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Proving What’s Possible in Healthcare <br />This document contains important terms and conditions which are incorporated by reference into and becomes <br />part of the terms of your contract with us. ©2024, Healthcare Management Administrators, Inc. <br />18 <br />Rebates as follows are for clients on our contract and <br />are effective January 2025 –December 2025.* <br />Pharmacy Benefits <br />*Please Note: <br />•Other fees, terms and conditions apply –please see the CVS/Caremark Add’l Fees, Pricing, and Terms & Condition section. <br />•Please see Participating Group Agreement and supplement documents for full Terms and Conditions. <br />•Standard implementation requires a minimum of 100 days prior written notice. PrudentRx requires a minimum of 130 days prior <br />written notice. <br />Rebates <br />Standard Control Choice Formulary 2 Tier Qualifying, 3 Tier Non-Qualifying, & 3 <br />Tier Qualifying (per brand claim) <br />Retail $365.00 <br />Specialty at Retail $365.00 <br />Mail/Maintenance Choice $789.00 <br />Specialty at CVS Health Specialty $3690.00 <br />Advanced Control Specialty at CVS Health Specialty $3763.00 <br />Advanced Control Choice Formulary 2 Tier Qualifying, 3 Tier Non-Qualifying, & 3 <br />Tier Qualifying (per brand claim) <br />Retail $372.00 <br />Specialty at Retail $372.00 <br />Mail/Maintenance Choice $804.00 <br />Advanced Specialty at CVS Health Specialty $3763.00 <br />Basic Control Formulary 2 Tier Qualifying, 3 Tier Non-Qualifying, & 3 <br />Tier Qualifying (per brand claim) <br />Retail $310.00 <br />Specialty at Retail $310.00 <br />Mail/Maintenance Choice $670.00 <br />Specialty at CVS Health Specialty $3136.00 <br />Advanced Control Specialty at CVS Health Specialty $3763.00 <br />Standard Opt-Out Formulary 2 Tier Qualifying, 3 Tier Non-Qualifying, & 3 <br />Tier Qualifying (per brand claim) <br />Retail $292.00 <br />Specialty at Retail $292.00 <br />Mail/Maintenance Choice $631.00 <br />Specialty at CVS Health Specialty $2952.00 <br />Advanced Control Specialty at CVS Health Specialty $3763.00 <br />Pricing for Specialty drugs listed on CVS’s Specialty Fee Schedule <br />Discount Rate <br />Exclusive AWP -21% <br />Open AWP –17% <br />New to Market Brand & Generic Drugs AWP -15% <br />New to Market limited and exclusive distribution drugs AWP –10% <br />Dispensing fee $0.00 <br />Rates as follows are for clients on our contract and <br />are effective January 2025 –December 2025.* <br />Specialty Drugs”means certain pharmaceuticals,biotech or biological drugs (including “biosimilars”or “follow-on <br />biologics”)that are Covered Products and that are defined by CVS Caremark,that are used in the management of <br />chronic,complex,rare or genetic disease,including but not limited to,injectable,infused,inhaled or oral medications,or <br />products that otherwise require special handling,including without limitation those on CVS’s Specialty Fee Schedule <br />(which CVS Caremark may amend from time to time).The rates quoted herein apply to Specialty products dispensed <br />from CVS Specialty mail pharmacies,including through the Specialty Connect process.