2018 PHARMACY COVERAGE. Get the most from your pharmacy benefits. Classic Pharmacy Network with FlexRx Drug List

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1 2018 PHARMACY COVERAGE Get the most from your pharmacy benefits Classic Pharmacy Network with FlexRx Drug List

2 Understanding your prescription coverage Take an important first step to getting the most from your pharmacy benefits for your health and your wallet by understanding how they work. Here you ll find important details that outline terms, guidelines and tips to avoid unnecessary out-of-pocket costs. PHARMACY NETWORK Just like you have a network for the doctors you see, there s a network for getting your prescriptions filled as well. The pharmacies in your network offer the best service at the best price for Blue Cross and Blue Shield of Minnesota members. To pay the lowest out-of-pocket cost it s important to choose a pharmacy that participates in your network. For 2018, your pharmacy network has changed to the Classic Pharmacy Network. The Classic Pharmacy Network provides access to a large network of pharmacies with top retailers including Walgreens and independent pharmacies. Please note that CVS, Target and a small number of other independent pharmacies are not included in this network. If you need to transfer a prescription to a pharmacy in your new network, here are a few options to consider: 1. Take your prescription bottle to your new pharmacy. They will contact your current pharmacy to transfer your prescription. 2. Call your new pharmacy and ask them to contact your current pharmacy for your prescription information. 3. Ask your doctor to call your new pharmacy with your prescription information. 3 ways to save on Rx Stay within your network Opt for generic Choose drugs on your formulary SAVE TIME WITH 90dayRx Ask your doctor for a 90-day prescription for medications you take regularly. Fill at your local pharmacy or through our mail order program. Details regarding mail order are available on your member website. INFORMATION WHEN AND WHERE YOU NEED IT bluecrossmnonline.com Your member website has all the information you need at your fingertips. Register today.

3 MEDICATION LIST The list of drugs that are covered by your plan is called a formulary. For 2018, your formulary is FlexRx. FlexRx includes a broad, clinically complete list of drugs that include a good balance of brand-name and generic drugs. Your plan includes coverage for drugs not included on the formulary, however, your share of the cost is generally more than the drugs on the formulary. Some drugs may require quantity limits, prior authorization or step therapy to ensure safe and appropriate use. Tip: Use your spending accounts to cover out-of-pocket costs CHOOSE GENERIC AND SAVE Choosing the generic-equivalent to a brand-name drug will save you significant out-of-pocket costs with your plan. If you choose not to, you will pay the difference in the cost of the generic and brand drug in addition to the brand copay. The difference between the generic and brand does not count towards your deductible or out-of-pocket maximum. Sometimes, your prescription may say dispense as written. That means your caregiver wants you to get that specific brand of medication with no substitutions. In this case, you pay the brand copay plus the difference between the generic and the brand drug. PHARMACY BENEFIT CHANGES There are some changes to your pharmacy benefits to be aware of for 2018: Your pharmacy benefit no longer covers some over-the-counter medications, such as non-sedating allergy medications, nasal steroids and proton pump inhibitors. However, your plan will continue to cover the generic or brand versions of these medications with a prescription. Lifestyle medications that are not usually clinically necessary are no longer covered. These include medications for sexual dysfunction, weight loss or cosmetic-altering purposes, (such as Latisse for eyelash growth or medications for skin bleaching). If you choose to fill these prescriptions for those purposes, you will pay for them out of pocket. They may be eligible for reimbursement from your spending account (HSA or FSA). Please check with your tax advisor. EXAMPLE $100 brand drug $80 generic drug Member copay $25 $10 Cost difference between brand and generic $20 $0 Member cost $45 $10

4 FOR COMPLEX CONDITIONS If you have a condition such as multiple sclerosis, hemophilia, hepatitis or rheumatoid arthritis, you may need a specialty medication. Your plan includes a specialty drug network that includes pharmacies that specialize in these types of medications. A dedicated team of pharmacists and nurses can help with questions about your medications or side effects. Your plan requires you to use this network for your specialty drug needs. Specialty pharmacies have trained professionals and knowledgeable staff that will help you understand your specialty drug benefit and will ask a few questions to enroll you right over the phone. Information to have on hand when you call include: Member ID number Pharmacy and prescription information Doctor s name, phone and fax numbers Get started by calling: AllianceRx Walgreens Prime Fairview Specialty Pharmacy Children s Home Care (hemophilia medicines only) Who is Prime therapeutics? searching your network and formulary Visit bluecrossmnonline.com and follow the steps below to find a pharmacy in your new network or search for a drug in your new formulary. After your new plan becomes effective, simply log in to the member website to view your network and formulary. FIND A PHARMACY IN YOUR NETWORK Select Find a Doctor or Rx Select Find a Pharmacy. This will take you to the Prime Therapeutics site. Choose Classic Enter location details You can also call customer service at the number on the back of your member ID card CHECK YOUR FORMULARY Choose Find a Doctor or Rx Select Find a Drug Click on Search covered drug lists Use drop down menu and select FlexRx If you have questions regarding your pharmacy network, formulary or benefits, please contact the number on the back of your member ID card to get more information. We work with Prime Therapeutics to manage your pharmacy benefit. When you search for your pharmacy network or drug list, you ll be brought to the Prime Therapeutics website. Prime Therapeutics LLC is an independent company providing pharmacy benefit management services.

