75 Covered Charges (Formulary) Covered charges include only the reasonable and customary charges for drugs and medications, which, in accordance with federal or state laws, may not be dispensed without the written prescription issued by a physician. The CVS Caremark covered drug list (formulary) includes coverage for most prescription drugs; however, some products are excluded from the formulary in favor of therapeutic equivalents. A therapeutic equivalent is a drug that has essentially the same effect in the treatment of a disease or condition as one or more other drugs; or more simply, a drug that controls a symptom or condition in the exact same way as another. CVS Caremark may make changes to the formulary from time to time. To determine whether a particular drug is covered, you can go to the CVS Caremark website at www.caremark.com , and register to obtain specific benefit information. Also, you can call the CVS Caremark Customer Care line at 800-282-8503. In addition, if your physician feels there is a clinical reason why you, your Spouse, or your Eligible Dependent Child cannot, or should not, use any of the available therapeutic equivalent alternatives in place of an excluded product, CVS Caremark will provide a review option. Your physician can call CVS Caremark toll-free at 855-240-0536 to initiate such a review. Diabetic Testing Equipment The formulary limits glucose monitors and related test strips to OneTouch devices. OneTouch blood glucose meters will be provided at no charge, by the manufacturer, to the covered individuals who are using a meter other than OneTouch. For more information on how to obtain a blood glucose meter, and any limitations that apply to the program, call 866-871-0839. Generic Step Therapy The Plan includes a generic step therapy program that requires participants to try one or more generic equivalent alternatives in most drug classes before the Plan will provide coverage for a brand name medication. If a brand name medication is required, it must be specifically ordered, and the physician will be required to verify that the drug is Medically Necessary using the CVS Caremark prior authorization process. If you have not tried a generic alternative, and do not have prior authorization approval of Medical Necessity, you will be responsible for full payment of the brand name medication even if the prescription is marked “dispense as written.” To avoid any confusion at the pharmacy, we suggest that you inform your physician about the Generic Step Therapy program and ask them to call CVS Caremark at 800-294-5979 before accepting a prescription for a brand name drug. CVS Caremark will inform your provider regarding whether the Plan covers the brand name drug, what alternatives are available, and will initiate the Medical Necessity review process where appropriate. If you have not tried a generic or generic equivalent to the brand name drug, your physician will be offered generic alternative options and will be required to select one. Your brand name prescription will be changed to the generic alternative chosen by your physician. Exceptions to Generic Alternatives Your physician can provide CVS Caremark with historic information about alternatives you have tried, if applicable, and request approval for coverage of a brand name drug. Your physician should provide a statement of Medical Necessity that explains the clinical reasons why the brand name drug is required. The brand name drug will be allowed if CVS Caremark confirms Medical Necessity. Your provider also