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