JOHNSONN INC. DIRECTT PAYY DRUG G PLAN …

1 JJOOHHNNSSOONN PPAAYY DDRRUUGG PPLLAANNPPHHAARRMMAACCYY UUSSEERR GGUUIIDDEE1) GENERAL IINNFFOORRMMAATTIIOONN Johnson Inc., as a member of ACE (Association for Claims Exchange), can process drug claims via electronic transmission utilizing the EMERGIS network. Johnson will not accept manual claims submitted by pharmacies. In the event that a Johnson Plan Member (Participant) chooses not to have their claim submitted via EDI, they should pay in full and submit for reimbursement. By transmitting your first claim, you have agreed to the terms in the Participating Pharmacy Direct drug Plan Agreement.

2 Our system operates seven days a week with the exception of Sunday 12:00 to 7:00 Telephone Toll-Free HELP Line number is 1-866-773-5467 Hours of Operation Monday-Friday 8 Eastern Web Site Access For the Agreement, as well as a copy of this Pharmacy user Guide, including updates, please visit our Web Site. Email address is 1 Name: JIM BOB ID #: 9999999 Issued: May 01, 2002 SEMI-PRIVATE HOSPITAL EXTENDED HEALTH CARE DENTAL Not Covered 777777 Couple 888888 Couple 22)) SSUUBBMMIITTTTIINNGG AA CCLLAAIIMM (a) Your Johnson Pharmacy Number Pharmacies currently registered with Johnson will have received their Pharmacy number in the mail.

3 If you have not received your Pharmacy number then contact us via the telephone or Internet as outlined in the General Information section of this Guide. You will need your Pharmacy number for submission of a claim as well as retrieval of reports and general inquiries. (b) Johnson Inc. drug Card While Johnson Inc. drug cards may differ among Clients, we are working toward a common card for all Clients. Although the cards may vary, there are several common characteristics: All cards have the Johnson Inc. logo clearly shown. All cards have: -The Member s ID or Certificate number (# 9999999 in the sample below).

4 -Policy number(s) (# 777777 and 888888 in the sample below). Dependent information is not shown. Below is a copy of a sample Johnson card with the appropriate information indicated. Name: JIM BOB ID #: 9999999 Issued: May 01, 2002 SEMI-PRIVATE HOSPITAL EXTENDED HEALTH CARE DENTAL Not Covered 777777 Couple 888888 Couple 2 (c) Relationship Code and Date of Birth Spouse and Dependent claims should be entered using the patient s first name and last name, date of birth and the CPhA standard relationship codes.

5 While Johnson Inc. drug cards do not currently contain dependent information, we expect subsequent reprints of the cards will include the eligible dependents. (d) CPhA Error / Rejection Messages Johnson Inc. uses the CPhA messages and error codes for all transmissions. For a complete list of these codes check the Johnson web site. (e) Diabetic Pseudo DINS Listed below are the Pseudo DINS that should be used to submit claims for products that do not have a DIN assigned to them. TESTING STRIPS AB, ON, NT, NU, YT QC NS NL, PE.

6 NB BC SK MB ACCU-CHEK COMPACT STRIPS 9854282 99004364 97799962 977070 44123026 950900 977999 ACCU-CHEK EASY STRIPS 09853081 00920118 00977060 00977060 44123007 ACCCUSOFT TEST STRIPS 00909459 00909459 00909459 00909459 00909459 ACCUTREND GLUCOSE TEST STRIPS 9853162 908193 977031 977031 44123006 950432 906697 ACETEST TABLET 9853294 35106 97799916 977292 35106 980506 ACCU-CHEK ADVANTAGE TEST STRIPS (Accusoft or Advantage Comfort) 9854002 99002884 97799960 908312 44123021 950883 905348 ADVANTAGE COMFORT TEST STRIPS (Accusoft) 09854002 99002884 00908312 00908312 44123021 BD LATITUDE TEST STRIP 909955 963720 97799900 977107 44123030 950911 900142 CHECKMATE PLUS BG TEST STRIP 44123022 CHEMSTRIP BG (VISUAL) 990906 398314 97799957 977411 44123020 977284 CHEMSTRIP BG (ACCUCHEK)

7 9853189 895393 97799958 977284 44123009 950068 990027 CHEMSTRIP GP 903604 903604 97799951 977446 CHEMSTRIP UG/K 903612 647659 97799956 977470 950238 980692 CLINISTIX (D/C 2002) 980633 35114 977306 977306 980633 CLINISTIX 00980633 00035114 00977306 00977306 CLINITEST TABLET 980420 35122 97799915 977152 35122 980420 ASCENSIA AUTODISC (Breeze / Dex 2 / Glucometer Dex Strips)

8 9853693 99002604 97799926 977471 44123019 950878 904945 3 TESTING STRIPS AB, ON, NT, NU, YT QC NS NL, PE, NB BC SK MB ASCENSIA ELITE TEST STRIPS (Previously Glucometer Elite)

9 9854088 920363 977308 977308 44123002 950572 980100 ASCENSIA MICROFILL TEST STRIPS 990125 964476 97799877 990125 44123032 950924 990125 COMPANION II BG TEST STRIP 44123013 DEXTROSTIX 09853197 00894923 00977144 00977144 44123001 ENCORE TEST STRIPS 9853103 920371 97799922 977033 44123003 950505 980200 EXACTECH TEST STRIPS 09853219 00898570 00977802 00977802 44123014 FAST TAKE TEST STRIPS (Lifescan) 9854029 99002809 97799982 977995 44123017 950882 903531 FREESTYLE TEST STRIP 909653 99004704 97799829 977838 44123028 950907 905500 GLUCOFILM TEST STRIPS 09853227 00907650 00977969 00977969 44123004 ASCENSIA TEST STRIPS (GLUCOMETER DEX STRIPS)

10 09853197 00894923 00977144 00977144 44123001 GLUCOSTIX 9853235 895946 977489 977489 44123005 950408 980749 KETO-DIASTIX 990647 35149 97799912 977179 35149 990647 KETOSTIX 9853286 35092 97799913 977322 35092 980595 NOVO GLUCOSE STRIPS 9853480 99003627 977032 977032 44123023 950889 900974 ONE TOUCH TEST STRIPS (Lifescan)