Prescription Benefits

TML IEBP's Pharmacy Benefit Manager is CVS/Caremark. Ineligible prescription drugs may receive Pharmacy Benefit Manager's discount, reducing the covered individual's out of pocket expenses. CVS/Caremark the nation's largest pharmacy chain with the leading pharmaceutical service company. CVS/Caremark creates the opportunity to deliver unique products and services that will help manage costs for clients and improve access and choice for consumers.

Over time you will have access to greater information and choices, and enhanced personal interaction with pharmacists either through the phone and in-person at CVS stores, making it easier to adhere to prescription requirements and get information about healthcare choices.

You can continue to use the participating retail pharmacies and Caremark mail service that you do today. Continue to use your same identification card, toll-free number and the Caremark.com website.

• Caremark: www.caremark.com
  The homepage of Caremark allows you to search for pharmacies and refill prescriptions online.
• To take a Site Tour of the Caremark website, please click this link: http://www2.caremark.com/sitetour/
• Caremark MAC list: The maximum allowable cost (MAC) list.
• Caremark Performance Drug List:
  The Caremark Performance Drug List contains preferred brand and generic drugs that help physicians identify products that help maximize clinical results and economic value. The list is also available at http://www.druglist.com/
• Caremark SpecialtyRx
  • Specialty Rx List -- effective October 1, 2008
  • Caremark Specialty Rx Referral Form: A form Providers use to refer patients to the Specialty Rx program.
• Mail Order Prescription Form
• Prescription Claim Form

Prescription Card Program

To improve the quality and cost management of pharmacy care, some innovative services may capitalize on clinical strengths, data capabilities and provider partnerships. The prescription therapeutic service specializes in prescriptions and supplies for medical diagnoses. A multitude of prescription plan options are available for the employer. Some of the options include: brand/generic copay plan, three-tiered copay plan, benefit percentage plan, medical benefit pass through plan and a generic incentive plan. TML IEBP administers a multitude of prescription programs that include retail and mail service copay plans, benefit percentage with deductible plans. Integrated Mail Service Program offers Covered Individuals the convenience of home delivery of a three-month maintenance prescription. Covered Individuals may reorder their mail service prescriptions through the TML IEBP website pharmacy link, by mail or by calling the toll free number.

Prescription Benefit Plan Options

MAC A
The MAC A Prescription benefit Plan only allows up to the generic Maximum Allowable Cost (MAC) for multi-source drugs on the Caremark MAC list. If a brand name drug is dispensed and a generic equivalent drug exists, the Covered Person pays the difference between the brand name and generic price in addition to the appropriate copayment for the brand name. The cost difference between the brand name and generic price does not apply to any individual deductibles or out of pocket amounts. The MAC differential applies to all prescriptions purchased through this program when a generic equivalent is available.

MAC C
The MAC C Prescription benefit Plan does not penalize covered individuals for choosing a brand name drug when a generic equivalent is available. Covered Individuals pay the appropriate copay for the prescription with no additional charges.

Copay Plan
On a Copay Prescription Plan, Covered Individuals pay either a generic or brand name copay for prescription drugs.

Tiered Copay Plan
The Tiered Copay plan has 3 separate copays for generic, brand and preferred drugs. The "preferred drug" copay applies to drugs listed on the Caremark Preferred Drug list. The preferred copay amount is typically more than the generic copay but less than the brand copay.

Core Plan
Core Prescription Plans pay pay 70% of eligible prescription expesnes. The Covered Individual pays 30% of eligible prescription expenses until the annual out of pocket prescription maximum of $2,000 is met.

Pass Through Plan
The Pass Through Prescription benefit plan is integrated with the covered individual's medical plan. Eligible prescription expenses go towards the covered individual's prescription deductible of $100, and a benefit percentage of 80% is applied.

Maintenance Dispensing Program
The Maintenance Dispensing Program allows Covered Individuals on certain maintenance medications to access up to a 90 day supply of medication at a discounted copay amount.

SpecialtyRx
SpecialtyRx makes injectible prescriptions that are available through CVS/Caremark.
The list of SpecialtyRx injectible prescriptions is available on TML IEBP's website www.tmliebp.org. SpecialtyRx is the most cost-effective way to purchase medications for Covered Individuals with chronic illnesses requiring life-sustaining medications. SpecialtyRx provides covered individuals with a cost-effective benefit to purchase specialty prescriptions. With SpecialtyRx, the covered individual will receive easy ordering and fast delivery from the Pharmacy Benefit Manager. In addition, the covered individual will receive an informative care management packet. The SpecialtyRx prescription may be delivered to the physician's or covered individual's address.

