The Regional Formulary and Therapeutics Committee meets to review new drugs and reconsider drugs currently on the market. After this review, they may add drugs to the formulary or remove drugs from it. If a drug is removed from the formulary, you will need to switch to another comparable drug that is on the drug formulary, unless your old drug meets exception criteria. Refer to the "Drug formulary exception process" in this rider for more information. If a formulary change affects a prescription drug you are taking, we encourage you to discuss any questions or concerns with your network provider or another member of your health care team. Drugs on our formulary may move to a different drug tier during the year. For example, a drug could move from the nonpreferred brand-name drug list to the preferred brand-name drug list. If a drug you are taking is moved to a different drug tier, this could change the cost-sharing you pay for that drug. To see if a drug or supply is on our drug formulary, or to find out what drug tier the drug is in, go online to kp.org/formulary. You may also call our Formulary Application Services Team (FAST) at 503-261-7900 or toll free at 1-888-572-7231. If you would like a copy of our drug formulary or additional information about the formulary process, please call Member Services at 1-877-221-8221. The presence of a drug on our drug formulary does not necessarily mean that your network provider will prescribe it for a particular medical condition. Drug formulary exception process Our drug formulary guidelines include an exception process that is available when a network provider or any licensed dentist prescribes a drug or supply that our drug formulary does not list for your condition, if the law requires the item to bear the legend "Rx only." The exception process is not available for drugs and supplies that the law does not require to bear this legend, or for any drug or supply prescribed by someone other than a network provider or any licensed dentist. A network pr ovider or any licensed dentist may request an exception if the provider determines that the non-formulary drug or supply is medically necessary. We will make a coverage determination within 72 hours of receipt for standard requests and within 24 hours of receipt for expedited requests. We will approve the exception if all of the following requirements are met: • We determine that the drug or supply meets all other coverage requirements except for the fact that our drug formulary does not list it for your condition. • Medical Group or a designated physician makes the following determinations: ♦ The drug or supply is medically necessary because you are allergic to, or intolerant of, or have experienced treatment failure with, any alternative drugs or supplies that our drug formulary lists for your condition. ♦ Your condition meets any additional requirements that the Regional Formulary and Therapeutics Committee has approved for the drug or supply. For this drug or supply, the pharmacy can provide a copy of the additional criteria upon request. In some cases, there may be a short delay in filling your prescription while your information is being reviewed. If we approve an exception through this exception process, then we will cover the drug or supply at the applicable cost-sharing listed in the Medical Benefits Chart. RSARX0124 3