Effective January 1, 2016

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1 Effective January 1, 2016 CONTENTS Prescription Benefit Changes Prescription Drug Benefit Highlights...3 Comparing Your Options...4 Filling Your Prescriptions...4 Benefit Coverage Tiers...5 Prescription Drugs Requiring Step Therapy..5 Specific Overly Expensive Medications...7 Diabetic Products...7 Alliance s prescription drug coverage helps pay for medications prescribed for you and your covered dependents. This benefit is based on the principles of: Encouraging higher-value medication choices choosing clinically effective and low-cost drugs when available, even if less convenient Step therapy trying lower-cost drugs that have been shown to be clinically effective for your condition, rather than immediately choosing higher-cost options Cost sharing paying for a reasonable share of the total cost, while avoiding unnecessary expenses and preventing waste Care coordination receiving medical-necessity review for specialty drugs and for treatments that present a patient-safety issue When you need medication, you and your health care provider can choose among several drug options to treat your health condition. It is important to understand how your choice affects how you and the Alliance Coal Health Plan share the total drug cost. Be sure to review this booklet with your doctor or nurse practitioner (NP). Also, if you would like to minimize your cost, ask your pharmacist to review your Alliance coverage in the Envision claims system, to determine if there are options that will save you money, and to discuss these options with you and your prescriber.

2 Prescription Benefit Changes The following changes will apply to the Plan beginning January 1, 2016: + Diabetic products will be covered only from approved manufacturers. Diabetes drugs and supplies are very similar from one manufacturer to another, but some companies charge overly high prices (such as Accu-Chek, Humalog, and Humulin). The Plan s benefits will be limited to approved products (such as OneTouch, Novolog, and Novolin). + Benefit coverage will not be provided for overly expensive drugs when clinically effective alternatives with more reasonable prices are available. For example, Zipsor and Zorvolex are pain relievers that typically cost $3 to $7 per pill. Diclofenac and Ketorolac are equally effective and cost less than $1 per pill. + For some new prescriptions, a step therapy approach will be required. Rather than providing immediate coverage for certain more-expensive drugs (for example, Ambien or Lunesta for insomnia), the Plan will require you to first try less-expensive drugs that have been shown to be clinically effective for your condition (for example, Zolpidem IR or Zaleplon). + Compound drugs will be provided by mail order only. For some medical conditions, your doctor may prescribe compound drugs medicines that are custom-made for an individual patient. Creating these drugs requires special expertise, and errors can have serious consequences. Compound drugs will be covered only when provided by Orchard Pharmaceutical Services. + Benefit coverage will change for proton pump inhibitors (PPIs) such as Prilosec, non-sedating antihistamines such as Claritin, and intranasal steroids such as Flonase. Over-the-counter drugs in these categories are now commonly available for you to purchase from many retailers (like you can purchase aspirin). Employer benefit plans typically reduce or eliminate coverage for products like these, because you can now easily obtain them without a prescription at a relatively low cost. The Plan s 2016 prescription drug tiers will identify the specific drugs in these categories that will be covered (or not covered) at pharmacies, which coverage level will apply (for example, 30% or 50% coinsurance), and any step-therapy requirements that must be satisfied in order to be covered by the Plan, as well as over-the-counter drugs that may be available at on-site Health Centers. The 2016 prescription drug tiers will be published on near the end of Same Effectiveness, Different Cost When pharmaceutical companies develop new brand-name drugs, they typically charge high prices often unreasonably high, compared to other available drugs with similar clinical results. Later, the drugs typically become available in generic form, usually with a lower price, but with the same active ingredients as required by law. 2

3 2016 Prescription Drug Benefit Highlights Common Medication Categories Approved Over-the-Counter Your Cost (In-Network) 0% only when obtained at on-site Health Centers Approved Disease-Management and Approved Preventive 0% Generic Preferred (Tier 1 ) 0% Generic Non-Preferred (Tier 2) 10% Brand-Name Preferred (Tier 3) 10% Brand-Name Non-Preferred (Tier 4) 30% Other Medication Categories Specialty Preferred (Tier 5), requires step therapy and prior authorization, covered only when provided by Orchard Pharmaceutical Services Specialty Non-Preferred (Tier 6), requires step therapy and prior authorization, covered only when provided by Orchard Pharmaceutical Services Your Cost (In-Network) 25%, up to $100 maximum coinsurance per prescription 25%, up to $200 maximum coinsurance per prescription The following types of medications are no longer covered: Overly expensive drugs when clinically effective alternatives are available* Non-approved diabetic products* Certain prescription drugs if step therapy is not tried first* Compound drugs (custom-made) if not provided by Orchard Pharmaceutical Services Not covered * Listed on pages 5-7. Each year, all drugs are reviewed and re-assigned to the appropriate coverage tier. The 2016 prescription drug tiers will be published on CoalBenefits.com near the end of For certain medications, additional restrictions apply. As before, if you use an Out-of-Network pharmacy, the Plan will pay only the amount it would have paid to an In-Network pharmacy, and you will pay the balance. 3

