A&M Care
2014 – 2015 Prescription Drug Program
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Agenda
Your Express Scripts prescription drug plan
 Benefit description
 Specialized care
Tools to help manage the prescription benefit
 Tools to help manage therapy
 Tools to help manage cost
 Other available resources
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Your Express Scripts Prescription Drug Plan
 Express Scripts administers your prescription
drug plans on behalf of A&M Care.
 Benefit includes both a retail and mail
component
 Express Scripts has its own mail-order
pharmacy where specialist pharmacists
focus on compliance and lower cost options
for patients. And, the automated filling
process ensures the prescription is filled
accurately.
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Prescription Drug Benefits
Annual Deductible
$50 per person per year / $150 per family per year
(Deductible does not apply to medical plan deductible)
Access Options
Generic Drug
Copayment
Retail – 30 Day Supply:
Refills allowed as prescribed. (Good
option for new prescriptions)
Retail – 90 Day Supply:
Refills allowed as prescribed
Home Delivery Pharmacy:
Up to a 90-day supply*. Refills
allowed as prescribed
(Best option for maintenance
medication)
Preferred Drug
Copayment
Non-Preferred
Drug
Copayment
$10
$35
$60
$30
$105
$180
$20
$70
$120
* If you obtain a brand-name drug when a generic equivalent is available, you are responsible for the generic copayment plus the cost
difference between the brand-name drug and the generic drug. Chart illustrates benefits when network pharmacies are used. Nonnetwork benefits are also available; see Enrollment Guide for more information.
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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The right care at the right time
Specialization and member engagement are critical components to
controlling health care costs and driving quality clinical outcomes:
 Specialist Pharmacists
 Accredo Health Group
 Closing Gaps in Care
 My Rx Choices®
 Digital and Mobile Tools
 Caregiver Coordination
 Worry-Free Fills
 Other available resources
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Express Scripts’ Specialist Pharmacists are an
integral part of the healthcare continuum
 Specialist Pharmacists are specially
trained to counsel patients about
their conditions, and connect with
physicians and healthcare coaches
– Average patient call lasts 12 minutes
– Calls are monitored and recorded for
training
– Pharmacists spend their time focused
on a single condition
– Advanced tools let pharmacists see
the “whole patient” along with their
drug regimen across prescribers and
pharmacies
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
97% of
patients
Extremely Satisfied/Very
Satisfied with overall
counseling experience
“We strive to have our pharmacists deliver the
level of patient care that any of us would want
for our families.”
Glen Stettin, M.D., Express Scripts Chief Medical
Officer
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Specialty Medications
 Express Scripts provides specialty pharmacy services through our wholly-owned
subsidiary, Accredo Health Group, Inc.
 What are specialty medications?
• High cost infused, injectable, and oral drugs that typically require added
supervision of patient therapy
 With Accredo, at no extra cost, you’ll benefit from:
• Personalized Care
• Safe, prompt delivery
• 24 hour support
• Refill reminders
• Drug safety monitoring
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Anticipated Annual Changes in U.S. Spending on
3-year
Specialty
Drugs
Therapy Class
2013
2014
2015
compounded
total
Inflammatory Conditions
25.1%
17.2%
17.4%
72.2%
Multiple Sclerosis
19.8%
18.5%
11.8%
65.6%
Cancer
21.3%
20.9%
21.0%
77.4%
HIV
9.2%
9.6%
9.4%
30.9%
Hepatitis C
33.0%
58.5%
168.4%
465.8%
Growth Deficiency
6.2%
5.9%
6.5%
19.9%
Anticoagulant
-0.3%
-0.2%
0.0%
-0.0%
Pulmonary Hypertension
11.0%
11.1%
10.5%
-14.2%
Respiratory Conditions
24.8%
29.5%
27.9%
36.3%
Transplant
-2.2%
1.0%
-1.2%
-2.4%
Overall Specialty
17.8%
19.6%
18.4%
66.8%
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Online Gaps in Care Alerts
Ability for patients
to self-close gaps
as appropriate
Information about
the alert and why
it’s important
Video clips
relevant to
each alert
Links to
additional
resources
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
Access to
email Express
Scripts pharmacists
Printable
information to take
to the doctor
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Registered Online Users
 40% of those on maintenance medications are protected by online gap in care
alerts
 60% of those on maintenance medications have an opportunity to activate
their protection and receive alerts to close gaps in care
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Worry-Free Fills
 Worry-Free Fills™ is an automatic refill program available to A&M
Care members who utilize the Home Delivery Pharmacy.
 Members enroll for the program at the drug level.
 If you choose to enroll a particular medication, a reminder letter is
either mailed or emailed to you approximately three weeks before the
prescription is filled.
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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My Rx Choices®
 Lower the cost of prescriptions with My Rx Choices®
Features include:
 Personal assessment of cost-saving opportunities based on the A&M Care
prescription plan
 Print a kit to help their doctor better understand the economic impact of
different medication alternatives
 Alternative medications are based upon greatest cost savings to you presented
in order, starting with the highest value
 Brand-to-generic and retail-to-mail comparisons are shown
 Simply visit www.express-scripts.com or call Express Scripts Member Services at
1-800-367-3636
 Prices can vary at different retail pharmacies, so it is important to shop around
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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My Rx Choices®
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Online tools and Mobile App help patients connect
Online prescription management:
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Refills, renewals and order status
Worry-free Fills ®
Transfer to mail
Claims, balances and history
Locate a pharmacy
Preferences
Benefit education and management:
 Benefit highlights
 Forms and cards
 Pricing and coverage details
 New! Accessibility features
Omission
Not Using Controller
Medication for Asthma
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
Gap In Care Alerts
Help participants identify
and address potential safety
issues with their prescriptions
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Transfer to mail online conversion program
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Information Resources

System Benefits Website – www.tamus.edu/benefits/
• Pharmacy Benefit Highlights
• List of participating retail pharmacies
• Download forms

Express Scripts Member Website – www.express-scripts.com
• Formulary Information
• Locate a Participating Pharmacy
• Health and Wellness Information
• My Rx Choices® / Price a Medication
• Online Ordering
• Express Scripts Mobile App
• Order Home Delivery Pharmacy Refills
• Caregiver Resources
• Download forms

Customer Service Number: 1-866-544-6970

Annual Enrollment Book (On-Line)
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Thank You
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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