Healthcare Management Administrators (HMA) 2/20/2025

Proving What’s Possible in Healthcare This document contains important terms and conditions which are incorporated by reference into and becomes part of the terms of your contract with us. ©2024, Healthcare Management Administrators, Inc. Pharmacy Benefits* Pharmacy Pricing and Fee Components Retail Non-Specialty Pharmacy –National Network PPO or HDHP National Network Brand Discount AWP –19.00% Retail 90 Day Network Brand Discount AWP –19.25% Generic -Flat Discount AWP –86.00% Dispensing Fee National Network-Brand and Generic per Claim $0.40 Dispensing Fee Retail 90 Day-Brand and Generic per Claim No Dispensing Fee Mail Order/Maintenance Pharmacy PPO or HDHP Brand-Flat Discount AWP –25.00% Generic -Flat Discount AWP –88.50% Dispensing Fee Brand and Generic per Claim No Fee Specialty at Retail PPO or HDHP Brands AWP –17.5% + $0.40 Dispensing Fee Generic AWP –40.00% + $0.40 Dispensing Fee Specialty at Retail Limited Distribution Drugs (With & Without Access)AWP –10.00% + $.0.40 Dispensing Fee Client-Owned Pharmacies PPO or HDHP Brand Pass Through Rates and Fees Generic Pass Through Rates and Fees Dispensing Fee Pass Through Rates and Fees Mail/Maintenance Choice PPO or HDHP Brand AWP-19.50% Flat Generic Discount AWP-91.75% Dispensing Fee (Brand & Generic)$0.00 per claim Administrative Fees PPO or HDHP Client Owned Pharmacy Administration Fee $1.50 per claim Electronic Claim Administration Fee $0.00 per claim Manual Claim Administration Fee $1.50 per claim 17 *Please Note: •Other fees, terms and conditions apply –please see the CVS/Caremark Add’l Fees, Pricing, Terms & Condition section. •Please see Participating Group Agreement and supplement documents for full Terms and Conditions. •Standard implementation requires a minimum of 100 days prior written notice. PrudentRx requires a minimum of 130 days prior written notice. CVS Health is one of the largest Pharmacy Benefit Managers in the United States and one of the leading PBMs in the self-funded insurance industry. We contract with CVS/Caremark to offer high-quality affordable prescription benefits. Clients may choose between a range of formularies designed to address each client’s benefits strategy and deliver the lowest net cost. Effective in January 2024, CVS Health partnered with GoodRx to introduce a new Cost Saver program. This program is included at no cost to the client or member and runs as a behind-the-scenes, real-time program so the member receives the lowest net price while at a network pharmacy on a selection of medications.Rates as follows are for clients on our contract and are effective January 2025 –December 2025.*