The PPOs offer three levels of prescription drug coverage-generic drugs, formulary brand-name drugs and non-formulary brand-name drugs. By knowing the options and discussing them with your doctor, you can make choices that will help keep your costs and the company’s costs down.

For many prescription drugs, there are brand name options, as well as generic equivalent options. In these cases, if you choose a brand-name drug instead of the generic equivalent, you will pay the difference between the brand and generic cost, in addition to the generic copay, unless the physician specifically requires you to take the brand name drug, and writes “DAW” (dispense as written) on the prescription.

Prescription drug benefits for the PPO Plans are provided through Medco member pharmacies. Lists of member pharmacies and formulary medications are available on the Medco Web site at www.medco.com. Because this list is periodically updated, be sure to check the list before you fill a prescription to make sure the medication is on the formulary- which will cost you less. If your medication is not on the list, consider contacting your provider to find out if a formulary medication is available.

About the Mail-Service Program

As shown in the chart on page 48, you can purchase up to a 90-day supply of prescription medications. This service can be used to obtain maintenance prescription medications-drugs that are used on a continued basis for the treatment of chronic conditions, such as high blood pressure, ulcers and diabetes, as well as oral contraceptives.

To use this program, complete and submit a mail order service form, available in the Forms Directory on BenefitsWeb and on the Medco Web site at www.medco.com. Make sure your physician writes your prescription for a 90-day supply of medicine with three refills (if possible). Be sure to include your payment information on your form.

To set up the service over the phone, you can contact the Medco By Mail team at 800-633-2662-the Medco By Mail representative will fill out an order form on your behalf and call your physician for a new prescription.

Drug Coverage Management Programs

ACS’s plan utilizes coverage management programs to help control rising drug costs and provide you with the coverage you need. Coverage management determines how your prescription drug plan will cover certain medications. Each program is administered by Medco.

Some medications are not covered unless you receive pre-approval, or prior authorization. Coverage management programs make use of two authorization processes-prior authorization and step therapy programs. Medications may fall under one or more programs. Note: This is not a complete list of affected medications; all medications and programs described below are subject to change.

Prior Authorization

Prior Authorization requires that you obtain pre-approval through a coverage review. The review will determine whether your plan covers your prescribed medication. Below are examples of common medications that may require pre-approval:

Topical Acne Medications (e.g. Retin-A, Tazorac, etc.) (Prior authorization requirement applies to members 27 years of age and older)

• - Erectile Dysfunction Agents (e.g. Viagra, Cialis, etc.)
• - Injectable Anemia Medications (e.g. Epogen, Procrit, Aranesp)
• - Injectable Growth Stimulating Medications (e.g. Humatrope, Tev-Tropin, Nutropin, etc.) (Excluded over age 18; approval required for age 18 and under)
• - Hepatitis Medications (e.g. Intron-A, Peg-Intron, Pegasys, etc.)
• - Multiple Sclerosis Medications (e.g. Copaxone, Avonex, Rebif, etc.)
• - Injectable Medications to treat Low White Blood Cell Count (e.g. Neupogen, Leukine, etc.)
• - Injectable Asthma Medication (e.g. Xolair)
• - Cancer Medications (e.g. Gleevec, Iressa, Tarceva, Sutent, etc.)

Step Therapy Programs

Step Therapy require first-line therapy failure before second- and third- line therapies are covered. These programs are effective starting in May, 2009.

