> **Criterion Advantage Indian Health Special Endorsement**
>
> **Prescription Drug Discount Card**
>
> **Prescription Reimbursement Rate by State**

  --------------------------------------------------------------------------------
  **I/T/U                                                                       
  Prescription                                                                  
  Reimbursement                                                                 
  Rate by State**                                                               
  --------------- --------------------------- ------------------------------ -- --
  **STATE**       **INGREDIENT COST**         **DISPENSING FEE**                

  Alabama         AWP - 10%                   \$6.40                            

  Alaska          AWP - 5%                    \$4.45                            

  Arizona         AWP - 15%                   \$3.00                            

  Arkansas        AWP -- 20% (generic); AWP - \$6.51                            
                  14% (brand)                                                   

  California      AWP - 10%                   \$5.05                            

  Colorado        AWP - 35% (generic); AWP -  \$5.00                            
                  13.5% (brand)                                                 

  Connecticut     AWP -- 40% (generic); AWP - \$4.60                            
                  12% (brand)                                                   

  Delaware        AWP - 14%                   \$4.65                            

  DC              AWP - 10%                   \$5.50                            

  Florida         AWP - 13.25%                \$5.23                            

  Georgia         AWP - 10%                   \$5.33                            

  Hawaii          AWP - 10.5%                 \$5.67                            

  Idaho           AWP - 12%                   \$5.94 (\$6.54 for unit dose)     

  Illinois        AWP -- 25% (generic); AWP - \$5.60 (generic); \$4.40          
                  12% (brand)                 (brand)                           

  Indiana         AWP - 20% (generic); AWP -  \$5.90                            
                  13.5% (brand)                                                 

  Iowa            AWP - 12%                   \$5.26                            

  Kansas          AWP - 27% (generic); AWP -  \$4.40                            
                  13% (single source)                                           

  Kentucky        AWP - 12%                   \$5.51                            

  Louisiana       AWP - 15%                   \$6.77                            

  Maine           AWP - 15%                   \$4.35                            

  Maryland        AWP - 12%                   \$5.69 (generic); \$4.69          
                                              (brand)                           

  Massachusetts   AWP - 14%                   \$4.50 (single source), \$6       
                                              (multiple source)                 

  Michigan        AWP - 15.1%                 \$4.77                            

  Minnesota       AWP - 11%                   \$4.65                            

  Mississippi     AWP - 12%                   \$4.91                            

  Missouri        AWP - 10.43%                \$5.09                            

  Montana         AWP - 15%                   \$5.70                            

  Nebraska        AWP - 11%                   \$4.27                            

  Nevada          AWP - 15%                   \$5.76                            

  New Hampshire   AWP - 16%                   \$2.75                            

  New Jersey      AWP - 12.5%                 \$4.73                            

  New Mexico      AWP - 12.5%                 \$4.65                            

  New York        AWP - 12%                   \$5.50 (generic); \$4.50          
                                              (brand)                           

  North Carolina  AWP - 10%                   \$6.60 (generic); \$5.00          
                                              (brand)                           

  North Dakota    AWP - 10%                   \$6.60 (generic); \$5.60          
                                              (brand)                           

  Ohio            AWP - 12.8%                 \$4.70                            

  Oklahoma        AWP - 12%                   \$5.15                            

  Oregon          AWP - 15%                   \$4.50                            

  Pennsylvania    AWP - 10%                   \$5.00                            

  Rhode Island    AWP - 14%                   \$4.40                            

  South Carolina  AWP - 10%                   \$5.05                            

  South Dakota    AWP - 10.5%                 \$5.75                            

  Tennessee       AWP - 13%                   \$6.00                            

  Texas           AWP - 15%                   \$6.14                            

  Utah            AWP - 15%                   \$5.40                            

  Vermont         AWP - 11.9%                 \$5.25                            

  Virginia        AWP - 10.25%                \$4.75                            

  Washington      AWP - 14%                   \$5.20                            

  West Virginia   AWP - 12%                   \$4.90                            

  Wisconsin       AWP - 11.25%                \$5.88                            

  Wyoming         AWP - 11%                   \$6.00                            

                                                                                

  AWP = average                                                                 
  wholesale price                                                               

  Source: Adapted                                                               
  from Medicaid                                                                 
  Prescription                                                                  
  Reimbursement                                                                 
  Information by                                                                
  State - Qtr                                                                   
  Ending June                                                                   
  2004                                                                          
  --------------------------------------------------------------------------------