/30 drospirenone/EE 3/30 EMERGENCY CONTRACEPTION DENTAL CARIES PREVENTION ethynodiol diacetate/EE 1/35 levonorgestrel/EE 0.1/20 and EE 10 levonorgestrel sodium fluoride levonorgestrel - Next Choice One Dose PEDIATRIC MULTIVITAMINS WITH levonorgestrel/EE 0.15/30 norethindrone acetate/EE 1/20 ELLA FLUORIDE - ALL MARKETED PLAN B ONE-STEP PRODUCTS norethindrone acetate/EE 1/20 and iron norethindrone acetate/EE 1.5/30 TRANSDERMAL PATCH HEREDITARY ANGIOEDEMA AGENTS norethindrone acetate/EE 1.5/30 and iron norelgestromin/EE 150-35 mcg/24 hr CINRYZE norethindrone/EE 0.4/35 norethindrone/EE 0.5/35 MISCELLANEOUS CONTRACEPTIVES IMMUNOSUPPRESSIVE AGENTS medroxyprogesterone acetate cyclosporine caps norethindrone/EE 0.8/25 chewable norethindrone/EE 1/35 150 mg/mL mycophenolate mofetil DEPO-SUBQ PROVERA 104 mycophenolate sodium delayed-rel norethindrone/EE 1/50 norethindrone/ME 1/50 DIAPHRAGM sirolimus FEMCAP tacrolimus norgestimate/EE 0.25/35 norgestrel/EE 0.3/30 LILETTA Gengraf MIRENA ASTAGRAF XL MINASTRIN 24 FE NEXPLANON CELLCEPT NUVARING ENVARSUS XR HIGH-DOSE MONOPHASIC PILLS ethynodiol diacetate/EE 1/50 PARAGARD T380A MYFORTIC SKYLA NEORAL norgestrel/EE 0.5/50

Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.

Preventive Therapy Options for High Deductible Health Plans Frequently Asked Questions

Background: Using Your High Deductible Health Plan Could Help You Save Money on Preventive Medications Your High Deductible Health Plan (HDHP) requires you to pay the full negotiated cost for your care until you reach your deductible for most health care expenses, including most prescription medications. After you meet the deductible, you pay only the copay* or coinsurance and your plan pays the rest.

If you are enrolled in a HDHP using medications on the preventive drug list will reduce your cost for select prescriptions that help prevent chronic health conditions when taken regularly. If you take medications on the preventive medication therapy list, you will pay only the copay or coinsurance for these medications even if you have not yet met your annual plan deductible.

To view a list of preventive care medications covered by this program, please refer to your Summary Plan Description. You can feel confident that the medications on the list have been approved by the U.S. Food and Drug Administration (FDA) for safety and effectiveness. Medical conditions that fall under this plan have been qualified by the Internal Revenue Service (IRS).

Below are answers to some of the questions you may have about the Preventive Therapy Options program.

General Questions:

Q1: What is an integrated (or combined) medical and pharmacy high deductible health plan? A1: Your integrated medical and pharmacy high deductible health plan is a health care coverage plan that has a single combined pharmacy and medical deductible that must be met before your plan will cover services and/or prescriptions. The deductible is usually pre-determined by your plan and/or health care providers.

Q2: How do I know if I (or my family) can participate in the Preventive Therapy Options program? A2: To participate in this program in 2015, the combined medical and prescription deductible for your high deductible health plan must be at least $1,300 per year for individual coverage, or $2,600 per year for family coverage. Keep in mind that your deductible may change each calendar year.

Q3: What is a preventive care medicine? A3: Preventive care medications are those taken regularly to prevent certain health conditions. They are: Taken by a someone who has developed risk factors for a disease or condition that has not yet become a health issue; Taken to prevent a disease or condition that is no longer showing symptoms from occurring again; and

*Copayment, copay or coinsurance means the amount a plan member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. ©2014 Caremark. All rights reserved. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. 106-21371a 071814

Used as part of procedures providing preventive services (e.g., obesity, weight loss and tobacco cessation programs).

All preventive care medications are approved by the FDA for safety and effectiveness.

Q4. Does my prescription benefit plan qualify preventive medicines differently than non-preventive? A4: Yes. Approved preventive care medications are excluded from your deductible. That means when you fill a prescription for a medicine used for preventive purposes, it will be covered as if you already met the deductible. You will only be responsible for either a copay or coinsurance.

