A&M Care
2015 – 2016 Prescription Drug Program
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
1
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.
2
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.
3
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.
4
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 Medications
 Therapeutic Resource Centers
 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.
5
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.
6
Accredo– a Patient’s Most Comprehensive Support
Accredo specialty
pharmacist
Other specialty
pharmacist
Retail pharmacist
Specialization
per condition
Most specialization – with deep focus
on patients with a small number of
conditions and therapies
Focus diluted across
dozens of conditions
and therapies
No specialization –
no focus
Experience
per condition
Focused training and experience
with patients with conditions and
needs in a single specialty
General training across Limited training
treatments and
and occasional
therapies
experience
Specific protocols
per condition
Condition and drug-specific protocols
developed by specialists
for every drug dispensed
Protocols only for
select specialty drugs
Dedicated field nurses
550 field nurses – all Accredo staff
NA
NA
Physician support
150 support experts in the field
NA
NA
Proactive patient
support
 Proprietary training in the specialty
AND applied behavioral science
 Deepest safety monitoring
 Unique apps and condition-specific
websites
NA
NA
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
NA
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Therapeutic Resource CentersSM (TRC)
Delivering Better Patient Care
• Specialty-trained pharmacists and nurses
• Comprehensive therapy management
• Monitoring and ongoing assessments
• Multimedia and online patient resources
• Complete medication and medical profile
• 24/7 access to pharmacists
HIV
Hepatitis C
RA & I
Oncology
Fertility
Rare
Disease
Multiple
Sclerosis
Transplant
Pulmonary Hypertension
Endocrine Pulmonary
Bleeding
Disorders
Immune
Disorders
SCALE ALLOWS DEEPER SPECIALIZATION
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Impact of Therapeutic Resource Centers
SAFETY
• Ensuring the safe use of medications
• 99.999% accurate, safe and efficient dispensing
• Increasing adherence; decreasing waste
EFFECTIVENESS
• Members with hepatitis C are 50% more likely
to complete therapy
• Ensuring financial options are leveraged
AFFORDABILITY
• Connected patients with more than $240M in
proactive copay assistance in 2014
• Easiest to use with the highest satisfaction
SERVICE
• 93% member satisfaction with our specialty
care
SPECIALIZATION IMPROVES PATIENT OUTCOMES
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Accredo National Footprint
Seattle, WA
Boston, MA
Elmsford, NY
Eagan, MN
Byfield, MA
Detroit, MI
Warrendale, PA
Dublin &
Columbus, OH
Elmhurst, IL
Whitestown, IN
Indianapolis, IN
Iowa City, IA
Omaha, NE
Salt Lake City, UT
Kansas City, MO
Englewood, CO
Corona, CA
Chesterfield, MO
Greensboro, NC
Las Vegas, NV
Oklahoma City, OK
Phoenix, AZ
Memphis, TN
Nashville, TN
Norcross, GA
Birmingham, AL
Dallas, TX


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Accredo® Office in State
Houston, TX
32 Accredo Locations
11 Nursing Offices
11 TRC Home and Support Offices
550 Field Nurses with 75-mile service-area radius
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
Willingboro, NJ
Pine Brook, NJ
New Castle, DE
Metairie, LA
Orlando, FL
Lake Mary, FL
Ft. Lauderdale, FL
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Personalized Care Alerts
• Unique clinical outreach helps keep
members safe by providing personalized,
actionable alerts when possible
omissions, adherence gaps and “ontrack” behavior are detected.
• Members can access alert
details, learn more about any
risks from resource links,
and take action using the
options provided.
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
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Actionable Alerts Educate and
Improve Adherence
1 in 5
gaps in care closed
online are for retail
prescriptions
Ability to self-close gaps
Information about the alert
and its importance
Printable information
to take to the doctor
Links to additional
resources
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
Contact specialist
pharmacists
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Worry Free Fills Offers
Convenience and Flexibility
• Patients elect to have
eligible prescriptions
shipped automatically*
• Patients alerted to
upcoming orders
• Patients can adjust
future fill dates
• Patients can
dis-enroll at any time
Confidential and Proprietary Information
© 2012 Express Scripts Holding Company. All Rights Reserved.
13
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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