2026 CODAC Benefit Summaries and Carrier Flyers

Exhibit C - Addendums / Amendments

Addendum or Amendment Name: Effective Date:

Enhanced Specialty Guideline Management

January 1, 2025 Please note that under our Enhanced Specialty Guideline Management program, which is a targeted utilization management initiative for specialty medications that require complex handling, administration, or monitoring, Plan coverage of certain high - cost specialty drugs will be subject to evidence - based clinical guidelines. This program is designed to ensure that you receive therapies aligned with the most current clinical best practices and optimize treatment outcomes. If you are prescribed a specialty medication that falls outside these guidelines, such medication is excluded. You or your physician will be prompted to consider an alternative regimen that meets the same therapeutic goals that meets these requirements under the Plan.

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CIDN:199534