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Prescription Drug Minimum Rebate Guarantee <br />National Formulary <br />Our standard and broadest formulary offering is the Anthem National Drug List. This formulary includes <br />brand -name and generic prescription medications selected through our P&T review process. We chose <br />medications based on safety, effectiveness and value. The National Drug List includes 98.5% of <br />prescription medications available in the market. <br />Aritham Natjonal Formulary Jan 2019 - Dec 2019 Jan 2020 - Dec 2020 Jan 2021 - Doc, 2021 <br />Retail (includes Specialty) Per $107.42 $152.59 $167.47 <br />Brand Script <br />Home Delivery (includes $1,219.09 $1,733.64 $1,965.43 <br />Specialty) Per Brand Script <br />We are passing through 100% of the actual rebates Anthem receives to the client, subject to the <br />minimum per brand script amounts indicated above. <br />Anthem may receive and retain administrative fees from our pharmacy vendor or directly from <br />pharmaceutical manufacturers. <br />summary of our guarantees <br />This is a summary of the guarantees we offer for our prescription drug benefit. It is not a legal contract. <br />If this summary conflicts with the Administrative Services Agreement, the Administrative Services <br />Agreement controls. <br />APPAQVID <br />of INJk" <br />X-3-3 <br />Signature Date <br />