2026 CODAC Benefit Summaries and Carrier Flyers

PATIENT ADVOCACY AND PATIENT ASSISTANCE PROGRAMS Patient Advocacy and Patient Assistance Programs may be part of the Rx Plan or separate from the Rx Plan as indicated in the Exhibits. Patient Advocacy involves a third party that assists individuals in obtaining Prescription Drugs that are often excluded from the Rx Plan and in such case, the Patient Advocacy Program is not part of the Rx Plan. Patient Advocacy and Patient Assistance Programs may also work to obtain financial assistance for individuals to augment the coverages provided under the Rx Plan. In such case, amounts paid through any Patient Advocacy or Patient Assistance Programs may or may not count toward meeting Plan Deductibles or Out-Of-Pocket Maximums. This will also be indicated in Exhibit A. Patient Assistance Programs may include copay cards, coupons and other such manufacturer sponsored assistance programs. Again see, Exhibit A for the indicator of whether or not such program exists under the Rx Plan, and its impact. PHARMACIST The term "Pharmacist" means a professional who is licensed under the applicable state and federal law to fill and dispense Prescriptions. PHARMACY AND PARTICIPATING PHARMACY A Pharmacy is a licensed provider authorized to prepare and dispense Drugs and Medications. A Pharmacy must have a National Association of Boards of Pharmacy identification number. A "Participating Pharmacy" is another term that describes a Network Pharmacy that contracts with the PBM. Participating or Network Pharmacies may be found through the PBM's pharmacy locator information at the PBM's website. See Section 4.1 and Exhibit A for more information. PHYSICIAN The term "Physician" means A Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), Doctor of Dental Surgery (D.D.S.), Doctor of Podiatry (D.P.M.), Doctor of Chiropractic (D.C.), Acupuncturist, Audiologist, Certified Nurse Anesthetist, Licensed Professional Counselor, Licensed Professional Physical Therapist, Master of Social Work (M.S.W.), Midwife, Occupational Therapist, Optometrist (O.O.), Pharmacist, Physiotherapist, Psychiatrist, Psychologist (Ph.D.), Speech Language Pathologist, Nutritionist/Dietician and any other practitioner of the healing arts who is licensed and regulated by a state or federal agency and is acting within the scope of their license. POST-SERVICE CLAIM The term "Post-Service Claim" means a Claim with respect to which the Covered Person has received the Medication and is requesting reimbursement, and which is not a Pre-Service Claim or an Urgent Care Claim. PREFERRED DRUG The PBM's Preferred Drug List is a list of Generic and Brand Medications that your Prescription Drug Plan covers as amended by the PBM from time to time. This list excludes Specialty Drugs. This may generally be referred to or be part of an approved Formulary, or may be the entire listing or entire Formulary. See information on the Preferred Drug Lists and Formularies that apply in Exhibit A. Such Preferred Drug list is subject to periodic review and modification. The Preferred Drug List is available at the PBM's website, see Section 4.1 and Exhibit A. PRESCRIBER The term "Prescriber" means a Physician or other health care practitioner licensed or authorized by law to issue an order for a Prescription Medicine. Prescribers may include other professionals who are licensed to prescribe Prescription Medicines, and the PBM will determine in its discretion which Prescribers have rights to be Prescribers and the scope of that capacity.

16

CIDN:199534