Harmonyˈhärmənē/noun

the quality of forming a pleasing and consistent whole

According to AIS Health1, two significant pharmacy benefit trends emerged in 2017:

• Unbundling of specialty drug services from their PBM

• 90 supply of maintenance meds for low or no copay

Harmony is the merger of two programs to create a complete answer to these two pressing concerns.

Harmony is available as an integrated or stand-alone service offering of: DirectScript PBM.

1. Plan Sponsors Zero In on Specialty Rx Costs, Retail 90 Networks

in 2017 Benefits, Maas, Angela. Health Benefits Daily, Jan. 17, 2017. http://aishealth.com/archive/ndbn110416-02

Specialty Drugs used by only 2% of the members generated over 35% of 2015 spend…

AND expectations are…

Rank* Drug Name Therapy Class Annual Cost**PMPY Spend

% Of Total Specialty Spend

1 Humira® Pen (adalimumab)Inflammatory conditions $49,656 $33.54 9.80%

2 Enbrel® (etanercept)Inflammatory conditions $50,640 $23.85 7.00%

3 Harvoni® (ledipasvir/sofosbuvir) Hepatitis C $95,445 $21.35 6.30%

4 Copaxone® (glatiramer) Multiple sclerosis $65,499 $13.76 4.00%

5 Tecfidera® (dimethyl fumarate) Multiple sclerosis $76,538 $11.81 3.50%

6Viekira Pak® (dasabuvir/ombitasvir/paritaprevir/ritonavir) Hepatitis C $84,152 $9.85 2.90%

7 Gleevec® (imatinib) Oncology $146,000 $7.85 2.30%

8 Revlimid® (lenalidomide) Oncology $46,914 $7.74 2.30%

9 Gilenya® (fingolimod) Multiple sclerosis $81,728 $7.30 2.10%

10 Atripla® (efavirenz/emtricitabine/tenofovir) HIV $28,985 $7.23 2.10%

Expectation for specialty trend increase by 17% annually between 2016 & 2018**Source: Express Scripts 2015 Drug Trend Report**Trend is forecast only for specialty medications billed through the pharmacy benefit

Therapy Class 2016 2017 2018

Inflammatory conditions 25.50% 25.50% 26.70%

Multiple sclerosis 11.20% 10.20% 7.20%

Oncology 21.10% 20.00% 20.00%

Hepatitis C 10.20% 8.10% 8.00%

HIV 17.70% 17.80% 18.90%

Growth deficiency 9.10% 9.10% 9.00%

Cystic fibrosis 58.20% 36.20% 28.80%

Pulmonary hypertension 16.60% 5.80% 5.90%

Hemophilia 17.30% 18.30% 22.40%

Sleep disorders 22.60% 21.50% 20.50%

Other specialty classes 6.70% 6.40% 6.40%

Total Specialty Trend ** 17.40% 16.80% 17.20%

The major contributors to rising PMPY spend for specialty medications will continue to be both brand inflation and high starting costs for new, highly targeted therapies.

Just a few medications are driving the trend in the specialty market:

SpecialtyAssist solution:

Cost Avoidance through Advocacy

• Aligns the interest of plan sponsor and beneficiaries• Reduce cost to both parties

• Works as part of a responsive medication management access model

• Typical specialty drugs are not fulfilled for weeks, SpecialtyAssist manages the entire process with little effect on the normal timeline

• Works symbiotically with existing healthcare benefit providers to access the matrix of payers available through alternate funding sources

• Offers significant enhancement to the existing specialty drug acquisition model

• Many alternate forms of coverage can help patients when benefits are designed to access them

A specialty assistance matrix exists…

Alternate Coverage is under-utilized in specialty markets.

SpecialtyAssist aligns primary, secondary, and tertiary payer options available to the member.