MinuteClinic

MinuteClinic Comprehensive Health Screen Data Elements
General values that apply to all tests

• Date of Exam
• Location of Exam
• CVS Caremark plan participant ID

Biometric Test Results
There are three basic test results captured. A1c and Glucose are mutually exclusive.

Cholesterol

• Total Cholesterol
• LDL
• HDL
• Triglycerides
• TC/HDL Ratio
• Date of test

A1c

• A1c Result (%)
• Date of test

Glucose Level

• Glucose Level (mg/dL)
• Date of Test

Other Exam Values
There are numerous other exam data elements that are captured, but are probably not for transfer to the employer or their claims administrator.

Exam elements: (Please note: This is a sample.)

• Blood Pressure: 160/80
• Weight: 160 Lbs/72.6 Kg
• Blood pressure method: Digital
• Blood pressure site: R arm
• Cuff Size: Adult
• Height: 6 feet 0 inches/1.83 meters
• Body Mass Index: 21.7
• Waist measurement (inches): 32
• Framingham CHD Risk Score: NA
• Estimated 10-year Heart Disease Risk: Moderate Risk

MinuteClinic Coding Health Screening
Biometric Screening-Comprehensive
CPT	Description
99402	Preventive counseling, Individual
no code	Body Mass Index (BMI)
no code	Waist circumference
no code	Hypertension
82947*	Assay, glucose, blood quant
83036*	A1c - Glycosylated hemoglobin test
80061	Cholesterol - Lipid panel
*includes 82947 OR 83036 depending on diabetic status of patient
Cholesterol Screen Only
CPT	Description
99401	Preventive Counseling, Individual
80061	Cholesterol Screen
Glucose Screen Only
CPT	Description
99401	Preventive Counseling, Individual
82947*	Assay, glucose, blood quant
83036*	A1c - Glycosylated hemoglobin test
*includes 82947 OR 83036 depending on diabetic status of patient
Hypertension Screen and Counseling
CPT	Description
99401	Preventive Counseling - Hypertension
BMI Screen and Counseling
CPT	Description
99401	Preventive Counseling - BMI

Patient History
The standard MinuteClinic exam captures additional patient history that is not shown in detail here. At a high level the patient history includes:

• Medication Allergies (medications use representative NDC codes)
• Medical Conditions
• Current Medications

Below are the MinuteClinic locations within Texas
(For a complete listing, please visit www.minuteclinic.com)

Get More for Your Health Care Dollars with the CVS Caremark ExtraCare® Health Card

As part of your benefit plan, PEBA is pleased to offer the CVS Caremark ExtraCare® Health card, a valuable new benefit that may help you save money on the health-related items you use most. The ExtraCare® Health card provides a 20 percent savings on certain CVS/pharmacy brand, flexible spending account (FSA)-eligible, health-related items.

How it Works

You may have already received three ExtraCare® Health key tags in the mail that can be used by you, your spouse and your dependents. Just present the key tag at the CVS/pharmacy register and automatically receive 20 percent off eligible items. A summary of your savings will appear on your receipt. You and your family can use the card at the more than 6,300 CVS/pharmacy locations nationwide.

Save up to $200 Annually*

The ExtraCare® Health card may provide savings on the health-related items you and your family use most, from cough and cold remedies to pain and allergy relief products. CVS/pharmacy brands are of the same high quality as national brands, but cost much less. With the ExtraCare® Health card, you can save even more-up to 40 percent-on these items. Please note that the discount does not apply to prescriptions, vitamins, nutritional supplements and non-health-related items.

Same Benefits as the ExtraCare Card

If you already have an ExtraCare® card, the ExtraCare® Health card will replace it. Using the ExtraCare® Health card also entitles you to all of the benefits of the ExtraCare® Rewards Program. This means in addition to your 20 percent discount, you will earn 2 percent in Extra Bucks® on non-prescription purchases and one Extra Buck® for every two prescriptions purchased.**

For more information or to transfer your ExtraCare® reward balance to your ExtraCare® Health card, call the toll-free number on the back of your new card.

*Source: CVS Caremark data, 2008; savings dependent on frequency of card use.
**Excludes Medicare and Medicaid recipients.
The 20 percent discount is restricted to items purchased for the health care of the cardholder, spouse or dependents. Excludes prescriptions, alcohol, tobacco, lottery, postage stamps, gift cards, money orders, pre-paid cards, photo finishing and CVS.com purchases, and are not valid on other items reimbursed by a governmental program. The FSA summary of your receipt includes the items (and tax) that may be eligible for reimbursement from your FSA/HRA/HSA plan. Plan restrictions may apply. Check with your plan administrator for more details.