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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 />21 <br />Core Clinical Services and Programs** <br />**Please note that all items are available but will need to be opted in to by the Participating Group. <br />Description Cost <br />Formulary Management No Additional Cost <br />Safety Programs <br />POS Safety Review No Additional Cost <br />Retrospective Safety Review with Pharmacy Claims No Additional Cost <br />Physicians Profiling Report No Additional Cost <br />POS Utilization Management, Dose Optimization, Quantity Limit, Step Therapy No Additional Cost <br />Savings Programs <br />Comprehensive Generics Solutions, DAW Solution 1 and or 2, Value Drug <br />Savings Tool, DAW Penalty <br />No Additional Cost <br />POS Preferred Product Messaging No Additional Cost <br />Generic Step Therapy (Prior Auth fee will apply)No Additional Cost <br />Pharmacy Advisor No Additional Cost <br />Pharmacy Advisor Support: Adherence No Additional Cost <br />Pharmacy Advisor Support: Ready Fill at Mail No Additional Cost <br />Pharmacy Advisor Support: Closing Gaps in Medication Therapy No Additional Cost <br />Pharmacy Benefits <br />Additional Fees as follows are for clients on our contract and <br />are effective January 2025 –December 2025.* <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 />CVS Caremark has partnered with PrudentRx to deliver additional savings on specialty drugs.PrudentRx is a vendor that <br />uses a coinsurance flat rate of 30% for all specialty medications exclusively dispensed by CVS Specialty Pharmacy, ensuring <br />clients pay a lower cost and members pay $0.00 out of pocket. <br />PrudentRx works in conjunction with CVS Caremark’s Advanced Control Specialty Formulary (ACSF) to offer the most optimal <br />savings for clients.The ACSF is required for opting in to PrudentRx.This is not required at the time of implementation and <br />can be implemented as a stand alone at each quarter of the year (January, April, July, October) and takes 90 days to <br />implement. <br />Caremark Cost Saver The pricing in this document assumes the use of the Caremark Cost SaverTM program, under which <br />CVS Caremark may compare the price available under the CVS Caremark contracted network with the price available <br />through a non-CVS Caremark contracted network if available for that pharmacy. If the price is lower through a non-CVS <br />Caremark contracted network (including an administrative fee paid to the third-party that contracts the network), the Claim <br />will be processed through that network. These Claims are included in the reconciliation of all financial guarantees. In these <br />instances, the generic drug prescription through retail may be less than the same generic drug, dosage form, and dose <br />through mail on the same day of adjudication. <br />Specialty Drug Savings Program: PrudentRx