Summary Plan Description

Retail Refill Allowance Program

To maintain the quality of your benefits while keeping your prescription costs as low as possible, you will pay more for your long-term drugs (such as those used to treat high blood pressure or high cholesterol) if you continue to purchase them at a participating retail pharmacy or at a nonparticipating retail pharmacy. Beginning with the third time you purchase each long-term drug at a participating retail pharmacy, you will pay 50 percent of the cost of the long-term drug. But if you use the Express Scripts By Mail Program, you will pay the mail-order copay ($14 generic, $30 brand-name listed on the drug program formulary, $60 brand-name not listed on the drug program formulary) for up to a 90-day supply. You will be notified by Express Scripts if you fill a long-term drug at a participating retail pharmacy that is subject to this program.