RXBIN 004336

RXPCN MEDDADV

RXGRP RXCVSD

SilverScript may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug and/or move a drug to a higher cost-sharing tier, we will notify you of the change at least sixty (60) days before the date the change becomes effective. However, if the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we may immediately remove the drug from our formulary and notification may be retrospective.

The table on the following pages outlines changes to SilverScript formularies that may impact you. All changes are effective JUNE 1, 2018, or otherwise if noted below.

* Please see attached for more information*