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About Express Scripts Express Scripts is the State of New Mexico’s chosen partner for administering your prescription plan We are a leading pharmacy.

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Presentation on theme: "About Express Scripts Express Scripts is the State of New Mexico’s chosen partner for administering your prescription plan We are a leading pharmacy."— Presentation transcript:

1 The State of New Mexico Group Benefits Prescription Plan Plan Year: January–December 2020

2 About Express Scripts Express Scripts is the State of New Mexico’s chosen partner for administering your prescription plan We are a leading pharmacy benefit manager that puts medicine in reach for tens of millions of people As an Express Scripts member, you have access to: 60k+ retail pharmacies located across the United States Convenient home delivery services Express-Scripts.com and our mobile app for ordering and managing your prescriptions Accredo specialty pharmacy for medications that treat complex and chronic health conditions Specialized pharmacists, nurses and other clinicians in condition-specific Therapeutic Resource Centers

3 Express Scripts Formulary
Your plan covers a broad range of medications that fall into three categories: First tier: Generic drugs Second tier: preferred brand-name drugs (lower cost) Third tier: Non-preferred brand-name drugs (higher cost than First and Second tier) Excluded: drugs that are not covered under your benefit

4 Participating retail pharmacies
(30-day supply) Home Delivery (90-day supply) Out-of-pocket (OOP) maximum BCBS Plans: $4,000 single / $12,000 family Presbyterian Plans: $3,750 single / $11,250 family (prescription and medical expenses count towards the OOP) Deductible for brands only $50 Individual / $100 Family (prescription and medical expenses count toward the deductible) Generic $6 $17 Brand (Preferred) 30% ($35 min / $95 max) $120 Brand (Non-Preferred) 40% ($60 min / $130 max) $155 Specialty Medications (30-day supply) – Accredo specialty pharmacy $60 Generic $85 Preferred Brand $125 Non-preferred Brand Prescription Costs *** If you choose a brand-name drug when a generic equivalent is available, you’re responsible for the brand copayment plus the cost difference between the brand and the generic drug. This does not apply to specialty medications. -deductible is a one-time charge on non-generic medications (including specialty). In a family situation, the maximum each member will pay is the $50 individual amount -member continues to pay the applicable copay until they reach their individual out-of-pocket amount, where a max a member will pay out of pocket is -Specialty drugs are injectable and non-injectable drugs that require specialized clinical care (frequent dosing changes, intensive clinical monitoring, patient training) and/or specialized handling needs -Specialty Drug list contains ~370 total medications and includes HIV and transplant drugs

5 Use Express Scripts Home Delivery for your Maintenance Medications
Receive up to a 90-day supply with free standard shipping Take advantage of our Automatic Refill Program for added convenience! State of New Mexico Home Delivery Program: 3 retail fills are allowed on maintenance medications before copay increases On the 4th fill at retail the copay will increase to the mail order copay for that drug tier (for a 30 day supply) Maintenance Drugs Retail Copay (30-day supply) Up to 3 fills Starting on 4th fill Generic $6 $17 Brand (Preferred) 30% ($35 min / $95 max) $120 Brand (Non-Preferred) 40% ($60 min / $130 max) $155

6 Vaccines State of NM members will pay $0 on certain vaccines including: Influenza (Flu), Pneumonia, Shingles, MMR, Hepatitis A & B, Meningococcal, Tetanus/Diphtheria/Pertussis, Varicella (chicken pox)…to name a few Vaccines through the pharmacy benefit are: A key preventive measure for seasonal influenza and other viral conditions More convenient and less expensive through your local pharmacy than at a private physician’s practices Likely to result in lower medical costs Call Customer Service to locate a certified pharmacist near you

7 Get Started With Express Scripts Mail Order
E-Prescribe (electronic prescribing) - Have your physician send your prescription direct to Express Scripts pharmacy for processing Phone – Call into Express Scripts customer service and request that your maintenance medication be moved to home delivery. We will consult your physician and take it from there! Register – on express-scripts.com or Express Scripts mobile app and transfer medications to home delivery with a click of a button Mail – Complete a home delivery order form and submit it, along with a paper prescription, for processing Payment Options - check card or credit card is the preferred method for online orders. ESI accepts Visa, MasterCard, American Express and Discover. Provide your check card or credit card information or choose to be billed later for mail in orders. Express Scripts Pharmacy=99.996% accuracy rating Worry Free Fill (automatic refill) experience for maintenance medications with proactive outreach to Dr when Rx is running out of refills IMPORTANT for members to regularly consult their physician about their therapy to ensure that the correct medication is being dispensed via home delivery

8 Ask your doctor if a generic medication will work for you
8 out of 10 prescriptions filled in the United States are for generic drugs Ask your doctor if a generic medication will work for you 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 Generics have the same chemical makeup as brand-name counterparts and have the same effect on the body Makers of generics spend less on research and advertising, and the savings get passed on to you

