2026 CODAC Benefit Summaries and Carrier Flyers

PRESCRIPTION Any order authorized by a Prescriber for a Prescription Medicine or a Non-Prescription Medicine that could be a Medication or supply for the Covered Person for whom prescribed. The Prescription must be compliant with applicable laws and regulations and identify the name of the Prescriber prescribing and the name of the Covered Person for whom prescribed. It must also identify the name, strength, quantity, and directions for use of the Medication or supply prescribed. PRESCRIPTION BENEFIT CARD The identification card issued by the PBM to Covered Persons who participate in the Prescription Drug Plan. PRESCRIPTION DRUG "Prescription Drug" (or "Prescription Medicine") is a Licensed Medicine that is regulated by legislation to require a Prescription before it can be obtained by a Covered Person. PRESCRIPTION DRUG CHARGE The "Prescription Drug Charge" is the rate that the PBM has agreed to pay its Network Pharmacies, including the applicable Dispensing Fee and any applicable sales tax, for a Prescription Medicine dispensed at a Network Pharmacy under the terms of this Rx Plan. The Eligible Employee or Dependent is responsible for paying the lowest of the: Applicable Co-Payment or Co-Insurance amount; PRESCRIPTION MEDICINE "Prescription Medicine" (or "Prescription Drug") is a Licensed Medicine that is regulated by legislation to require a Prescription before it can be obtained by a Covered Person. PRESCRIPTION ORDER OR REFILL A Prescription Order or Refill is the written or verbal order from a Prescriber to a Pharmacist for a drug to be dispensed. PRE-SERVICE CLAIM A Claim with respect to which receipt of the benefit requires approval in advance of obtaining medical care. Prior Authorization requests are usually Pre-Service. PRIOR AUTHORIZATION Prior authorization or pre-authorization, is a requirement that a Covered Person's Physician obtain approval from the PBM of the Rx Plan to prescribe a specific medication or for a Quantity Limit for Prescription Medications for a Covered Person. Prior authorization is based on current medical findings, FDA-approved manufacturer labeling information, and cost and manufacturer rebate arrangements. Without this prior approval, the Rx Plan may not provide coverage, or pay for, the Covered Person's medication. QUALIFIED INDIVIDUAL The term "Qualified Individual" means an individual who is properly enrolled in the Rx Plan and who is eligible to participate in an Approved Clinical Trial according to the trial protocol with respect to the treatment of cancer or another Life Threatening Condition or disease. To be a Qualified Individual, there is an additional requirement that a determination be made that the individual's participation in the Approved Clinical Trial is appropriate to treat the disease or condition. That determination can be made based on the referring health care professional's conclusion or based on the provision of medical and scientific information by the individual. 17 CIDN:199534 Network Pharmacy's Usual and Customary Charge for the Prescription Drug; or Prescription Drug Charge that the PBM agreed to pay the Network Pharmacy.