Q5: Why am I allowed to pay a copay for my medications before meeting my deductible? A5: Your plan sponsor understands that it is important for you to have access to preventive medicines to help maintain your health. By making this change to your plan, your plan sponsor has removed a cost barrier to help make your medicines more affordable.

Q6: How can I find out if the prescription(s) I am currently taking are considered to be for “preventive care?” A6: To find out which medications are considered to be for preventive care, please refer to benefit Summary Plan Description.

CVS/caremark Preventive Therapy Options Frequently Asked Questions for Clients

Preventive Therapy Options – Background Preventive Therapy Options – Consumer Directed Health Plan Design CVS/caremark takes a consumer-centric approach to health care. We actively promote prevention and health management, educating plan members to improve adherence and to encourage involvement in their total health care. Our Preventive Therapy Options program is another health care tool that clients can implement to help encourage positive member behavior, increase compliance and lower overall health costs.

The CVS/caremark Preventive Therapy Options Program involves prescription drugs that have been approved by the U.S. Food and Drug Administration to be used in the prevention of various medical conditions as defined by the Internal Revenue Service (IRS). Some of the prescription medication options may be prescribed for a non-preventive purpose under some circumstances, but are prescribed for preventive indications the majority of the time.

The CVS/caremark Preventive Therapy Options Program is available to clients at their direction.

These FAQs have been created to help you better understand this drug list.

Preventive Therapy Options – General Questions

Q1: When can the CVS/caremark Preventive Therapy Options Program be used? A1: According to the "Preventive Care Safe Harbor" guidance provided by Internal Revenue Code NOTICE 2004-23 SECTION 223 (c)(2)(C), a Preventive Therapy Options Program can be used in conjunction with a health savings account (HSA)-compatible high deductible health plan (HDHP). These plans are available today as long as the HDHP has a single combined deductible for medical and pharmacy.

Q2: Why did Congress allow prescription drugs that are deemed to be preventive in nature to bypass the required deductible in an HSA-compatible integrated medical and pharmacy high deductible health plan (HDHP)? A2: The Medicare Modernization Act of 2003 (MMA) was intended to cost-effectively improve quality of health care by, among other things, introducing a high deductible health plan that can be paired with a financial vehicle for accumulating savings, all while continuing to cover and encourage the use of preventive medical services to reduce the need for chronic care.

Pharmaceutical therapy is a recognized and valuable form of preventive care. MMA emphasizes preventive care in order to help beneficiaries maintain their health and pre-empt the need for costly chronic care. Supporting this intention, HDHP guidelines stipulate that preventive care – including pharmaceuticals used for preventive purposes – can be excluded from the deductible.

Q3: When did the IRS release the “Preventive Care Safe Harbor” guidance? A3: The guidance was released in March 2004. Additional clarification for prescription drugs was released in July 2004.

Q4: How does the IRS define preventive care with respect to prescription drugs? A4: According to the guidance in Internal Revenue Code NOTICE 2004-50 Q&A 27, drugs used to prevent an illness can be covered before the HDHP deductible is met. Such drugs, however, must meet at least one of the following conditions: (i) taken by a person who has developed risk factors for a disease that has not yet manifested itself (i.e., is asymptomatic) or (ii) to prevent the reoccurrence of a disease from which the person has recovered. Preventive care does not

©2014 Caremark. All rights reserved. This document contains confidential and proprietary information of CVS/caremark and cannot be reproduced, distributed or printed without written permission from CVS/caremark. 106-11323b 071814 Page 1 of 3

include drugs for treatment of an existing illness or condition. In addition, drugs or medications used as part of procedures providing preventive care services specified in Notice 2004-23, including obesity weight loss and tobacco cessation programs, are also preventive care.

Q5: Where can I obtain a copy of the IRS guidelines for preventive care? A5: You can find the Internal Revenue Service Notice online at http://www.treas.gov/offices/public- affairs/hsa/technical-guidance/.

Q6: What is an integrated medical and pharmacy high deductible health plan? A6: An integrated medical and pharmacy high deductible health plan is a health care coverage plan that has a single combined pharmacy and medical deductible that must be met before the plan will cover services and/or prescriptions. The deductible is usually pre-determined by the plan and/or health care providers.

For calendar year 2015, a HDHP is defined as a health plan with an annual deductible set at a minimum of $1,300 for individual coverage or $2,600 for family coverage, and the annual out-of- pocket (OOP) expenses (deductibles, copayments and other amounts, but not premiums) do not exceed $6,600 for individual coverage or $13,200 for family coverage. The required HDHP minimum deductible and maximum OOP dollar amounts may vary each calendar year.