4 Comparing Your Options Your physician may recommend specific prescription therapies for your treatment, but it is ultimately your choice. The total cost of specific drugs and your share of the cost can vary widely for different options, as shown in the example below. You may wish to get a second opinion from a member of Dr. Wells team or another physician to determine if a more cost-effective option is available. Example Assume your doctor is recommending that you take a prescribed medication to control your high blood pressure. There are a number of brand-name and generic drugs commonly prescribed to treat that condition. The chart below shows how much the total cost can vary and how your choice can affect your share of the cost. Option Tier Medication Total Cost Your Cost (coinsurance) Option #1 Brand-Name Non-Preferred Diovan HCT $170 30% x $170 = $51 Option #2 Generic Preferred Valsartan HCTZ $20 0% x $20 = $0 Filling Your Prescriptions On-Site Health Center Many approved over-the-counter medications are prescribed and available at the on-site Health Centers staffed by Raymond D. Wells PSC. Retail Pharmacy To fill or refill a prescription at a pharmacy, present your Health ID Card. The pharmacist will tell you the amount of your coinsurance, which you can pay directly to the pharmacist before receiving your prescription. As with other purchases you make, you should consider stores that offer lower costs for you and Alliance; for example, Walmart typically offers lower prices than Walgreens or CVS. Buying Compound and Specialty Drugs The Alliance Coal Health Plan covers specialty and compound medications only when provided by Orchard Pharmaceutical Services. Specialty medications are listed as Tier 5 and Tier 6 on the Plan s prescription drug coverage tiers. These are complex therapies, often with special storage and handling requirements. Some of these specialty medications include costly (for example, $30,000 per month) injectable therapies and select chemotherapeutic agents. Some examples of specialty medications are those intended for Rheumatoid Arthritis, Multiple Sclerosis, and Hepatitis C. Compound drugs are medicines that are custom-made for an individual patient. Creating these drugs requires special expertise, and errors can have serious consequences. To contact Orchard, call (option 6) toll free. 4

5 Benefit Coverage Tiers Each year, all drugs are reviewed and re-assigned to the Plan s prescription drug coverage tiers based on the EnvisionRxOptions Preferred Drug List (formulary) and each drug s average cost at the end of the previous year. The EnvisionRxOptions Preferred Drug List is maintained by the EnvisionRxOptions Pharmacy and Therapeutics Committee, made up of independent physicians and pharmacists. Regularly, new drugs are added to the list, and some drugs are re-assigned to different tiers. Example Let s assume in 2015 you were taking a generic drug that was Tier 1 (Generic Preferred, 0% coinsurance). If the drug is classified as Tier 2 for 2016, you may want to investigate whether another drug (or the same drug produced by a different manufacturer) is available as Tier 1 for Otherwise, you will share in the total cost of the Tier 2 drug by paying 10%, and the Plan will pay 90%. The 2016 prescription drug tiers will be published on CoalBenefits.com near the end of If you would like to minimize your cost, ask your pharmacist to review your Alliance coverage in the Envision claims system, to determine if there are drug options that will save you money, and to discuss these options with you and your prescriber. Prescription Drugs Requiring Step Therapy Not covered if specific alternatives are not tried first To receive prescription drug benefits for these medications, the Plan requires you to first try less-expensive drugs that have been shown to be clinically effective for your condition. If the less-expensive medication(s) is not effective for you, the Plan will then provide coverage for a more-expensive option. The Plan s 2016 prescription drug tiers will identify the step-therapy requirements; following are examples. Ask your doctor, nurse practitioner (NP), or pharmacist about these step-therapy options. Generally, your pharmacist can obtain a revised prescription from your doctor or NP by telephone or fax, with no need for you to make an additional office visit. Medication Type Prerequisite Steps Medications Covered Only If Prerequisite Steps Are Not Effective for You ADD/ADHD Medications Two generic ADD/ADHD medications Focalin XR Quillivant Ritalin LA Vyvanse ADD/ADHD Transdermal Two oral generic ADD/ADHD medications Daytrana Angiotensin Receptor Blockers Anticonvulsant Asthma Medications Blood Pressure Cholesterol Management Fibric Acid Derivatives Cholesterol Management Statins Two of the following generics: Irbesartan, Losartan (or Losartan/HCT), or Valsartan (or Valsartan HCT) Gabapentin Proair HFA or Ventolin HFA Metoprolol or Metoprolol XR Generic Fenofibrate Two of the following generics: Atorvastatin, Lovastatin, Simvastatin, or Pravastatin Atacand/HCT Avalide Avapro Benicar/HCT Cozaar Lyrica Proventil HFA Bystolic Antara Lipofen Altoprev Crestor Fluvastatin Lescol/XL Lipitor Edarbi Hyzaar Micardis/HCT Teveten/HCT Xopenex HFA Tricor Triglide Livalo Mevacor Pravachol Vytorin Zocor Step-therapy requirement examples continued on next page. 5