• - Rheumatoid Arthritis & Psoriasis Medications (e.g. Enbrel, Humira, etc.) - These are medications that are covered only if you have tried first-line therapies such as oral methotrexate (or other related medications).
• - ARB Medications (e.g. Diovan, Cozaar, Micardis, etc.) - These are second-line medications primarily used to treat high blood pressure. These medications are only covered if you have tried and failed on first-line agents called ACE-Inhibitors (e.g. Zestril, Lotensin, Accupril, etc.)
• - Heartburn/ Ulcer Medications - Medications such as Nexium, Aciphex, Prevacid and Protonix (and others) are covered only if you have tried and failed omeprazole or Prilosec OTC.
• - Asthma & Allergy Medications - Medications such as Singulair, Accolate & Zyflo (and others) are covered only if you have tried first-line agents for asthma (such as inhaled steroids) or first-line agents for allergies (such as nasal-inhaled steroids).
• - Cholesterol Lowering Medications - The following medications are covered only if you have tried and failed therapy on generic Zocor (simvastatin) or generic Pravachol (pravastatin): Altoprev, Lescol, Lipitor 40mg or less, Vytorin 10mg/10mg, Crestor 5mg or less.
• - Narcotic Pain Medications - Medications such as Actiq & Fentora are covered only if you have developed a tolerance to narcotic pain medications, as evident by long-term use of long-acting narcotic pain medications.
• - Ribavirin - This medication is covered only if you are currently receiving Interferon therapy (Injectable therapy for Hepatitis).
• - Depression Therapy - Medications such as Lexapro, Luvox CR, Effexor XR and Prestiq are covered only if you have tried generic antidepressants (e.g. generic versions of Celexa, Paxil, Prozac, Zoloft, etc.) or Cymbalta.
• - Insomnia Therapy - Medications such as Ambien CR, Lunesta and Rozerem are covered only if you have tried generic insomnia medications (e.g. generic Ambien, generic Restoril, etc.).

The Coverage Review Process

For your prescription drugs that need special authorization, you, your doctor, or your pharmacist may initiate the review process by calling Medco at 800-711-0917.

Your doctor will be sent a Coverage Review Fax Form to fill out and fax back to Medco. Medco will contact you and your doctor by phone or letter confirming whether or not coverage has been approved (usually within 2 business days of receiving the necessary information).

If coverage is approved, you simply pay your normal co-payment for the medication. If coverage is not approved, you will be responsible for the full cost of the medication or there may be an alternative drug that would be covered. NOTE: You have the right to appeal the decision. Information about the appeal process will be included in the notification letter that you receive.

Quantity Limitations

For some medications, your plan may cover a limited quantity within a specified period of time. A coverage review may be necessary to have additional quantities of these medications covered by your plan.

The medications listed below are authorized for limited quantity only. Note: This is not a complete list of affected medications; all medications listed below are subject to change.

• - Erectile Dysfunction Medications (limited to 6 units per month, 18 units per 3 months)
• - Medications To Treat Severe Nausea & Vomiting (e.g. Zofran, Kytril, Anzemet, etc.) - These medications are limited to a quantity sufficient for 7 treatment days per month when used up to the maximum recommended daily dosage. Benefit coverage for prescriptions submitted for greater quantities is determined through a prior authorization process.
• - Heartburn/ Ulcer Medications (e.g. Prilosec, Nexium, Prevacid, Protonix, etc.) - Doses greater than the following are limited for up to 90 days: 20 mg omeprazole (Prilosec, Zegerid) 30 mg Prevacid, 20 mg Aciphex, 40 mg pantoprazole (Protonix), or 40 mg Nexium per day. Benefit coverage for prescriptions submitted at higher doses after 90 days is determined through a prior authorization process.
• - Migraine Medications (e.g. Imitrex, Maxalt, Zomig, Frova, etc.) - Coverage is limited to an amount sufficient for up to 4 treatment days per month. Benefit coverage for prescriptions submitted for greater quantities is determined through a prior authorization process.
• - Narcotic Pain Medications: Actiq - Coverage is limited to 120 units per month; Fentora - 100mcg and 200mcg tablet strengths = 240 tablets per 30 days (No prior authorization available) or 300 mcg, 400 mcg, 600 mcg, and 800 mcg tablet strengths = 120 units per 30-days. Benefit coverage for prescriptions submitted for greater quantities is determined through a prior authorization process.

For more information on medication coverage or limitations, please visit www.medco.com and click “Price a medication” in the left navigation menu under “Prescriptions & benefits”, search for your medication, then click “review coverage notes”. Or, you can call Medco Member Services at 800-711-0917.

Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.