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DateJuly 19, 2016To:ILWU Longshore, Ship Clerk, Walking Boss/Foreman, and Watchmen LocalsFrom:Mario Perez, Manager, Welfare PlansSubject:ILWU-PMA Coastwise Indemnity Plan – Compound DrugsThe attached letter will be sent out to members enrolled in the ILWU-PMA CoastwiseIndemnity Plan. The letter explains the process for obtaining compound drugs, effective August22, 2016.Attachmentcc: Area Welfare DirectorsA copy of this memo can be downloaded at www.benefitplans.orgMP:jkt/opeiu29aflcio/Memo to Ports - ILWU-PMA CIP – Compound Drug - 071916

July 2016Important NoticeRegarding Your ILWU-PMA Welfare Plan coverageTo:Participants Enrolled in the ILWU-PMA Coastwise Indemnity Plan (CIP)Prescription Drug ProgramSubject:ILWU-PMA Coastwise Indemnity Plan Compounding Drug Portion of thePrescription Drug ProgramThis is to advise you that effective August 22, 2016, the compounding drug portion of the PrescriptionDrug Program under the ILWU-PMA Coastwise Indemnity Plan (CIP) will only cover compounded drugsthat, in addition to other Plan terms are dispensed by an OptumRx Compound Credentialed Pharmacy.In addition, the compounding drug portion of the Prescription Drug Program will no longer include bulkchemicals on the OptumRx list of excluded bulk chemicals (see attached OptumRx CompoundMedication Exclusions list).Compound prescriptions that cost more than 1,000 will continue to require prior authorization.Bulk chemicals are sometimes used by pharmacies to make compound prescriptions. Many bulkchemical products are not FDA-approved or are available in alternate forms. Other bulk chemicals haveFDA-approved formulations thereby minimizing the need for compounding these ingredients.Effective August 22, 2016, participants will have to pay out-of-pocket for prescription compounddrugs that contain non-covered bulk chemicals or that are filled by a compound pharmacy thatis not credentialed by OptumRx.WHAT IS A COMPOUND DRUG?Compound drugs require a prescription from a doctor and are prepared by a pharmacist who mixes oradjusts drug ingredients to customize a medication to meet a patient’s individual needs. Due toconcerns about member safety and drug effectiveness the requirements listed above are beingimplemented.OPTUM RX CREDENTIALED PHARMACYIf your compound pharmacy is not on the current Credentialed Pharmacies Listing attached, yourcompound prescription will not be covered. Please talk to your physician and transfer your prescriptionto a credentialed pharmacy on the attached Credentialed Pharmacies Listing. You may not see apharmacy near you (or even in your state of residence) listed, however the credentialed pharmacieslisted are licensed to dispense and ship compound medications to you.(Over)

Note that the list is subject to change. Please refer towww.benefitplans.org/compoundingpharmacies.html for the current list of credentialed compoundpharmacies, or for pharmacies outside the states of California, Oregon and Washington. You may alsocontact the ILWU-PMA Benefit Plans Office at (415) 673-8500.PRIOR-AUTHORIZATION OF COMPOUND PRESCRIPTIONSIf the compound drug you are being prescribed will cost more than 1,000 per prescription you musthave the prescription prior-authorized. To request a prior-authorization your doctor and/or pharmacycan: Call OptumRx at the toll-free number on the back of your OptumRx ID cardFAX a completed prior-authorization form available