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 •Each Participating Group shall have sole financial responsibility for the payment of Claims for benefits rendered. •Payments not received shall bear a service fee of one percent (1%) per month (or, if less, the highest rate allowed by law), from the due date until paid in full. •Participating Group shall provide CVS/Caremark with a current and accurate copy of the Plan Document, concerning Plan design, prescription drug benefit planning, eligibility, benefits to be provided, limitations and claim review and procedures. •Participating Group acknowledges that Participating Group’s use of the Program may impact the Agreement and underwriting assumptions, including Rebates. •Neither your Administrator nor CVS Caremark will be liable for any loss, expense, cost, liability, damages or claims incurred by Participating Group as a result of Participating Group’s Program, including but not limited, to the IRS’ disallowance of any drug claim that bypassed a HDHP deductible through Participating Group’s Program. •Participating Group accepts and adopts the Preventive Care Drugs List as a part of Participating Group’s plan design to be administered by CVS Caremark. •Financial Responsibility. If at any time during the Plan term, Participating Group fails to comply with the payment terms as set forth in related agreements and the Participating Group Agreement on three (3) or more occasions within a four (4) month period, then CVS Caremark may request information, reasonable assurances or both from Participating Group as to Participating Group’s financial responsibility (including a deposit in an amount equal to two (2) billing cycles based upon the average of the last three (3) months of billing history). Specialty: •Non-specialty medications dispensed by the specialty pharmacy will receive standard retail 30-day supply rates. •Prior Authorization, $30.00 per PA; fee doesn’t apply to specialty drug claims when Participating Group with Exclusive CVS Specialty pharmacy elects Specialty Guideline Management (SGM) program. •Instances in which Administrator's Participating Groups elect Exclusive Specialty, CVS Specialty mail pharmacies, including Specialty Connect, will be the exclusive provider of specialty pharmacy services. Claims for specialty products will not be processed through the retail network, except for those specialty drugs that CVS Specialty mail pharmacies are unable to dispense. •Limited Distribution Drug” means a Covered Drug that is distributed by a limited number of specialty •pharmacy providers as determined by exclusive or preferred vendor arrangements with the pharmaceutical •Manufacturer. •In the event of an industry-wide product shortage, CVS Caremark reserves the right to adjust pricing upon notice to the Participating Group. Specialty Per Diems: •Remodulin, Veletri, Flolan, Epoprostenol Sodium & Treprostinil Sodium & Zulresso for Injection: $60 per day. •Ventavis: Participating Group acknowledges and agrees an I-Neb is necessary for the administration of Ventavis. •For each I-Neb provided to Plan Participant, upon the initiation of therapy or in the event a replacement 1-Neb is necessary, Participating Group shall reimburse CVS Caremark $1,811 for each I-Neb. •Unless otherwise stated above: $75 per dose. •Nursing Charges: $225.00 per visit up to 2 hours, $110.00 for each hour thereafter. •Alternatively, CVS Caremark can refer any medically necessary nursing services to the Participating Group’s contracted nursing agency, in which case nursing services will be billed separately by those agencies. * Please Note: •Please see Participating Group Agreement and supplemental documents for full Terms and Conditions 26 Additional Terms and Conditions as follows are for clients on our contract and are effective January 2025 –December 2025. Pharmacy Benefits