HDHPs may have first-dollar coverage (no deductible) for preventive care medical services and prescriptions.

Q7: Can CVS/caremark administer a Preventive Therapy Options Program in conjunction with an integrated HDHP? A7: Yes. CVS/caremark can support a client’s desire to carve out these types of prescriptions from the required deductible under an HSA-compatible high deductible health plan for all claim types.

Q8: In general, how are prescription drugs that are deemed preventive adjudicated during an integrated medical and pharmacy HDHP? A8: If a plan benefit is attached to a Preventive Care Drug List, any drug on the list that is transmitted to the CVS/caremark adjudication system will be processed at the appropriate copay or coinsurance, as if the deductible had been met. All other drugs that are covered under the plan benefit would be subject to the deductible until it is met.

Q9: What are the benefits to clients and their members if a Preventive Therapy Options Program is used in conjunction with an integrated HDHP? A9: CVS/caremark understands the importance of drug therapy as a critical part of physicians' recommended treatment programs for preventing the onset of disease or preventing the reoccurrence of a disease state. The benefits of implementing a Preventive Therapy Options Program in conjunction with a HDHP include: • Helping members to stretch pre-tax funds • Encouraging members to obtain and take prescriptions as prescribed • Reducing the risk of medical utilization due to sub-optimal plan participant adherence of prescription medications • Improving member perception of the HDHP offering because needed preventive care medications will be available at the appropriate copay or coinsurance and not subject to the deductible (first-dollar coverage) • Limiting plan participant disruption in converting from a traditional benefit plan to an HDHP

Q10: What was the approval process for the drugs that are part of the Preventive Therapy Options Program? A10: CVS/caremark worked with internal clinicians, including physicians and pharmacists, to develop a template list of preventive care drugs. Clinicians were asked to evaluate suggested drug classes to ensure that the indications for which the drugs are commonly prescribed are of a preventive nature within the meaning of the letter and spirit of the guidance provided by the IRS.

Each drug within the suggested classes was then reviewed for inclusion on the template list. The drug list also underwent external clinical validation. Evaluation and approval did not consider costs or formulary status.

Q11: Can clients customize the drugs that are part of the Preventive Therapy Options Program? A11: Yes. Clients can choose to remove or add specific drug classes or drugs that are considered “preventive” and therefore coded to bypass the deductible.

Q12: Are there any potential liabilities from an IRS/taxation perspective? A12: Yes. There appears to be potential liability from an IRS and tax perspective. Clients should consult with their own tax and benefits advisors prior to implementation to make a risk assessment and to be sure that their preventive care drugs meet the plan’s needs and can be administered by CVS/caremark for the plan.

Q13: Are plan sponsors ultimately liable for meeting the IRS guidelines? A13: Yes.

Q14: Will clients implementing a Preventive Therapy Options Program be required to sign a contract addendum prior to implementing the program? A14: Yes.

Preventive Therapy Options – Contact Information

To learn more about how CVS/caremark Preventive Therapy Options can work for you, contact your CVS/caremark Account Representative.

The ExtraCare Health Card oﬀ ers a 20 percent discount1 on thousands of CVS/pharmacy Brand, health-related items. Use your ExtraCare Health Card at any CVS/pharmacy store nationwide, or create an account with your ExtraCare Health Card number to shop online at CVS.com. Eligible items are clearly marked on CVS.com. The following are examples of some of the categories and items eligible for the ExtraCare Health discount.2

Allergy Remedies Baby Care First Aid • Decongestant • Diaper Rash Ointment • Rubbing Alcohol • Allergy Relief • Digital Thermometer • Adhesive Strips • Loratidine (compare to Claritin®) • Dressings • Cetirizine (compare to Zyrtec®) • Anti-Bacterial Ointment • Hydrocortisone Cream • Burn Relief • Cotton Gauze • Hand Sanitizer Cough and Cold • Hot and Cold Packs • Cough Suppressant • Peroxide • Cough Drops Pain Relievers • Pain Relieving Patches • Acetaminophen • Anti-Bacterial Wipes • Aspirin • Cold and Flu Relief • Children’s Aspirin • Cold and Sinus Relief • Migraine Relief • Children’s Cold and Allergy Elixir • Ibuprofen • Decongestant • Naproxen • Digital Thermometer • Nasal Spray

This page contains references to brand-name prescription drugs • Lozenges that are trademarks or registered trademarks of pharmaceutical manufacturers that are not aﬃ liated with CVS Caremark. Discount-Eligible Items (cont.)

