TrueScripts has been retained by the Plan Administrator to provide Prior Authorization services for a particular set of drugs. The Plan has approved a predetermined set of criteria to be applied to this Prior Authorization process. For a drug which is subject to Prior Authorization to be covered by this Rx Program; the pharmacist, Participant, or prescriber must call the TrueScripts Customer Care Department to obtain Prior Authorization before the drug is purchased. TrueScripts will fax the prescriber the necessary forms to obtain the information necessary to determine whether the drug will be a covered expense, based upon the predetermined set of criteria and the information supplied by the prescriber. TrueScripts will notify the pharmacy/Participant or prescriber who submitted the request for Prior Authorization within 72 hours (once the letter of medical necessity is received from the prescriber) that the drug is or is not covered by the Plan. The request for Prior Authorization is considered to be a pre-service claim as described in the U.S. Department of Labor Regulations 2560.503-1 (issued November 21, 2000). TrueScripts authorization is not a guarantee that the drug is eligible for payment under the Rx Program or Plan. The Rx Program may include a Step Therapy program which promotes the utilization of certain Preferred Drugs in specific drug categories such as cholesterol lowering statins and proton pump inhibitors (gastro- intestinal agents); however, others may be identified. Certain drugs have been identified which will not be covered under the Rx Program if the Step Therapy program has not been followed and a Prior Authorization obtained. The Step Therapy program requires documentation from a prescriber that the Participant has tried a minimum number of alternative drug treatments and that they did not successfully treat the Participant’s condition. If a medication the Participant is taking is identified as a Step Therapy drug, the Participant is not required to change medications, but it will not be covered under the Rx Program unless approved through TrueScripts. For more Information on this Step Therapy program, please contact TrueScripts at (844) 257-1955 or visit www.truescripts.com. For a list of drugs that require prior authorization, please visit www.truescripts.com or by calling (844) 257- 1955. APPEALING A DENIED CLAIM OR PRIOR AUTHORIZATION Procedures to appeal denial of claims, services or pre-authorization requests are set forth in the Medical Component Plan and are deemed incorporated herein. However, all appeals for Rx Program shall be sent to and administered by: TrueScripts Management Services, LLC, C/O Appeals Dept. 513 E. South St. Washington, IN 47501. TrueScripts has the discretionary authority to determine the right to benefits and any appeals under the Rx Program. EMERGENCY SUPPLY For covered medications under this Rx Program and in instances in which a Prior Authorization cannot be immediately obtained, Participants may receive and be reimbursed for up to a 72-hour supply of a covered Huntington County Community Schools Prescription Benefits Program SPD January 1, 2025 Page 11 of 15