Prescription Benefit Plan

At the request of SAMBA, Medco manages your prescription drug benefit under the SAMBA Health Benefit Plan (High Option and Standard Option) and the SAMBA Dependent Children Health Benefit Plan (Standard Option only). The benefit includes a list of drugs preferred by your plan. This list, sometimes called a formulary, has a wide selection of generic and brand name medications.

Bring the Preferred Prescriptions^® Formulary Member Guide with you to each doctor visit to discuss whether a drug on the list is right for you. You may purchase the drugs at a retail network pharmacy or through Medco By Mail, Medco's mail-order pharmacy.

To keep your costs low, your copayment will be less when you purchase a generic or formulary brand-name drug. And, if you purchase your drugs through the Medco By Mail, mail-order pharmacy your costs are usually much lower.

Refer to your handbook for details pertaining to the plan option that you have coverage.

High Option: Your 2006 Prescription Drug Benefit Handbook

Standard Option: Your 2006 Prescription Drug Benefit Handbook

Patient Safety Features

SAMBA has several programs to promote prescription drug patient safety. The result is improved care for all of our members and their dependents'. Patient safety programs include:

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Prior Authorization: Certain prescription drugs and supplies have coverage limits and require pre-approval before the first prescription or supply can be dispensed. More information is needed to determine whether the use of the prescription or supply meets the plan coverage conditions and the FDA approved prescribing and safety information, clinical guidelines, and uses that are normally considered reasonable, safe, and effective. Click here to access a list of drugs that will require pre-approval.

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Smart Prior Authorization: This program feature identifies when a prescription quantity or dosage exceeds the FDA approved prescribing and safety information, clinical guidelines, and uses that are normally considered reasonable, safe, and effective. When this situation occurs, the doctor must be contacted before the prescription is filled.

If you or your dependent encounter either of these events, Prior Authorization or Smart Prior Authorization, the following will occur:

	Retail Pharmacy - to initiate the review process, contact Medco Monday through Friday 8:00 a.m. to 9:00 p.m., eastern time, at 1-800-417-1764
	Medco By Mail - if you use the mail-order pharmacy, Medco will contact your doctor directly to begin the review process.

Medco will notify you and your doctor of the decision in writing (usually within 2 days of receiving the information). If coverage is approved, the letter will indicate the length of time that the coverage will be valid. If coverage is denied, a written explanation will be provided along with instruction on how to submit an appeal.

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Dose Optimization, applies only to Medco By Mail: The doctor may prescribe a lower dose drug to be taken several times a day when a higher dose drug could be taken less number of times per day with the same results. If this should occur, Medco will contact the doctor with the suggestion to change to the higher dose. The doctor will make the final decision whether to change the dosage of the drug.

Copayments

HIGH OPTION
Prescription Drugs	Plan Pays: Preferred Pharmacy	Plan Pays: Non-Preferred Pharmacy
Retail pharmacy Rx drugs and medicines – 30-day supply	No deductible 100% after copayment of: $10 per generic $25 per formulary name brand $40 per non-formulary name brand	No deductible Reimbursement based on SAMBA's cost of prescription at a participating retail pharmacy
Mail order Rx drugs and medicines – 90-day supply	No deductible 100% after copayment of: $10 per generic $5 per generic for Medicare B Primary $45* per formulary name brand $20 per formulary name brand for Medicare B Primary $60* per non-formulary name brand *$35 per non-formulary name brand for Medicare B Primary	Not applicable

STANDARD OPTION
Prescription Drugs	Plan Pays: Preferred Pharmacy	Plan Pays: Non-Preferred Pharmacy
Retail pharmacy Rx drugs and medicines – limited to initial fill, 30-day supply, and one refill	No deductible 100% after copayment of: $10 per generic $30 per formulary name brand $45 per non-formulary name brand	No deductible Reimbursement based on SAMBA's cost of prescription at a participating retail pharmacy
Mail order Rx drugs and medicines – 90-day supply	100% after copayment of: $20 per generic 25% of the Plan allowance ($45 minimum/$80 maximum for each) formulary name brand 25% of the Plan allowance ($60 minimum/$100 maximum for each) non-formulary name brand	Not applicable

If you have questions, you can call Medco's Member Services toll-free at (800) 283-3478, 24 hours a day, 7 days a week, except Thanksgiving and Christmas, or you can log on to Medco's website at www.medco.com. You can also contact SAMBA's Customer Service toll-free at (800) 638-6589.