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GENERICS AS LOW AS

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Hy-Vee’s Prescription Program Rules Hy-Vee’s Prescription Program (the “Program”) is available at all Hy-Vee, Hy-Vee Drugstore and Hy-Vee Health Market pharmacies (“Hy-Vee Retail Pharmacies”). The Program applies to certain generic drugs at commonly prescribed dosages. You may obtain a list (“Retail Drug List”) of these generic drugs and dosages covered under the Program on hy-vee.com or at a Hy-Vee Retail Pharmacy. The Retail Drug List of covered generic drug and dosages may change over time and may vary by state. Not all formulations of a drug (for example, enteric-coated, extended or timed release formulations) are covered under the Program. Program pricing is not available for covered drugs dispensed as part of a compound.

The Program includes eight categories: Category:

Common Drug Types:

Pricing:

Category 1A

• Allergies, Asthma, Cold & Flu • Arthritis & Pain • Mental Health • Gastrointestinal Health • Women’s Health

• Glaucoma & Eye Care • Anti-Viral • Skin Conditions • Vitamins & Nutritional Health • Other Medical Conditions

Category 2B

• Arthritis & Pain • Heart Health & Blood Pressure

• Diabetes • Cholesterol

Category 3

• Mental Health

• Gastrointestinal Health

Category 4B

• Mental Health • Heart Health & Blood Pressure • Cholesterol • Diabetes

• Gastrointestinal Health • Skin Conditions • Other Medical Conditions

Category 5C

• Women’s Health

Category 6

• Men’s Health

Category 7

• Arthritis & Pain

Category 8

• Antibiotics

$4.00 for 30 day supply OR $10.00 for a 90 day supply

$10.00 for a 90 day supply $9.00 for a 30 day supply OR $25.00 for a 90 day supply $25.00 for a 90 day supply $9.00 for 28 day supply OR $25.00 for 84 day supply $25 for 4 tablets $25.00 for 9 tablets $10.00 as indicated on the Retail Drug List

A. Prices for quantities between a 30-day supply and a 90-day supply of drugs in this Category are prorated based on the 30 day Program price. B. Prices for quantities other than a 90-day supply of drugs in this Category will be subject to standardized pricing for a supply other than 90 days until reaching the 90-day program price. C. Prices for quantities between a 28-day supply and an 84-day supply of drugs are prorated based on the $9 Program price, but will not exceed $25.

General Limitations:

1. P rorated pricing may not be available under the Program for prepackaged drugs. For pricing policies relating to prepackaged drugs (such as tubes, vials or bottles), see a Hy-Vee Retail Pharmacy. 2. D ue to state law, prices of certain drugs covered by the Program may be higher in some states. Please see the Retail Drug List for further information. 3. Program pricing may be limited to select manufacturers of a covered drug. 4. Program pricing is available as long as supplies are in stock at the dispensing Hy-Vee Retail Pharmacy. 5. You may pay less or more than the Program price, depending on the terms of your health plan. 6. Prescriber permission may be required to change a 30-day prescription to a 90-day prescription. 7. Certain plans, including government-funded programs, may not cover a 90-day supply. 8. T hese Program Details are subject to change without advance notice. Program participants should regularly check hy-vee.com for the most current version of Hy-Vee’s Prescription Program Rules.