9 Have a question about a medication? Give us a call
Each specialist pharmacist has had specialized training in the medications used to treat a specific condition, such as: High cholesterol High blood pressure Depression Diabetes Asthma Osteoporosis Cancer You can contact a pharmacist 24/7 to ask about: Drug interactions Side effects Risks and benefits of your medication Help taking your medication as prescribed — which is one of the best ways to help maintain or improve your health Talk with an Express Scripts pharmacist for general counseling — or a specialist pharmacist for complex concerns – by calling the number on the back of your prescription drug ID card

10 Therapeutic Resource Centers Personalized care for patients
Typically generalists who dispense medications for many conditions Juggle many tasks: filling prescriptions, checking orders, overseeing pharmacy Setting offers minimal privacy to counsel patients Average time talking to each patient is less than Retail pharmacists Extensively trained in medications for a single disease state Focused on disease and therapy management Speak to patients in their homes or wherever they prefer Average time talking to each patient is Specialist Pharmacists 2 minutes* 12 minutes Amc Footnotes: “Counsel patients with broad based conditions when needed”: Stanley D. RPh. Understaffed and overwhelmed, Drug Topics, February www,drugtopics.com. Accessed 07/01/2010; “24,000 prescription drugs, over-the-counter medications, and natural products”: 2. Drugs.com homepage. Available at: 07/01/2010; “Competing demands on time” & “ Limited specialized training”: Bureau of Labor Statistics. Accessed 08/01/2010; “Minimal patient privacy”: American Journal of Pharmaceutical Education 2004; 68 (1) Article 4; “Accredo book-of-business data, December 2011. *Source: CVS data

11 Prior Authorization Some medications require a Prior Authorization – a process to ensure the medication prescribed is appropriate for the patient and/or the condition and is covered by the prescription drug plan Use the mobile app with your doctor to search if your medication requires a Prior Authorization. Many doctors can submit the required documentation electronically for a faster turnaround time! Most Prior Authorizations expire after 1 year

12 The complexity of specialty medications
One prescription = 16 items Coban™ adherent wrap Large cooler boxes Kendall alcohol swabs Sterile gauze pads Bandages CADD-Legacy® Infusion Pump Sharps container Patient education binder BD 60cc syringes Sterile exam gloves Remodulin® – medication that treats pulmonary arterial hypertension Tape Medication administration sets Sodium chloride 0.9% flushes Heparin flushes Sterile water for injection As you can see from the image in this slide, when a patient receives a specialty prescription, they often receive much more than just the drug. In fact the three little boxes of Remodulin is all the medication that a patient with the condition pulmonary arterial hypertension would receive in a shipment like this – the rest of the items are all the materials and supplies needed to administer the medication. Living with a specialty condition and being treated with specialty medication can be stressful. Therefore, it’s important to understand just what patients face in order to manage and care for them appropriately.

13 Accredo Specialty Pharmacy
15 Areas of focus, including: Hepatitis C Oncology Multiple sclerosis Bleeding disorders Rare diseases Pulmonary hypertension Rheumatoid Arthritis Cardiovascular Endocrine Cystic fibrosis Fertility Immune disorders HIV Pulmonary Transplant Unique clinical protocols maximize safety, effectiveness and affordability One-on-one counseling from specialty pharmacists and nurses Accredo places patients at the center of all we do. We specialize in specific conditions in order to deliver the right care and support to patients, specific to their condition, the drugs they’ve been prescribed and according to their unique needs. It’s all about giving them a great and personalized pharmacy experience.

14 Making information available wherever and whenever
Simple landing page Intuitive site navigation Interactive mobile app Multiple ways to get started Easy to Use Self-Service Tools Easy Rx refill or renewal Print forms, ID cards Submit reimbursement claims online Making Information Available Wherever and Whenever Today, people are used to being able to self-serve. They have told us they want an experience like Amazon which has set the bar. Members told us our website and mobile app weren’t easy to use. So, we have been focused on providing members faster and easily accessible information with a few clicks as well as a more consistent experience across these channels. We made the following improvements to the web site: Created new simple landing page Improved site navigation and made it more intuitive Incorporated User friendly headers on all pages to guide the member Made it easy for members to Contact Us and get answers to their frequently asked questions Made it easy for member to provide feedback All and all, made it easier to find information with improved site navigation We also redesigned our mobile app, making it easier to use and removed barriers to use. A year ago, our app rating was 2 stars. Now we have a 4+ star user rating on iTunes which is higher than Amazon’s app rating A year ago, our login on the mobile application took 18 seconds…it was too slow.  Now it takes 5 seconds. A year ago, the password was hard to use…now we have iPhone and iPad iTouch authentication using a thumb print. In ????, we have witnessed a 200% increase in member mobile app usage. And, we provide easy to use self-service tools. Members can do the following: Checkout anytime from any page Print forms, ID cards, claims and history And new in 2017, members will have access to a digital benefit guide for the open enrollment period…Enabling members to register from the start for a better experience and ultimately better health outcomes. We are currently piloting this program with a small group of clients for the 2017 plan year. Bottom-line, we are investing in these channels for members that want to self-serve so they can do it fast, simply and easily. © 2019 Express Scripts Holding Company. All Rights Reserved.

