Prescription Drug coverage has been modified as follows effective January 1, 2004:

• Retail (34 day supply): $5 Co-pay for all generic and brand name drugs.
• Mail Order (90 day supply): $5 Co-pay for all generic and brand name drugs.

• Retail (34 day supply): $5 Co-pay for generic and $10 co-pay for brand name drugs.
• Mail Order (90 day supply): $5 Co-pay for generic and $10 co-pay for brand name drugs.

• Retail (34 day supply): $5 Co-pay for all generic and brand name drugs.
• Mail Order (90 day supply): $2 Co-pay for all generic and brand name drugs.

• Retail (34 day supply): $5 Co-pay for generic and $10 co-pay for brand name drugs.
• Mail Order (90 day supply): $2 Co-pay for all generic and brand name drugs.

• Mail Order (90 day supply): $5 Copay for all generic and brand name drugs for all persons beginning January 1, 2005.

If RX is written for a brand name that has a generic equivalent, the pharmacy will dispense the generic at the generic co-pay, except:

At a Retail Pharmacy, if enrollee requests the brand name, he/she will pay the generic co-pay plus the full difference in program cost between the generic and the brand name.

If the brand name is dispensed at physician direction, enrollee will pay brand name co-pay plus the difference in program cost between the generic and brand name (up to a max of $10).

Thereafter, a review will determine medical necessity for the brand name. If necessity is established, amounts paid in excess of brand name co-pay will be refunded. If necessity is not established in regard to future purchases, the enrollee will be charged the generic co-pay, plus the full difference in program cost between the generic and the brand name.

If the physician directs dispensing of the brand name, an automatic review of medical necessity will be initiated. If necessity is not established, the brand name will be dispensed and the enrollee will pay the co-pay plus the full difference in program cost between the generic and the brand name.

There are a few brand name drugs that will not be substituted for because of safety concerns. The brand name co-pay will apply with no additional charges.

Beginning January 1, 2004, following the original prescription purchase and two refills of each drug, the

enrollee will be charged 100% of Program cost for that drug at the retail pharmacy. To avoid this charge, additional purchases must be made through the Mail Order Pharmacy.

Benefit Plan Reps

1st Shift: Stu Wilson, Jerry Reid, and Jolan Jackson

Alternates: Grant Holst and George Casarez

2nd Shift: Lauri Veneman, Alternate Denise DeBoer