Exhibit_A,_Attachment_A.3_-_Medicare_Part_D_Drug_List.xlsx

This is a Medicare Part D Drug List exhibit submitted by the County of Volusia, Florida, for its Medical and Pharmacy Plan for Medicare Eligible Retirees. The document provides a comprehensive formulary listing highly utilized medications with corresponding National Drug Codes (NDCs) and required tier classifications. Contractors are tasked with classifying each of the approximately 100 listed medications into one of five tiers: Generic (1), Brand Preferred (2), Brand Non-Preferred (3), Specialty (4), or Not Covered (5). The drug list encompasses a broad range of therapeutic categories including cardiovascular agents, diabetes management medications, immunosuppressants, anticoagulants, and specialty pharmaceuticals. The plan is structured as a Partial Part D HMO with major chain pharmacy networks, requiring contractors to maintain the capability to report participation separately for the County and participating agencies, with plan effectiveness beginning January 1, 2027.

The plan operates as a fully insured Medicare Supplement and Part D Employer Group Waiver Plan (EGWP) benefit program for eligible Medicare retirees and dependents, with the County's Third Party Administrator, WEX, currently handling eligibility, enrollment, and billing functions. Medicare-eligible retirees and dependents under age 65 may elect to remain on self-funded plans, while those age 65 and older are required to enroll in the County's Medicare plans. The drug formulary identifies specific out-of-pocket exclusions and notes that certain medications are covered under the Medical Plan rather than the Pharmacy benefit, ensuring clarity on coverage pathways and cost-sharing responsibilities for plan participants.