Home Diagnostics Oral Hygiene Stomach Remedies • Alcohol Preps • Anti-Plaque Mouthwash • Antacid • Glucose Test Strips • Oral Anesthetic • Acid Reducer • Gauze Pads • Dry Mouth Relief • Fiber Supplements • Needles • Cold Sore Treatment • Laxatives • Auto-Injectors • Motion Sickness Relief • Blood Pressure Cuﬀ • Pink Bismuth • Glucose Meter • Lancets • Glucose Tablets • Pedometer Eye and Ear Care • Contact Lens Solution • Eye Drops • Pink Eye Relief Vitamins and Supplements • Ear Wax Remover • Multivitamin Supplement Tablets • Ear Plugs • Vitamin C Nicotine Replacements • Calcium • Nicotine Gum • Vitamin D • Nicotine Patches • Ginko Biloba • St. John’s Wort

1 The 20 percent discount is restricted to eligible items purchased for the health care of the cardholder, spouse or dependents. 2 This list is not all inclusive and is subject to change.

Maximize Generic Use through Plan Design

CVS Caremark clients who have adopted DAW plan designs promoting generics as first-line therapy can expect to save up to 1.5% of gross pharmacy cost. Our low cost drug plan designs encourage prescribers and plan members to use cost-effective FDA “A”-rated generic equivalents when available. DAW (for ‘Dispense as Written’) plan designs require the member to pay the difference between a brand drug and the generic equivalent in addition to the usual brand copay if a brand is dispensed when a generic equivalent is available.

Only 10% of physicians are aware of the cost of a drug to the member, and most think it is the pharmacist’s job to address this cost. However, 70% of their patients do not know the cost of their prescription before payment is requested, and 60% of patients without prescription coverage don’t talk to physicians about cost.2 DAW plan designs increase prescriber Clients who have adopted awareness of generics and member awareness of costs. Prescribing DAW Plan Designs can generics to members who are new to therapy increases their likelihood expect to save up to 1.5% of reaching optimal adherence.2 of gross pharmacy cost.1

There are two types of DAW plan design rules applied to prescription claims marked as DAW 1, DAW 2, or both that require members to pay a financial penalty when a generic equivalent is available. DAW 1 means the prescriber writes “Dispense as Written” on a prescription indicating that a generic equivalent should not be substituted for the brand. DAW 2 means that a member is requesting the brand and that (s)he does not want the generic equivalent even though the prescriber allows substitution.

Balancing Prescriber and Member Satisfaction Our core low cost drug plan designs seek to educate both members and prescribers to improve generic utilization. The DAW plan designs include all brands that have a generic equivalent available. continued DAW Plan Design Example at Retail Product Drug Cost Standard Copay Multi-Source Brand $90 $20 Generic $30 $5 • If the member or prescriber requests the brand when a generic equivalent is available, the copay is $80 ($20 plus $60, the cost di erence between the brand and generic). • If the prescriber or member accepts generic conversion, the copay is $5 (member savings of $75).

Daw Solutions Mail DAW 1 CVS Caremark will contact prescribers via fax or telephone to determine if we can substitute the generic for brand medications at mail service. These interventions occur for prescriptions that were written “Dispense as Written” by the prescriber. Mail DAW 2 CVS Caremark will contact members via telephone to determine if we can substitute the generic equivalent for the requested brand medication. These interventions occur for prescriptions that were Members have access to written by the prescriber to allow for generic substitution, but the member Customer Care for help requested the brand. in understanding DAW Retail DAW 2 In our network of more than 64,000 retail pharmacies, plan design features or pharmacists are required to substitute brands with generic equivalents as to speak to a pharmacist. allowed by state and federal law. In our more than 7,200 CVS/pharmacy locations, pharmacists will identify generic substitution opportunities and educate members with face-to-face counseling to help them make cost- eff ective decisions.

Results from DAW Solutions Outreach

25% Generic Conversion Success Rate 5% MAIL DAW 1 MAIL DAW 2 INTERVENTIONS INTERVENTIONS

Source: CVS Caremark Enterprise Analytics Evaluation of DAW Solutions, R284, 2010.

1 Source: Projections based on CVS Caremark data. Individual results will vary based on plan design, formulary status, demographic characteristics and other factors. Client-specifi c modeling available upon request. 2 Source: www.silverlink.com, accessed June 11, 2009. caremark.com