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. CVS Formularies ( high-level descriptions) : •Standard Opt-Out: The most open formulary that CVS Caremark offers. This formulary less rebates in exchange for a broader list of available drugs covered under the formulary. •Basic Control: Formulary option that is slightly more restrictive than Standard Opt-Out. Offers more rebates, but less drugs are covered under the formulary. •Standard Control Choice: CVS Caremark’s standard formulary that offers optimum rebate savings, but a balance of drugs covered under the rebate. •Advanced Control Choice: Most restrictive formulary CVS Caremark has to offer. This formulary offers the most rebate savings and less coverage of drugs on the formulary. The formularies above, with the exception of the Standard Formulary Opt-Out, include certain preferred brand drugs where the Tier 1 cost share shall be assessed to members. CVS publishes quarterly updates to each formulary. Formulary Terms and Conditions: Step Therapy: •Participating Group shall adopt CVS Caremark’s generic step therapy plans (hereinafter referred to as the “GSTP Program”), as amended from time to time by CVS Caremark, as part of its Plan design. •Participating Group receiving the GSTP pricing directs CVS Caremark to implement the coverage limitations, generic substitutions, step-therapies or prior authorizations for the therapeutic classes as identified in the PDD. •Participating Group receiving the GSTP pricing above fails to adopt the GSTP Program conditions or otherwise qualify for the GSTP Program, then CVS Caremark reserves the right to modify the financial terms of this Agreement, including any financial guarantees. •Participating Groups will need to approve any amendments on any Plan documents, as it deems appropriate, to reflect the GSTP Program as part of its benefit. Voluntary Maintenance Choice: •Participating Group’s who adapt the voluntary Maintenance Choice Program requires a plan design that requires Cost Share for Maintenance Choice Prescription to be the same or similar as the Cost Share (copayment or coinsurance) for the same days’ supply at mail to provide an incentive for participants to move to a 90-day supply, allows CVS Caremark to communicate with plan participants regarding the benefits of moving to a 90-day supply consistent with the plan design and limits the ability of participants to receive 90-day supplies to CVS Caremark Pharmacy retail locations and CVS Caremark mail service only. •The Program applies only to “Maintenance Choice Prescriptions”. •Pricing discounts and dispensing fees will be the same whether the plan participant fills their prescription at a retail location or in mail order. •CVS Caremark may modify or suspend the Program with written notice to the Participating Group. Maintenance Choice All Access: •Maintenance Choice All Access provides plan participants with prescription delivery from a local CVS Retail pharmacy at a reduced rate. •Participating Groups will receive a program credit from CVS Caremark which will be applied to reduce the delivery fee charged by CVS Caremark Pharmacy. •The program credit shall constitute and shall be treated as discounts against the price of drugs within the meaning of 42 U.S.C 1320a-7b •Pricing discounts and dispensing fees will be the same whether the plan participant fills their prescription at a retail location or in mail order. •CVS Caremark will provide Participating Group with an additional discount off the price of drugs dispensed under the Agreement (the “Program Credit”). •Participating Group agrees to allow CVS Caremark to communicate with Plan Participants regarding the features of the Program. Retail Network: •National Network as well as the CVS Caremark Retail 90 Network is available for Participating Groups. * Please Note: •Please see Participating Group Agreement and supplement documents for full Terms and Conditions. 22 Additional Terms and Conditions as follows are for clients on our contract and are effective January 2025 –December 2025.* Pharmacy Benefits