©2011 Caremark. All rights reserved.

ERS HealthSelectSM of Texas Pharmacy Benefits

Effective September 1, 2012

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Prescription Drug Copays: Retail (Up to 30 Day supply) • Deductible of $50 per person combined for mail and retail

Non-Maintenance Copays Maintenance Copays

Tier 1 $15 $20

Tier 2 $35 $45

Tier 3 $60 $75

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Prescription Drug Copays: Mail (Up to 90 Day supply) • Deductible of $50 per person combined for mail and retail

Tier 1 $45

Tier 2 $105

Tier 3 $180

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Prescription Drug Copays: Extended Days’ Supply Retail (31-90 Day supply)

• Some retail pharmacies in the HealthSelect network will fill 31- to 90-day supplies of maintenance medicines at the mail service copay and will not charge you a maintenance fee.

• List of participating Extended Days’ Supply (EDS) pharmacies can be found at www.caremark.com/ers

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31-60 Days 61-90 Days

Tier 1 $30 $45

Tier 2 $70 $105

Tier 3 $120 $180

©2011 Caremark. All rights reserved. Caremark proprietary and confidential information. 5

• Without Member Sign In: − Plan Information − Pharmacy Locator (EDS and standard network) − Check Drug Coverage and Cost − Preferred Drug List − Prior Authorizations − Mail Service Program − About Generics

• With Member Sign In: − Find Savings and Opportunities − Check Order Status − Check Prescription History − Request a Prescription − Refill a Prescription

Website Features www.caremark.com/ers

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• All name brand Non-Sedating Antihistamines (NSAIDs) and Proton-Pump Inhibitors (PPIs) will remain at Tier 3.

• Sleep Aid class requires use of generics as first line of therapy. • Some medications, including Specialty medications, require Prior Authorization;

a list of the PA required drugs is located on the website. • Specialty medications are those used to treat complex conditions; medications

handled by a specialty pharmacy often include those that are injectable, infused, biological, high-cost and/or have special delivery and storage instructions.

Other

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• Prior Authorization is the program that some medications need to go through to be covered by the benefit plan; a physician’s medical diagnosis is required, and some medications may require additional information from your physician.

• Some medications include quantity limits. • If you have any questions on plan design, contact Caremark Customer Care

toll-free at (888) 886-8490 or www.caremark.com/ers.

Other Continued

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