Common use of Prescription Drugs Clause in Contracts

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- five dollars ($25.00) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager shall prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable), and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-out of pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00675), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-non- preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager shall Benefit Manager shall, prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the drug list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Benefit Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable), and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-out of pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00675), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred to as “the list” shall change to the standard national formulary of the Pharmacy Benefits Manager and the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listBenefit Manager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the drug list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Benefit Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.00) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-non- preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred to as “the list” shall change to the standard national formulary of the Pharmacy Benefits Manager and the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listManager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- five dollars ($25.00) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-of- pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager Manager shall prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA VTA contends that the list or revision finally implemented by the State violates this agreement, the VSEA VTA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- five dollars ($25.0025) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-out of pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00675), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager shall Benefit Manager shall, prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the drug list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Benefit Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.00) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-non- preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager shall prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager Manager shall prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- five dollars ($25.00) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-of- pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager Manager shall prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- five dollars ($25.0025) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager Manager shall prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager Manager shall prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-co- payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. change to the standard national formulary of the Pharmacy Benefits Manager and the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listManager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits parti Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-co- payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred to as “the list” shall change to the standard national formulary of the Pharmacy Benefits Manager and the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listManager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.00) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-non- preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred to as hall change to the standard national formulary of the Pharmacy Benefits Manager and the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listManager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy c cy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.00) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-out- of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred to as “the list” shall change to the standard national formulary of the Pharmacy Benefits manager and the State shall have the authority to authorize the Pharmacy Benefits manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager Manager shall prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-out of pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00675), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager shall Benefit Manager shall, prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the drug list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Benefit Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-of- pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred to as is ll change to the standard national formulary of the Pharmacy Benefits Manager and the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listManager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.ea

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.00) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager Manager shall prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA VTA contends that the list or revision finally implemented by the State violates this agreement, the VSEA VTA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable), and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-out of pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00675), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-out- of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listBenefit Manager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the drug list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Benefit Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable), and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-out of pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00675), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred to as he standard national formulary of the Pharmacy Benefits Manager and the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listBenefit Manager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the drug list promptly. The parties must consider each other’s other positions in good faith. During any year, the Pharmacy Benefits Benefit Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.00) per patient for each year. As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager Manager shall prior to implementing the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-of- pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. The Pharmacy Benefits manager shall prior Effective January 1, 2019, the prescription drug formulary, formerly referred to implementing as “the list, and annually thereafter, provide a proposed list of the division of drugs into tiers prior ” shall change to the implementation standard national formulary of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, shall have the VSEA retains all rights authority to contest this action.authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.00) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-out- of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred to as “the list” shall change to the standard national formulary of the Pharmacy Benefits Manager and the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listManager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable) and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment pay for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-of- pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred to as “the list” shall change to the standard national formulary of the Pharmacy Benefits Manager and the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listManager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO (if applicable), and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- twenty-five dollars ($25.0025) per patient for each year. Commencing on January 1, 2019, the initial deductible will increase to fifty dollars ($50.00). As is currently the case, the State may select the Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with the State. The Pharmacy Benefits Manager shall, in accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred brand. There shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred brands, and forty percent (40%) for non-preferred brands. If there is no effective generic or preferred alternative to it, the co-payment for non-preferred brands shall be twenty percent (20%). There shall be a maximum out-of-out of pocket by the patient, in addition to the deductible, of six hundred seventy-five dollars ($675.00675), effective January 1, 2009, and seven hundred fifty dollars ($750) effective January 1, 2010. Co-payments made at the forty percent (40%) rate for non-preferred brands shall not be counted toward the maximum out-of-pocket limit (i.e., there shall be no maximum out-of-pocket limit for co-payments made at the forty percent (40%) rate for non- non-preferred brands). The maximum out-out- of-pocket shall apply to all co-payments made at the ten percent (10%) or twenty percent (20%) rate. The maximum out-of-pocket limit shall also apply to all co-payments made for Specialty drugs at the forty percent (40%) rate. Effective January 1, 2019, the prescription drug formulary, formerly referred to as “the list” shall change to the standard national formulary of the Pharmacy Benefits Manager and the State shall have the authority to authorize the Pharmacy Benefits Manager to apply reasonable quality and cost measures such as prior authorization and drug quantity management. The Pharmacy Benefits manager shall prior to implementing the listBenefit Manager shall, and annually thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation of such drug list. The parties will meet, review and discuss the drug list promptly. The parties must consider each other’s positions in good faith. During any year, the Pharmacy Benefits Benefit Manager may bring forward revisions for discussion and review in accordance with this paragraph. If VSEA contends that the list or revision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.

Prescription Drugs. The prescription drug benefit for the Total Choice, Health Guard PPO and Select Care POS Plans shall implement the following. There shall be an initial deductible of twenty- five dollars dol lars ($25.0025) per patient for each yeary ear. As A s is currently the caset he ca se, the State may select the t he S xxxx m ay se lect t he Pharmacy Benefits Manager, who shall implement the terms of this section in accordance with its contract with w ith the StateS xxxx. The Pharmacy P harmacy Benefits Manager shallsh all, in i n accordance with industry standards, categorize (and may subsequently recategorize) prescription drugs into three (3) tiers: generic, preferred brand and non-preferred non -preferred brand. There T here shall be a co-payment by the patient on each prescription of ten percent (10%) for generic drugs, twenty percent (20%) for preferred pr eferred brands, and forty percent (( 40%) for non-preferred brandsnon -preferred br ands. If there is I f t here i s no effective generic ef fective g eneric or preferred alternative to ital ternative t o i t, the co-payment for non-preferred brands t he co -pay f or non -preferred br ands shall be twenty percent (per cent ( 20%). There shall be a maximum out-of-pocket by for the patient, in addition to the deductible, of six hundred seventy-five dollars dol lars ($675.00), effective January Ja nuary 1, 2009, and seven hundred fifty dollars se ven hundr ed f ifty dol lars ($750) effective January Ja nuary 1, 201020 10. Co-payments made at the forty percent (t he f orty per cent ( 40%) rate for non-preferred r ate f or non -preferred brands shall not be counted toward the maximum out-ofco unted t oward t he m aximum out -of-pocket limit (i.e., there shall t here sh all be no maximum out-ofout -of-pocket limit for co-payments l imit f or co -payments made at the forty percent (t he f orty per cent ( 40%) rate for non- r ate f or non - preferred brands). The maximum out-of-pocket shall apply to sh all co-payments appl y t o al l co -payments made at the ten t he t en percent (10%) or twenty percent per cent (20%) rater ate. The maximum out-of-pocket limit shall also apply to all co-payments co -payments made for f or Specialty drugs dr ugs at the forty percent (f orty per cent ( 40%) rater ate. The Pharmacy Benefits manager Manager shall prior to implementing the list, and annually annual ly thereafter, provide a proposed list of the division of drugs into tiers prior to the implementation i mplementation of such drug listdr ug l ist. The parties par ties will meet, review and discuss di scuss the list l ist promptly. The parties T he par ties must consider co nsider each otherot her’s positions in good g ood faith. During any year, the Pharmacy Benefits Manager may bring forward revisions for discussion and review in accordance with this acco rdance w ith t his paragraph. If VSEA contends I f V SEA co ntends that the list t he l ist or revision r evision finally implemented by the State violates this agreement, the VSEA retains all rights to contest this action.