on OptumRx.com to OptumRxSubmit the information through the online provider portal at OptumRx.comAfter OptumRx receives the request, they will notify you, your doctor, and/or your pharmacy to let youknow if the medication is covered under your pharmacy benefit plan. If coverage of the compoundmedication is not approved you can still get the medication, but you will pay the full cost of theprescription.If you have any questions regarding coverage for benefits provided by OptumRx, please contact theILWU-PMA Benefit Plans Office at 415-673-8500.MP:jkt/opeiu29aflcio/Notice to Members re Compound Drugs in the ILWU-PMA CIP Rx Drug Program V3 Final 071816

Each page provides a list of the pharmacies credentialed and licensed to dispense within that state.Symbols next to the pharmacies are provided for reference for some of the more routine types ofcompounded products. If your type of product is not listed, or if you are unsure of the type of compoundedproduct you are filling; the pharmacies listed should be able to answer your questions based on theprescriptions and direct you appropriately as to their ability to compound the product.How to find a pharmacy that dispenses a specific type of compound medicationThe abbreviations below represent routine types of compounds. Not all pharmacies are credentialed todispense all types of compounds.The charts on each page will let you know which pharmacy may be able to compound the medication youneed. (For example if the prescription appears to be for a topical product look for the TOP symbol after thepharmacies within your state.) TOP:HRT:PED:NAS:STR:denotes topical products (e.g. pain ointments/gels and topical hormone creams)denotes hormone replacement therapy and fertility medications (e.g. estriol)denotes pediatric (children) custom products (e.g. liquid g-tube preparations)denotes nasal or oral inhaled therapies (e.g. antibiotic or steroid nasal compounds)denotes sterile Preparations (e.g. IV, IM, SC and Epidural injections, Ophthalmic preparations andfortified antibiotic/antifungal drops)SUP: denotes Supplements (e.g. Enzymes, EFA’s, Vitamin A/C/D and Calcium)PTD: denotes Medicare Part D (e.g. a compound claim for a Medicare Part D beneficiary)Please Note: You may not see a pharmacy near you (or even in your state of residence) listed, however theNCCP pharmacies listed for each state are licensed to dispense and ship compound medications to that state.Not all NCCP pharmacies participate in all networks.Please verify the compound credentialed pharmacy participates in your Plan’s network.5-27-2016

CALIFORNIA (CA)Pharmacy NameAddressCityState PhoneFaxAdvanced Infusion Solutions623 Highland Colony Parkway Suite 100RidgelandMS877-443-4006888-298-2220TOP HRT PED NAS STR SUP PTDAdvanced Therapeutics319 E Palm Dr. Ste A & BPlacentiaCA(714) 667-3832 (888) 978-5154XAmerica's Best Care Plus, Inc1825 Everett Drive W.Fort PayneAL800-638-6305800-638-0294XXXXXXAssured Rx13555 Automobile Blvd Suite 230ClearwaterFL727-451-6815888-209-4962XAvella of Deer Valley, Inc.23620 N 20th Drive Suite 12PhoenixAZ877-792-7684866-792-7684XXXBoothwyn Pharmacy2341 Chichester AveBoothwynPA610-485-1130610-485-9223XXXBudget Drugs13150 SW 134 al Avenue Pharmacy, Inc133 Fifteenth StreetPacific GroveCA831-373-1225831-373-3705XXXXXChemistry Rx829 Spruce Street Suite ound Pharmaceutical Technologies1048 Stanton Road Suite BDaphneAL251-626-2820251-626-2850XXXXConversio Health720 Aerovista Place