Prescriptions Effective: January 1, 2027 PRESCRIPTION COVERAGE | COPAYS | B730ADT | G8K6ADT | | $7,850 HDHP Plan | $2,400 PPO Plan | | Generic | | Preferred Brand | $5 / $10 | | No cost after | $50 | | Non-Preferred | deductible | $100 | Brand $250 / $350 Specialty 90 Day Supply Depending on your medication, you might also be eligible for a 90-day supply delivered directly to your home, a convenient option for maintenance prescriptions. To check availability and get started, visit your health plan’s member portal or pharmacy benefits section online. Ways to Save Ask your doctor about generic alternatives Use mail-order or 90-day supply options for maintenance medications, if available Check for discount programs or manufacturer coupons Review your plan’s formulary list to see which medications are covered at the lowest cost Coverage Rules to Know Some prescriptions may require extra steps before they’re approved: • Prior Authorization: You may need approval before the plan will cover certain medications. • Step Therapy: You might be required to try lower-cost alternatives before moving to higher-cost medications. • Formulary Exclusions: Not all medications are covered. You can review the plan’s drug list or speak with customer service for details. 7