13. Medications used for conditions and/or at dosages determined to be experimental or investigational, or unproven, unless TrueScripts or the Plan have agreed to cover an experimental or investigational or unproven treatment. 14. Except for the assistance provided in 14(a) below, if a drug manufacturer or third party provides for rebates, discounts, and/or reimbursement of all or a portion of the medication supply, that supply portion may be excluded under the terms of the Rx Program. Manufacturer and third-party payment programs do change, and information about this exclusion may be obtained by calling TrueScripts. If a Participant is eligible for a rebate, discount, or reimbursement from a manufacturer or third party, and does not apply for this rebate, discount, or reimbursement, the number of Scripts associated with that rebate, discount, and/or reimbursement will be excluded unless/until the Participant completes and submits an Affidavit establishing that the Participant did not apply and stating the reason(s) for the failure to apply or provides evidence that any application for such rebate, discount, and/or reimbursement was denied. (a) Notwithstanding the foregoing, the Rx Program may establish, by written procedure, a maximum benefit for copay card assistance for each Participant in certain circumstances. The maximum Plan benefit shall be $30,000 and, thereafter, the Plan shall remit to the Participant, as payment assistance within 90 days from month end of benefit determination an amount equal to 10% of the excluded amount paid with a copay card up to $50 per month. Any assistance under this provision shall be deemed to be used by the Participant for medical expenses, and, therefore, tax exempt. 15. All exclusions and limitations under the Medical Component Plan. 16. Medications that are illegal under applicable law. 17. In accordance with the preferred formulary and procedures implemented by TrueScripts, as modified from time to time, certain prescriptions will be deemed processed under the Major- Medical portion of the Medical Component Plan, and therefore excluded under the prescription program. All other prescriptions covered by the Rx Program are excluded by the Major-Medical provisions of the Medical Component Plan DEDUCTIBLES AND OUT-OF-POCKET MAXIMUMS The following amounts do not accrue towards the total covered expenses that are the responsibility of the Participant and do not accumulate toward the applicable Deductible and/or Out-of-Pocket Maximum: 1. Premiums; 2. Expenses that are excluded under the Rx Program; 3. Expenses in excess of the reasonable and customary charges for services or supplies; 4. Expenses in excess of any maximum quantity list in the Rx Program; 5. Penalties; 6. Expenses reimbursed, waived, or covered through manufacturer or third-party assistance programs or discount programs; 7. Expenses for brand-name drugs above the applicable generic copay the Participant would have paid as outlined in the “Dispensed as Written Drug Provision”; and/or 8. Any cost related to a drug that is partially or wholly excluded. PRIOR AUTHORIZATION REQUIREMENT Huntington County Community Schools Prescription Benefits Program SPD January 1, 2025 Page 10 of 15