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Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 1 The State of New Mexico Prescription Drug Program 2013
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 2 Agenda Your Prescription Drug Plan Express Scripts Company Overview Specialty Medications Your Prescription Benefits Express Scripts Formulary Generic Medications Tools to Help Manage the Prescription Benefit My Rx Choices ® Smart Phone App Worry Free Fills Express Scripts Web Site & Customer Service
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 3 Who Is Express Scripts? In 2012, Medco and Express Scripts joined together to become one company. Better together, our combined company is the largest Prescription Benefit Manager for more than 100 million people nationwide Retail network includes 60,000 pharmacies Provides administration for Retail pharmacy program Medco Pharmacy Mail-order program Specialty drug program through Accredo
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 4 Specialty Medications Express Scripts will provide 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 © 2011 Express Scripts, Inc. All Rights Reserved 5 Prescription Costs Participating retail pharmacies The Medco Pharmacy mail-order service Days’ supplyUp to a 34-day supplyUp to a 90-day supply Deductible $50 per family; applies to Formulary & Non Formulary only Generic drugs (Tier 1) $5$15 Brand-name drugs (Tier 2) (preferred)*** 30% ($30 min, $90 max)$95 Brand-name drugs (Tier 3) (non-preferred) *** 40% ($55 min, $125 max) $125 Specialty Medications – 2 fills allowed at retail, then must move to mail order $150 copay up to $1500 OOPM; $75 after OOPM is met *** 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.
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 6 Express Scripts Formulary First tier: Generic drugs Second tier: preferred brand-name drugs (lower cost) Third tier: nonpreferred brand-name drugs (higher cost than First and Second tier) Your plan covers a broad range of medications that fall into three categories:
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 7 Facts About Generic Drugs
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 8 Ask Your Doctor… When you receive a prescription from your doctor, or if you are taking brand- name drugs today, ask: If a generic version of the medication is available. If generic medications are right for you. If there are any risks if you change from a brand-name drug to a generic drug.
Confidential and Proprietary Information © 2012 Express Scripts Holding Company. All Rights Reserved.9 My Rx Choices Clear identification of potential savings Access to Consumer Reports Best Buy Drug information Side-by-side drug details
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 10 New Smart-phone applications help patients and their caregivers more effectively manage their medications 10 Provides the patient with an easy tool to cope with the array of instructions that accompany multiple prescriptions Sends alerts to your Smartphone so you never miss a dose or refill My Rx Choices Loads and updates your medications. Also ideal for: > Caregivers > Physicians > Hospitals
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 11 Worry Free Fills Worry-Free Fills™ is an automatic refill program available to members who utilize the Medco Pharmacy. Members enroll for the program at the drug level. If a member chooses to enroll a particular medication, a reminder letter is either mailed or ed to the member approximately three weeks before the prescription is filled.
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 12 Express Scripts Web Site Visit to find useful information and resources. Here, you can:www.express-scripts.com Refill mail-order prescriptions Review your prescription history Locate a participating retail pharmacy Look up medication and disease state information Check the formulary View copay information Price a medication Check your order status Print and/or Order ID Cards
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 13 Express Scripts Customer Service Customer Service Number Is located on the back of your Rx ID Card Dedicated Customer Service Unit Specially Trained on The State of New Mexico benefit plan
Confidential and Proprietary Information © 2011 Express Scripts, Inc. All Rights Reserved 14
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