Upcoming changes to your prescription drug coverage Here are important details about upcoming plan changes.

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1 151 Farmington Avenue Hartford, CT March, 2015 Upcoming changes to your prescription drug coverage Here are important details about upcoming plan changes. The enclosed chart shows changes that start on July 1, We re adding some brand-name and generic drugs to our pharmacy plan and specialty drug list and removing others. We re changing your plan s precertification, quantity limits and step-therapy programs. If these updates affect the prescription drugs you take, the amount you pay for these drugs may also change. Talk to your doctor about your treatment options. In the end, you and your doctor make the decisions about your drug therapy. Drug coverage reviews Some drugs must meet certain coverage requirements. We review them to make sure they meet these requirements. The following reviews and coverages may be part of your plan: Precertification We have to approve some drugs before we can cover them. Quantity limits Some drugs have quantity limits to make sure that you get a safe amount of your drug. Step therapy Your doctor may need to prescribe certain drugs first before we ll cover another drug. Check to see if you can lower your costs You can find your pharmacy plan and specialty drug list at Use the list to lower your out-of-pockets costs by choosing a preferred alternative drug to treat your conditions. If your doctor agrees that a preferred alternative will work for you, ask to have your prescription changed. Know what to expect when using brand-name drugs If you choose a non-preferred brand, you can fill that prescription but you may pay more. We call drugs preferred because your copay may be lower than the copay for non-preferred drugs. You typically pay lower out-of-pocket costs when you use preferred drugs. You and your doctor can decide if using the brand-name drug is best for you. If so, your doctor will write DAW on your prescription. This stands for dispense as written. In this case, your pharmacist will fill your prescription with the brand-name drug. You ll pay the difference in cost between the brand name and generic, plus your copay. We re here to help If you have questions, visit your Aetna Navigator secure member website. Just visit Or, call us at the toll-free number on your member ID card Aetna Inc FC_subscriber_AET (1/15) ET

2 Enclosure This document is available in other languages: Please note that if your prescription drug benefits plan changes, the information in this letter may no longer apply. A copayment is a flat fee. Coinsurance is a percentage of the rate that Aetna negotiates with the plan sponsor for covered prescriptions except as required by law to be otherwise. Some drugs on the Aetna Pharmacy Plan and Specialty Drug List are subject to manufacturer rebates. Coinsurance is calculated before any rebates are subtracted. That means it may be possible for your cost of a preferred drug to be higher than your cost of a non-preferred drug. Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining the Aetna Pharmacy Plan and Specialty Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Information is subject to change. For more information about Aetna plans, refer to In accordance with state law, commercial fully insured members in Louisiana and Texas (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added or removed from the Aetna Pharmacy Plan and Specialty Drug List will continue to have those medications covered at the same benefit level until their plan s renewal date. In Texas, precertification approval is known as preservice utilization review. It is not "verification" as defined by Texas law. In accordance with state law, fully insured commercial California HMO members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are to receive precertification or steptherapy reviews will continue to have those medications covered, for as long as the treating physician continues prescribing them, provided that the drug is appropriately prescribed and is considered safe and effective for treating the enrollee's medical condition. In accordance with state law, fully insured commercial Connecticut PPO members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are to receive precertification or steptherapy reviews will continue to have those medications covered for as long as the treating physician prescribes them, provided the drug is medically necessary and more medically beneficial than other covered drugs. Nothing in this section shall preclude the prescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this section be construed to prohibit generic drug substitutions. The drugs on the Aetna Pharmacy Plan and Specialty Drug List including formulary exclusions, precertification, quantity limit and step-therapy reviews are subject to change. The quantity limits and step-therapy drug coverage review programs are not available in all service areas. For example, step-therapy programs do not apply to fully insured members in Indiana. Step therapy does not apply to fully insured members in New Jersey. However, these programs are available to self-funded plans. This material is for information only. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. For more information about Aetna plans, refer to Aetna Inc FC_subscriber_AET (2/15) ET