Plan Sponsors At Risk Entities

Charities Manufacturers

SpecialtyAssist: Operating Model Pharmacy transfers

RX to SpecialtyAssist

SA receives RX and confirms patient

eligibility

SA contacts pt to explain service and

get consent

SA enrolls pt in alternate coverage

program(s)

SA sends alt coverage and RX to

select pharmacy

SA tracks dispenses, alt coverage, and

cost savings

SA maintains alt coverage eligibility

Targeted SP Drug Claim Halted

No impact on PBM rebates or guarantees.*SDL = PBM Specialty Drug ListMembers not meeting alternate coverage criteria referred to SP

Patients Receive Drug On-timeSpecialtyAssist does not affect the normal specialty prescription dispensing timeline

Normal 1st Specialty Prescription Fill experience under Current Program1 month or more 5-30 days

SpecialtyAssist:Real-World Example

EXAMPLE: 30 day supply of Tecfidera Oral for Multiple Sclerosis

Tecfidera [claim cost (AWP-18%)] $4,460 (Typical Plan Pays)

Alternate Assistance Program Cost $0.00 (Pt. Pays)

Cost Savings/Avoidance Net of Fees $4,014 (Plan Saves)

Annual Savings per Patient Prescribed $40,143 (Annual Savings PPPY)

EXAMPLE: 30 day supply of Humira Injection

Humira claim cost (AWP-18%) $2,656 (Typical Plan Pays)

Alternate Assistance Program Cost $5.00 (Pt. Pays)

Cost Savings/Avoidance Net of Fees $1,988 (Plan Saves)

Annual Savings per Patient Prescribed $23,900 (Annual Savings PPPY)

SpecialtyAssist Summary:A Unique Service Offering

• Complimentary to current prescription drug benefit program, does not require change in PBM

• Augments existing PBM program

• Neutral effect on drug rebates and PBM network guarantees

• No change to the benefit level for members

• Minimal impact on member treatment timeline with high customer service level

• Therapeutic substitution is not required

• Service based on cost avoidance vs. rebate model

Rx 'n Go is an alternative pharmacy network designed to enhance existing pharmacy benefit.

As an increasing number of employers are implementing consumer driven health plan designs along with higher deductibles, employees require additional choice and alternatives to use their benefits economically. By offering Rx ‘n Go program, creative and innovative employers offer their employees / members access to a very meaningful and valuable alternative for their prescription medication needs. Rx ‘n Go provides prescription drug cost savings to both the employer and employees.

• Provides participants option to receive 90 day supply of maintenance meds by mail with no copay.• Typical 15% to 25% savings to plan sponsor.1

• Rx ‘n Go compliments the existing PBM provider.• Employer only pays when their employees fill their prescriptions with Rx ‘n Go. • There are no other costs associated with the Rx ‘n Go program.

Rx ‘n Go Summary:

•Offers a proprietary list of nearly 1,200 generic drugs for chronic conditions

•Flat fee includes all shipping and handling as well as all administration, eligibility maintenance, billing, customer service and account management costs

•Covers 50 chronic disease categories

•Convenient delivery via mail to home or office

•All US based solution, and

•Provides savings to both employer and employee.

Rx ‘n Go Benefits:

•Offered as an alternative and not a replacement of the existing PBM provider

•Value based benefit that offer members an alternative/choice for where to fill their prescription

•Fully transparent fixed fee pricing model that makes budgeting, tracking and communication easier

•Improved utilization of more efficient and convenient mail order delivery

•Integrates into the existing PBM/benefit consultants reporting structure

•Creates a clear pathway for brand to generic conversion opportunities, and

•Likely improved drug compliance for members with chronic conditions.

Our creative and innovative prescription medication program helps employer groups expand their pharmacy benefit for employees/members with ongoing medicationneeds while reducing prescription drug cost for both employer and employees.

Rx ‘n Go enables employers to add an all US based pharmacy benefit alternative that delivers generic prescription medication conveniently to the employees/members home thereby savings them both time and money.

Studies show that people using home delivery for their prescription medication needs are generally more compliant. Increased medication compliance leads to improved employeeproductivity, lower absenteeism, and most importantly, fewer emergency room visits/hospital admissions. Rx ‘n Go is easy to implement and does notreplace your existing PBM program.

QUESTIONS AND NEXT STEPS

THANK YOU FROM THE DIRECTSCRIPT FAMILY OF SERVICES