15 Express Scripts Registration
Use express-scripts.com and the Express Scripts mobile app to manage your medications and prescription benefit plan. There are two easy ways to register: … download the Express Scripts mobile app for free and register Register at express-scripts.com or …. Register using your member ID number or Social Security Number (SSN) One user name and password is all you need for web and mobile app access

16 Informative and actionable express-scripts.com home page
Order status is #1 REASON members visit the website. Provides a one-stop shopping experience Offers the services patients expect right up front… Order status with tracking Refilling a prescription Enrolling in automatic refills Visibility to home delivery savings Transferring a prescription to home delivery Navigating to anywhere in the site Our member home page provides a one stop-shopping experience. And offers the services that patients expect right up front – where is my order, refilling a prescription, visibility to home delivery savings and transferring a script to home delivery. Members have easier access to their prescription information with fewer clicks Action sections are better organized and information has subtle color coding for easy identification Members make better choices with visibility to home delivery savings and pharmacy prices. View all prescriptions, order refills and renewals for member or the whole family Enroll in — and manage — automatic refills Receive medication-related alerts and take action

17 Order Status gives members real-time visibility
Clear, detailed order status Actionable self- service messages Track shipping Real-time order confirmation Order Status: Questions about order status are the #1 reason members call our contact center and visit our website or mobile app. Web used to be vague and members had to call the PCA. To address this situation, we have updated the home page to show the status of all orders being processed with estimated shipping dates. Order status is now synched across all channels. In addition, we provide…. Enhanced messaging throughout the order status process for more transparency. For instance, if an order is delayed, members are notified with concise and consistent messaging. For example, we will let members know when we reach out to their physician and tell them the date we reached out and the number of days we are going to wait for their physician to respond. We also note that they might want to call the physician to help speed up the process. Proactively members who have selected this as their communication preference to confirm their order with an estimated ship date, advise of a delay and the reason, if known, updated order information, and order shipped Provide expanded Rx details Benefit: fewer member calls to contact centers and more satisfaction that members have real-time knowledge of their order status.

18 My Rx Choices on express-scripts.com - explore options
Side-by-side drug comparisons to help you select the right medication at the best cost See potential savings by moving to home delivery Helpful drug information Ability to print research for doctor review Access to Consumer Reports Best Buy Drug information Displays 25+ possible lower-cost options to help you shop smart Accessible from Price a Medication

19 Easy to locate in-network retail pharmacies
Search by zip code or city/state Results provide: Nearby in-network pharmacies with address and contact details in Google Maps Link to Price a Medication from the selected pharmacy Link for directions using Google Maps Easy to find in-network pharmacies within a range and interface with google maps.

20 Register or Login Biometric authentication Convenience & simplicity
Biometric authentication – touch or facial recognition, as available on the member’s device. © 2019 Express Scripts. All Rights Reserved.

21 Convenience & simplicity
Dashboard Quick access to popular actions and easy access to the full menu Dashboard Members can quickly and easily refill and renew home delivery prescriptions Not available to members of Retail-only clients © 2019 Express Scripts. All Rights Reserved.

22 Peace of mind & versatility
Dose Reminders Easy step-by-step instructions accommodate multiple medicines Dose Reminders Members can easily manage multiple prescriptions with reminder alerts that can be set up to notify when it’s time to take medications. © 2019 Express Scripts. All Rights Reserved.

23 Pharmacy Options Find a Pharmacy
Convenience & simplicity Pharmacy Options Find a Pharmacy Find nearby in-network pharmacies and access driving directions Find a Pharmacy/Pharmacy Options Find convenient in-network pharmacies based on your ZIP code or current location Helpful when travelling © 2019 Express Scripts. All Rights Reserved.

24 Member ID Card Two-sided virtual ID card goes where the member goes
Convenience & simplicity Member ID Card Two-sided virtual ID card goes where the member goes Virtual ID Card Members can access their member ID card conveniently and immediately – one less card to carry © 2019 Express Scripts. All Rights Reserved.

25 Express Scripts: We’re here for you
Register at Express-Scripts.com, using the information on your member ID card Download the Express Scripts mobile app from your app store to manage your medicines anywhere, anytime Call the Member Services number on the back of your member ID card:

26 Thank you


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