attached to and made part of Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Preferred Blue PPO Preferred Provider Plan Subscriber Certificate R13-7054 (2022) to be attached to HMO-PPO Page 1 hppo13-7054 Rider Prescription Drugs This rider modifies the terms of your health plan. Please keep this rider with your Subscriber Certificate for easy reference. The outpatient benefits described in your Subscriber Certificate for certain covered drugs and supplies have been changed. This health plan will provide full benefits for certain smoking and tobacco cessation drugs and aids (such as nicotine gum and patches). For these covered drugs and supplies, you pay nothing. For a complete list of these covered drugs and supplies, refer to the Blue Cross Blue Shield HMO Blue drug list. If your health plan has a separate drug deductible, it will not apply to the covered drugs and supplies described in this rider. If this is the case, the drug deductible will be described in the Schedule of Benefits for your plan option and/or any riders that apply to your coverage in this health plan. For more information on the covered drugs and/or supplies described above, you can call the Blue Cross Blue Shield HMO Blue customer service office. The toll free phone number to call is shown on your ID card. A Blue Cross Blue Shield HMO Blue customer service representative can help you find out the cost share you will pay for a specific covered drug or supply. Or, you can also go online and log on to the Blue Cross Blue Shield HMO Blue Web site at www.bluecrossma.org. All other provisions remain as described in your Subscriber Certificate.