6 Prescription Drugs Requiring Step Therapy (cont.) Medication Type Prerequisite Steps Medications Covered Only If Prerequisite Steps Are Not Effective for You Cox II Inhibitor Generic NSAID in the last 180 days; or be on Anticoagulant, GI, or steroid therapy; or be older than age 50 Celebrex Celecoxib Diabetes Medications Janumet, Januvia, Kombiglyze, or Onglyza Jentadueto Tradjenta Erectile Dysfunction Medications Gout Medications Viagra or Levitra Allopurinol Cialis (ED) Staxyn Uloric Stendra Zyloprim Growth Hormones Hematological Agent Hematopoetic Agents Hepatitis C Genotropin or Norditropin Clopidegrel Procrit Pegays or PegIntron Humatrope Nutropin AQ Omnitrope Effient Aranesp Intron-A Saizen Tev-Tropin Zomacton Epogen Infergen Inflammatory Bowel Disease Medications Apriso or Lialda Asacol HD Delzicol Pentasa Inflammatory Condition Medications Both Enbrel and Humira Actemra Cimzia Cosentyx Kineret Orencia Otezla Simponi Xeljanz Insomnia Agents Migraine Drugs Both Zaleplon and Zolpidem IR Any two generics indicated for this condition Ambien Ambien CR Edluar Lunesta Alsuma Amerge Frova Imitrex Sonata Zolpidem CR Zolpimist Maxalt Relpax Sumavel Zomig Multiple Sclerosis Medications Avonex, Copaxone, Gilenya, or Tecfidera Aubagio Betaseron Extavia Rebif Narcotic-Addiction Medications Suboxone Film Bunavail Buprenorphine/Naloxone Zubsolv Opioid Oral Osteoporosis Medications Parkinson s Disease Fentanyl or Fentanyl citrate buccal Alendronate or Ibandronate Any generic indicated for this condition Abstral Actiq Actonel Boniva Neupro Fentora Fosamax Rheumatoid Arthritis Medications Both Enbrel and Humira Actemra Cimzia Kineret Orencia Simponi Stelara Xeljanz Selective Serotonin Reuptake Inhibitors (SSRIs) Two generic SSRIs Brintellix Fetzima Khedezla Luvox CR Pexeva Viibryd Serotonin (SSRI) and Norepinephrine Reuptake Inhibitor (SNRI) With a depression diagnosis: two generic SSRIs or SNRIs (step therapy not required with a chronic pain diagnosis) Cymbalta Stimulant Nuvigil Modafinil Step therapy is not required for a given medication if you are already using it before Step-therapy requirements are subject to change at any time. In-Network pharmacists always have access to up-to-date information in the Envision claims system, to ensure they can inform you of your cost before you complete any purchases. 6

7 Specific Overly Expensive Medications Not covered because clinically effective alternatives are available Ask your doctor, nurse practitioner, or pharmacist about alternative medications. Generally, your pharmacist can obtain a revised prescription from your doctor or NP by telephone or fax, with no need for you to make an additional office visit. Antidepressants Pexeva Venlafaxine HCL ER tablets Androgens Testim Anti-inflammatory Products Duexis Ravos Vanos Diabetes Medications Glumetza ER Fortamet ER Drug/Alcohol Dependence Medication Vivitrol Hepatitis C Medications Olysio Technivie Viekira Pain Relievers All brand-name narcotic pain relievers Relyyt Sprix Vimovo Zipsor Zorvolex Premenstrual Dysphoric Disorder Relievers Sarafem (or Fluoxetine HCL tablets) Medications that have not been approved by the FDA as safe and effective (with FDA-approved labeling); for example: Sinelee Reciphexamin QRoxin Diabetic Products Covered: approved products Diabetes/Glucose Testing Supplies Freestyle OneTouch Precisio Insulin Novolog Novolin Injectable Antidiabetic Bydureon Byetta Victoza Not covered: non-approved products Diabetes/Glucose Testing Supplies Accu-Chek Breeze Contour Insulin Apidra Humalog Humulin Injectable Antidiabetics Tanzeum Trulicity The lists on this page are subject to change at any time. In-Network pharmacists always have access to up-to-date information, to ensure they can inform you of your cost before you complete any purchases. 7

8 Where to Get More Information Find a network pharmacy at: Find a retail pharmacy Check the Plan s prescription drug coverage tiers at: Prescription Drug Coverage Tiers Learn more about your prescription drug benefits at: Health Care» Prescription Drug (login required) Call EnvisionRxOptions customer service (24/7): This booklet provides highlights of the prescription drug benefits under the Alliance Coal Health Plan, which is explained more fully by the summary plan description (SPD) contained in the benefits handbook at If you have any questions, refer to your SPD, contact your local Human Resources representative, or call Corporate Benefits at If there are any differences between the information in this booklet and the official plan documents, the plan documents govern. Benefit coverage provided by the Plan may change or end at any time. Nothing in this booklet provides an offer or guarantee of continued employment. AC-OE