5 NOTICE OF NONDISCRIMINATION PRACTICES Effective July 18, 2016 Blue Cross and Blue Shield of Minnesota and Blue Plus (Blue Cross) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or gender. Blue Cross does not exclude people or treat them differently because of race, color, national origin, age, disability, or gender. Blue Cross provides resources to access information in alternative formats and languages: Auxiliary aids and services, such as qualified interpreters and written information available in other formats, are available free of charge to people with disabilities to assist in communicating with us. Language services, such as qualified interpreters and information written in other languages, are available free of charge to people whose primary language is not English. If you need these services, contact us at or by using the telephone number on the back of your member identification card. TTY users call 711. If you believe that Blue Cross has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or gender, you can file a grievance with the Nondiscrimination Civil Rights Coordinator by at: by mail at: Nondiscrimination Civil Rights Coordinator Blue Cross and Blue Shield of Minnesota and Blue Plus M495 PO Box Eagan, MN or by phone at: Grievance forms are available by contacting us at the contacts listed above, by calling or by using the telephone number on the back of your member identification card. TTY users call 711. If you need help filing a grievance, assistance is available by contacting us at the numbers listed above. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at: by phone at: or (TDD) or by mail at: U.S. Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington, DC Complaint forms are available at image_0006_ndl_portrait (09/16) Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

6 This information is available in other languages. Free language assistance services are available by calling the toll free number below. For TTY, call 711. Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al Para TTY, llame al 711. Yog tias koj hais lus Hmoob, muaj kev pab txhais lus pub dawb rau koj. Hu rau Rau TTY, hu rau 711. Haddii aad ku hadasho Soomaali, adigu waxaad heli kartaa caawimo luqad lacag la'aan ah. Wac Markay tahay dad maqalku ku adag yahay (TTY), wac 711. erh>uwdrundusdm'd;< Aw>u[h.eRusdmw>rRpXRuvDwz.M.vDRIAud; vx ATTY t*d><aud; 711 wuh>i إذا كنت تتحدث العربية تتوفر لك خدمات المساعدة اللغوية المجانية. اتصل بالرقم للھاتف النصي اتصل بالرقم 711. Nếu quý vị nói Tiếng Việt, có sẵn các dịch vụ hỗ trợ ngôn ngữ miễn phí cho quý vị. Gọi số Người dùng TTY xin gọi 711. Afaan Oromoo dubbattu yoo ta e, tajaajila gargaarsa afaan hiikuu kaffaltii malee. Argachuuf bilbilaa. TTY dhaaf, 711 bilbilaa. 如果您說中文, 我們可以為您提供免費的語言協助服務 請撥打 聽語障專 (TTY), 請撥打 711 Если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Звоните Для использования телефонного аппарата с текстовым выходом звоните 711. Si vous parlez français, des services d assistance linguistique sont disponibles gratuitement. Appelez le Pour les personnes malentendantes, appelez le 711. አማርኛ የሚናገሩ ከሆነ ነጻ የቋንቋ አገልግሎት እርዳ አለሎት በ ይደውሉ ለ TTY በ 711 한국어를사용하시는경우, 무료언어지원서비스가제공됩니다 으로전화하십시오. TTY 사용자는 711 로전화하십시오. ຖ າເຈ າເວ າພາສາລາວໄດ, ມການບ ລການຊ ວຍເຫ ສາລ ບ. TTY, ໃຫ ໂທຫາ 711. ອພາສາໃຫ ເຈ າຟຣ. ໃຫ ໂທຫາ Kung nagsasalita kayo ng Tagalog, mayroon kayong magagamit na libreng tulong na mga serbisyo sa wika. Tumawag sa Para sa TTY, tumawag sa 711. Wenn Sie Deutsch sprechen, steht Ihnen fremdsprachliche Unterstützung zur Verfügung. Wählen Sie Für TTY wählen Sie 711. របស ន ប អនកន យ យភ ស ខមរមន អនកអ ចរកប ន សវ ជ ន យភ ស ឥតគ ត ថល ទ រស ពទមក លខ សរម ប TTY ស មទ រស ពទមក លខ 711 Din4 k'ehj7 y1n7[t'i'go saad bee y1t'i' 47 t'11j77k'e bee n7k1'a'doowo[go 47 n1'ahoot'i'. Koj8 47 b44sh bee hod77lnih TTY biniiy4go j8 b44sh bee hod77lnih. image_0002r02_general_portrait (01/17)

7

8 As Minnesota s health care leader, we live fearless. We believe good health is for everyone not just our members. It s a big vision. And that s why we re investing in the communities we serve and empowering individuals to make smart choices about their health. Live fearless with the peace of mind that comes from knowing you re protected by the strength and stability of Blue Cross. We invite you to join us. Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association. M01182 (11/17) Open

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