A&M Care 2014 – 2015 Prescription Drug Program

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A&M Care 2014 – 2015 Prescription Drug Program


AgendaYour 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


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.


Prescription Drug Benefits

* 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. Non-network benefits are also available; see Enrollment Guide for more information.

Annual Deductible $50 per person per year / $150 per family per year(Deductible does not apply to medical plan deductible)

Access Options Generic DrugCopayment

Preferred DrugCopayment

Non-Preferred DrugCopayment

Retail – 30 Day Supply:Refills allowed as prescribed. (Good option for new prescriptions)

$10 $35 $60

Retail – 90 Day Supply:Refills allowed as prescribed $30 $105 $180

Home Delivery Pharmacy:Up to a 90-day supply*. Refills allowed as prescribed(Best option for maintenance medication)

$20 $70 $120


The right care at the right timeSpecialization 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


Express Scripts’ Specialist Pharmacists are an integral part of the healthcare continuum

Extremely Satisfied/Very Satisfied with overall counseling experience

97% of patients

“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

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


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


Anticipated Annual Changes in U.S. Spending on Specialty DrugsTherapy Class 2013 2014 2015

3-year 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%


Online Gaps in Care AlertsAbility for patients to self-close gaps as appropriate

Information about the alert and why it’s important

Printable information to take to the doctor

Access to email Express Scripts pharmacists

Links to additional resources

Video clips relevant to each alert


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


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.


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

http://www.express-scripts.com/


My Rx Choices®


Online tools and Mobile App help patients connect

OmissionNot Using Controller

Medication for Asthma

Online prescription management: 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 featuresGap In Care Alerts

Help participants identifyand address potential safety issues with their prescriptions


Transfer to mail online conversion program


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)


Thank You

Documents

A&M Care 2014 – 2015 Prescription Drug Program