Benefits or as determined by TrueScripts’ P & T Management Committee exercising the settlor authority of the Employer as it relates to the formulary. For specialty drug maximum unit of measure quantity limit coverage per person/calendar year and Specialty Drugs available through the Specialty Pharmacy contact TrueScripts Member Care Team at (844)-257-1955. Further, some Specialty Drugs may be excluded from a formulary Level. A Participant who is prescribed a Specialty Drug should contact TrueScripts Member Care at the above phone number to determine if the Specialty Drug is excluded from the Participant’s Formulary Level and to determine if other Formulary Levels are available to the Participant that cover the Specialty Drug. DIRECT PARTICIPANT REIMBURSEMENT In order for a request for reimbursement to be processed, a Participant must complete a prescription drug claim form, obtained from the Employer or at www.truescripts.com, attach the receipt, and submit it to TrueScripts at the following address: TrueScripts Management Services 513 E. South St. Washington, IN 47501 Attn: Claims Department A Participant will be reimbursed the amount he/she paid to the pharmacy subject to the terms set forth in the Plan and this Rx Program. CLINICAL TRIAL COVERAGE Benefits for clinical trial coverage under this Rx Program will be administered consistently with the requirements of the Affordable Care Act. Please see the Medical Component Plan document for terms related to clinical trials. LIMITATION OF PHARMACY SELECTION If TrueScripts determines that you may be using prescription drugs in a harmful or abusive manner, or with harmful frequency, your selection of network pharmacies may be limited. If this happens, you may be required to select a single network pharmacy that will provide and coordinate all future pharmacy services. Benefits will be paid only if you use the designated single network pharmacy, subject to the terms of this Rx Program. SUPPLY LIMITS Some prescription drugs are subject to supply limits that may restrict the amount dispensed per prescription order or refill. Additionally, a maximum unit of measure quantity limit per person/plan year may apply to Specialty Drugs. To determine if a prescription drug has been assigned a supply limit or maximum unit of measure quantity limit per person/plan year for dispensing call TrueScripts at (844)-257-1955. Whether or not Huntington County Community Schools Prescription Benefits Program SPD January 1, 2025 Page 7 of 15