3 Key: PA = NC = NPB = NPL = PB = QL = ST = = Prior Authorization only applies if your plan includes Precertification. If this is required, your doctor must contact us to request approval for coverage. Not Covered Non-Preferred Brand National Precertification List. This means prior authorization required for all plans. Your doctor must contact us to request approval for coverage. Preferred Brand Quantity Limits only apply if your plan includes Precertification. If you go past the quantity limit, your doctor must contact us to request approval for coverage. Step Therapy only applies if your plan incudes Step Therapy. This means that you must try one or more prerequisite drug(s) before we cover a step-therapy drug. Specialty Drug List. This means the drug is on the Specialty Drug List. If your plan includes the Specialty Drug list, you may pay higher out of pocket costs and may be required to obtain these products at an Aetna Specialty Pharmacy Network Provider like Aetna Specialty Pharmacy. Specialty products are not available at Aetna Rx Home Delivery. For questions, call UPPERCASE = Brand-name medication; lower case italics = generic medication ACCOLATE 3 3 removed QL ACTONEL TAB 5/30MG 3 3 alendronate TAB 5/10/40MG (generic FOSAMAX) alprazolam ER/XR TAB (generic XANAX) AMNESTEEM 1 1 APTIOM 3 3 AZILECT 2 2 BANZEL TAB 3 3 BONIVA TAB 3 3 calcitonin (generic MIACALCIN) CARBATROL 3 2 CELEBREX 3 3 CELLCEPT CAP, TAB, SUSP NPB NPB mycophenolate added to CELONTIN 3 2 CLARAVIS 1 1

4 clopidogrel (generic PLAVIX) COLCRYS 2 2 DEPAKOTE 3 3 DIASTAT 3 2 diazepam GEL (generic DIASTAT) DILANTIN 30/50/100MG 3 2 DILANTIN DUEXIS 3 3 DUREZOL 3 2 EFFIENT 2 2 BRILINTA, clopidogrel added PA EVISTA 3 3 florometholone SUSP (generic FML LIQUIFORM) 1 1 removed QL FML FORTE LIQUIFILM SUSP 3 3 removed QL FML LIQUIFILM SUSP 3 3 removed QL fortical FOSAMAX + D 3 3 FOSAMAX TAB 3 3 FUSILEV NPB NPB added to NPL FYCOMPA 3 3 gabapentin SOL (generic NEURONTIN) GABITRIL 3 3 ILARIS PB PB INDOCIN SUS 3 2 added to NPL KEPPRA TAB/SOL 3 3 KEPPRA XR 3 3 LAMICTAL ODT TAB 3 3 LAMICTAL XR KIT 3 3 LAMICTAL XR TAB 3 3 lamotrigine ER (generic LAMICTAL SR) lamotrigine orally disintegrating tablet

5 levetiracetam ER (generic KEPPRA) LOSEASONIQUE 3 3 LOVAZA 3 3 MAXIDEX SUSP 3 3 removed QL mefenam acid (generic PONSTEL) 1 1 removed QL MIACALCIN INJ 3 3 MIACALCIN SPR 3 3 MIRAPEX 2 3 pramipexole MIRAPEX ER 3 3 MITIGARE CAP 3 3 mycophenolate CAP, TAB, SUSP Generic Generic added to MYALEPT PB PB added to NPL MYORISAN 1 1 naproxen SOD TAB 220MG 1 NC Rx naproxen NIASPAN 2 3 OLYSIO NPB NPB HARVONI, SOVALDI added to ST OMNIPRED SUSP 3 3 removed QL ONFI SUS 3 3 ONFI TAB 3 3 OXTELLAR XR 3 3 PHENYTEK 3 2 PLAVIX 3 3 PONSTEL 3 3 removed QL POTIGA 3 3 PRED FORTE SUSP 3 3 removed QL PRED MILD SUSP 3 3 removed QL prednisolone acetate SUSP (generic PRED FORTE) 1 1 removed QL prednisolone sodium phosphate SOL 1 1 removed QL PREVPAC 3 3 QUARTETTE 3 3 QUDEXY XR 3 3

6 REQUIP XL 3 3 risedronate TAB 5/30/35M G (generic ACTONEL) ropinirole ER (generic REQUIP XL) SABRIL 3 3 SEASONIQUE 3 3 SINGULAIR 3 3 SKELID 3 3 TEGRETOL 3 2 tiagabine (generic GABITRIL) 1 1 TOPAMAX 3 3 TOPAMAX SPR 3 3 topiramate CAP (generic TOPAMAX) TROKENDI XR 3 3 ULORIC 3 3 VALCYTE TAB, SOL PB PB valganciclovir added to valganciclovir TAB, SOL Generic Generic added to VASCEPA 2 2 VEXOL SUSP 3 3 removed QL VIMPAT SOL 3 3 VIMPAT TAB 3 3 XANAX XR 3 3 zafirlukast 1 1 removed QL ZAVESCA NPB NPB added to PA removed from NPL ZELAPAR 3 3 ZENATANE 1 1 ZORVOLEX 3 3 ZYFLO 3 3 removed QL ZYFLO CR 3 3 removed QL