Suite DSan Luis ObispoCA(866) 239-3784 (800) 977-9255CureRx Compounding Pharmacy5060 W. Sunset Blvd Suite CLos AngelesCA323-667-1111323-667-1131XXCurexa3007 Ocean Heights AveEgg Harbor Township NJ609-927-0390609-927-0392XXXXXXXXXCustom HealthCare Compounding Pharmacy24022 Calle De La Plata Suite 510Laguna HillsCA(949) 595-2273 (949) 595-2275XXXXEastern States Compounding Pharmacy338 Union ntial Pharmacy Compounding620 N 114 StreetOmahaNE402-408-0015402-408-0020XXXXXFarma Pharmacy5240 San Fernando RoadGlendaleCA(844) 849-3690 (818) 638-3136XFoothills Professional Pharmacy4545 E. Chandler #100PhoenixAZ480-496-4444480-496-4450XFoundation Care, LLC4010 Wedgeway CourtEarth CityMO314-291-1122314-291-1133XFusion Rx Compounding Pharmacy2001 Westwood Blvd. Suite A1100 Canyon View Drive Suite CLos AngelesSanta ClaraCAUT(310) 204-6676 (310) 204-6678435-703-9680 435-703-9681XXXXFusion Specialty PharmacyXXXXHarbor Compounding and Home Healthcare2000 Harbor Blvd Suite C100Costa MesaCA949-642-0106949-642-5039XXXXXXXHopewell Pharmacy1 West Borad inity Compounding Solutions1204 SE 28th Street Suite on Compounding Inc6095 Pine Mountain Road NW suite 108KennesawGA770-421-1399770-426-1965XXXXXIron Horse Specialty Pharmacy1479 Ygnacio Valley Rd. Ste 101Walnut CreekCA(925) 949-8915 (925) 954-8254XXKohana Pharmacy181 Tank Farm Road Suite 120San Luis ObispoCA805-542-0864805-542-0867XXXXXXLa Vita Compounding Pharmacy3978 Sorrento Valley Blvd #300San DiegoCA858-453-2500858-453-2501XXXXXXLake Side Pharmacy10005 AL Hwy 9 NCedar BluffAL256-422-5010866-609-4582XXXLee Silsby Compounding Pharmacy3216 Silsby RdCleveland XXXXXXXXXLifetime Value Pharmacy301 E. 17th StreetSanta AnaCA(714) 862-2470 (714) 862-2471XMasterPharm115-02 Liberty AvenueRichmond HillNY718-529-5500XMedaus Pharmacy6801 Cahaba Valley Rd Suite 116BirminghamAL(205) 981-2352 (205) 981-2767XXXMillers Compounding Pharmacy678 Wyckoff AvenueWyckoffNJ888-891-3334866-891-3334XXXXOwens Healthcare #82025 Court Street Suite BReddingCA530-244-8669530-243-0687XXXXXXPark Compounding9257 Research DrIrvineCA949-551-7195949-551-1950XXXXXXXPartell Specialty Pharmacy East5835 S Eastern Ave Suite 101Las VegasNV702-791-3800702-791-3630XXXXXXPatient Care America5371 Hiatus RoadSunriseFL954-473-4717954-473-9519Pentec Health, Inc.4 Creek ParkwayBoothwynPA800-223-4376610-494-7328Pharmacy Innovations2936 W. 17th STEriePA814-838-2102814-838-2103Pharmacy Solutions5204 Jackson Road Suite CAnn ArborMIRiverpoint Pharmacy528 E Spokane Fall Blvd #110Spokane718-529-2780XXXXXXX(734) 821-8000 (734) XXXRoxSan Pharmacy465 N. Roxbury Dr. Ground FloorBeverly HillsCA(310) 273-1644 (310) 276-4152XXSan Ramon Custom Care Pharmacy124 Market PlaceSan RamonCA(925) 830-0555 (925) 830-0450XXXXXXXScriptworks Pharmacy480 N Wiget LaneWalnut CreekCA925-934-4400925-934-4442XXXXXXValley Prescription and Compounding Pharmacy330 E. 13th StMercedCA209-722-5765209-722-3296XXXVasco Rx Specialty Pharmacy4045 E Bell Rd Suite 163PhoenixAZ(602) 971-6950 (602) 404-2504XXXXXXWoodland Hills Pharmacy20361 Ventura Blvd ste 305Woodland HillsCA(855) 876-3060 (866) 893-9320XXXXXXXPlease Note: You may not see a pharmacy near you (or even in your state of residence) listed, however theNCCP pharmacies listed for each state are licensed to dispense and ship compound medications to that state.Not all NCCP pharmacies participate in all networks.Please verify the compound credentialed pharmacy participates in your Plan’s network.5-27-2016