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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 />2025 additional pricing, terms and conditions <br />Definitions: <br />“Rebates” means the formulary rebates received by CVS Caremark from various pharmaceutical companies whether <br />directly or indirectly including in CVS Caremark’s capacity as a group purchasing organization for the Plan that are <br />attributable to the utilization of Covered Products by Plan Participants. <br />“Brand Drug” shall mean drugs or devices for which the Medi-Span Multisource Code field contains “M” (co-branded <br />product), or “N” (single source brand), or “O” (originator). For purposes of adjudication, in limited circumstances, CVS <br />Caremark may override the M, N, or O indicators and deem the drug to be a Generic Drug after a review of additional <br />information including other Medi-Span data, FDA application data (NDA/ANDA) and price. <br />“Generic Drug” shall mean drugs or devices for which the Medi-Span Multisource Code field contains a “Y” (generic). <br />Claims with DAW 5 code (“House Generics”) shall also be classified as Generic Drug Claims. For purposes of <br />adjudication, in limited circumstances, CVS Caremark may override the M, N, or O indicators and deem the drug to be <br />a Generic Drug after a review of additional information including other Medi-Span data, FDA application data <br />(NDA/ANDA) and price. <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, <br />or products that otherwise require special handling, including without limitation those listed on CVS’s Specialty which <br />CVS Caremark may amend from time to time.” <br />"3408 Claim" means a Claim identified by the submission of "20" in any of the Submission Clarification Code fields <br />and/or a Claim submitted by pharmacy owned by a covered entity, as defined in Section 340B(a)(4) of the Public <br />Health Services Act, whose 340B status is coded as "38" or "39" in the NCPDP DataQ database. 1.32. <br />"Specialty Connect" means a convenience offering of CVS Caremark where, subject to applicable law, a Plan <br />Participant may submit a Specialty Drug prescription to a CVS Specialty Pharmacy through any CVS retail pharmacy. In <br />addition, where permitted by law, CVS Specialty Pharmacy prescriptions can be picked up at any CVS retail <br />pharmacy." <br />“Biosimilar” means a biological product that is highly similar to a biological product already approved by the FDA (i.e. <br />reference product) and is licensed and approved by the FDA as a Biosimilar notwithstanding minor differences in <br />clinically inactive component but otherwise no meaningful differences between the biologic product and the reference <br />products in terms of safety, purity and potency of the product. <br />* Please Note: <br />•Please see Participating Group Agreement and supplemental documents for full Terms and Conditions <br />23 <br />Additional Terms and Conditions as follows are for clients on our contract and <br />are effective January 2025 –December 2025. <br />Pharmacy Benefits