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. . 2025 additional pricing, terms and conditions: •Participating Groups may not have any direct or indirect agreement or arrangement with any pharmaceutical company or other third party related to any rebates or discounts. •Participating Groups acknowledge that CVS Caremark shall be the exclusive PBM and related PBM services. •Participating Group will be required to sign a Participating Group Agreement which allows CVS Caremark and us to act on behalf of the Participating Group and engage with CVS Caremark as the pharmacy benefits manager (PBM). •Participating Group’s retail networks include the CVS National Network as well as the CVS Caremark Retail-90 Network as its. In the instance where a Participating Group chooses the Retail-90 Network in place of the National Network, the following shall apply: The CVS Caremark Retail-90 Network is a subset of the National Network which provides a flexible option of a nationwide network of retail pharmacies that can fill up to a 90 days’ supply of medications. CVS Caremark Retail-90 Network pricing is applicable for non-specialty claims equal to or greater than an 84 days’ supply filled by a participating CVS Caremark Retail-90 Network pharmacy. Claims up to the Participating Group’s qualified retail days’ supply plan design limits can be filled at any participating pharmacy. Claims greater than Participating Group’s qualified retail plan design limits shall only be filled by a CVS Caremark Retail-90 Network pharmacy. Implementation of Maintenance Choice and/or a mandatory plan design may limit the implementation of this offering. •The participating pharmacy may collect from the member the lowest of the discounted cost, applicable cost share, or the participating pharmacy’s usual and customary price. •All pricing in this document is available to our new clients that become Participating Groups on and after the effective date of this document and to existing Participating Groups on the effective date. •If a Participating Group terminates either their PBM contract thru us or terminates with us altogether, and has passed runout, the Participating Group will be responsible for paying directly to CVS Caremark any Medicare or Medicaid claims that are billed up to three (3) years after date of service. •Custom mailing requests to assist a Participating Group on a plan participant mailing project, current postage rate could apply. •If elected by Participating Group, CVS Caremark may provide to Plan Participants filling prescriptions at Participating Pharmacies discounts on prescription drugs that are not Covered Products. Claims that process with such discounts are excluded from any and all commitments CVS Caremark may have to Participating Groups under this agreement including those relating to pricing, rates or rebates. The Participating Group acknowledges that CVS Caremark will retain rebates, if any, and charge Plan Participant fees that may be part of a Plan Participant’s prescription price for claims processed through this program to assist CVS Caremark in funding this program. •Appeals: Determination of Prescription Benefit Coverage and Eligibility; Independent Physician Specialist Review or IRO (Independent Review Organization) External Review (See Appeals FeeTable) •Participating Group requested audits are not available under our Caremark Agreement. Any client requests for individual audits of Caremark may be considered on a case-by-case basis subject to Caremark’s approval. If such request is approved, Participating Group must pay any fees assessed by Caremark and pay for a Caremark- approved independent auditor. •In the event Participating Group terminates Administrative Services Agreement with us, we may use pharmacy rebates as a set-off against amounts due to us from Participating Group or may delay remittance of these rebates to allow for final adjustments. •Participating Group acknowledges that CVS Caremark provides an administrative credit to us in compensation for the services provided including enrollment processing, invoice processing and customer service among other duties. We have credited the Medical Administration fee by $2.00 PEPM under this acknowledgement. We have also considered the receipt of this administrative allowance in the calculation of the Plan’s TPA fees. *Please Note: •Please see Participating Group Agreement and supplemental documents for full Terms and Conditions 24 Additional Terms and Conditions as follows are for clients on our contract and are effective January 2025 –December 2025.* Pharmacy Benefits