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Principal Life Insurance Company
This prescription drug listing is provided to you by Principal Life Insurance Company. You should read the
prescription drug section of your coverage booklet-certificate for an explanation of drug benefits and
Your benefit design may exclude coverage for injectables, diabetic supplies, weight loss medications,
vitamins, smoking deterrents, cosmetic drugs (including anti-aging, sun damage, and hair
growth/removal drugs), or other drugs. Some drugs listed here may not be covered under your
program. You should refer to your coverage booklet-certificate for specific coverage information. This
list is not all inclusive.

This listing is organized alphabetically. All drugs in this listing are specified by tier. Which tier a drug is inwill determine the amount of your co-payment. Even though a drug is listed in a specific tier, this does notnecessarily mean it is a covered benefit under your contract language. The co-payment tier is noted behindthe drug name. Asterisks (*) after brand name drugs indicate there is a generic equivalent available. Drug tiersmay change during the year.
Tier 1: Consists of drugs with the lowest co-payment and includes most generics. A few drugs commonly thought of as generics are actually classified as brand name drugs and do require payment of a higher co-pay.
Tier 2: Includes brand name drugs in selected drug classes. There may also be some generic drugs listed in this tier. These drugs have the second lowest co-payment. Most of these drugs do not have a generic equivalent. Select classes have all brand name drugs in Tier 2.
Tier 3: Includes brand name drugs not in Tier 2. These drugs have the highest co-payment. If you choose the brand name product when a generic is available, your cost share may be more than your Tier 3 co-pay.
Drugs may change tiers during the year.
You may take this listing to your physician's office, so your doctor can review the drug choices and identifyappropriate drug(s) in a lower tier.
In addition, select prescriptions that are not covered by your normal prescription drug or medical coveragemay be obtained at up to a 20% discount by showing your ID card at the time of purchase.
For Questions

Review the prescription drug section in your coverage booklet.
Call toll-free at 1-877-683-6838 to speak with a customer service representative. and click on Prescription Drug Tools.
Generic Drugs

Many brand name prescription products have generic equivalents. In this listing, if a brand name drug has generic availability, it is indicated with an asterisk (*).
Generics contain the same active ingredients as brand name drugs, even though the generics may be a different color, shape or size.
Generics are as safe and effective as their brand name counterparts.
Generics are generally priced lower than brand name products, and you will usually pay the lower co-pay when you purchase a generic. If you choose the brand name drug, you will pay more. Notice
The information contained in this prescription drug listing is provided for the convenience of members. It is
not intended to be comprehensive in nature. This is not an insurance contract/plan document and does notcontain all the qualifications and limitations that apply to your coverage. This drug listing is not intended asa substitute for the knowledge, expertise, skill and judgment of the medical provider in his or her choice ofprescription drugs. Principal Life Insurance Company assumes no responsibility for the actions or omissionsof any medical provider based upon reliance, in whole or in part, on the information contained herein. Themedical provider should consult the drug manufacturer’s product literature or standard references for moredetailed information.
The drug names listed here are the registered and/or unregistered trademarks of third-party pharmaceuticalcompanies unrelated to and unaffiliated with Principal Life Insurance Company. These trademarked brandnames are included for informational purposes only and are not intended to imply or suggest any affiliationbetween Principal Life Insurance Company and such third-party pharmaceutical companies.
The information contained in this document is proprietary information. The information may not be copiedin whole or in part without the written permission of Principal Life Insurance Company. # Atacand should be reserved for participants who meet CHARM (Candesartan in Heart Failure - Assessment of Reduction in Mortality and Morbidity) trial criteria.
^ Serotonin norepinephrine reuptake inhibitor


Case 3:13-cv-07299-JAP-TJB Document 1 Filed 12/05/13 Page 1 of 17 PageID: 1John E. Flaherty Jonathan M.H. Short McCARTER & ENGLISH LLP Four Gateway Center 100 Mulberry Street Newark, New Jersey 07102 (973) 622-4444 Counsel for Plaintiffs AstraZeneca AB, Aktiebolaget Hassle, AstraZeneca LP, KBI Inc., and KBI-E Inc. Einar Stole Ed Rippey COVINGTON & BURLING LLP 1201 Pennsylvania Ave., NW

NEW PATIENT QUESTIONNAIRE In order for us to better serve the needs of our new patients, we would appreciate a brief health history to assist in the examination. Name: _____________________________ Occupation: _______________________________ E-mail: _________________________________________________________________________ How did you hear about us : _____________________________________

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