Overview of Express Scripts, Inc

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Overview ofExpress Scripts, Inc

• Pharmacy Benefit Administrator
• for
• Destiny Health
• March 10, 2008

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ESI Overview

• ESI became the pharmacy benefit management (PBM)
  vendor on 12/1/07
• Improved Rx savings
• ESI has developed extensive on-line tools that
  support a consumer driven environment
• ESI retained to provide Customer Service support
  coverage available 24/7
• Member education tools to raise awareness of
  potential cost savings
• Through ESI, Destiny implements Step Therapy
  program
• Promotes generic utilization for medications for
  long-term maintenance of chronic conditions
• Through ESI, Destiny expands Quantity Management
  program
• Full service mail pharmacy
• Specialty Rx provided through Curascript

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ESI Overview

• Transition Support and Communication
• Formulary Changes
• Posting of new ESI formulary at
  www.destinyhealth.com
• Identification and notification of members
  disrupted by Formulary changes
• Step Therapy Program
• Posting of informational brochure at
  www.destinyhealth.com
• Identification and notification of members
  potentially impacted by Step Therapy
• Quantity Management Program
• Posting of informational brochure at
  www.destinyhealth.com
• Identification and notification of members
  potentially impacted by Quantity Management

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ESI Overview Mail Services

• Life of a Script
• Operational Matrix

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ESI Overview - Formulary

• What is a Formulary?
• A formulary is a drug list that is used as a
  guide for determining the amount you pay as a
  copayment for each prescription. Drugs listed on
  the formulary are typically available at a lower
  copayment to you. A formulary may also be
  referred to as a preferred drug list.
• Whats available for Destiny Health members?
• The Destiny Health prescription plan through
  Express Scripts plan features the High
  Performance Formulary. This formulary is a
  comprehensive list of recommended prescription
  medications that is created, reviewed, and
  continually updated by a carefully selected group
  of physicians and pharmacists.
• The formulary contains a wide range of brand name
  preferred products that have been approved by the
  Food and Drug Administration (FDA). Your doctor
  can use this list to select medications for your
  health care needs, while helping you maximize
  your prescription drug benefit.

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ESI Overview Generics

• Efficacy
• Safety
• Available Information

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ESI Overview Step Therapy

• Why Step Therapy?
• Step Therapy is a program especially for people
  who take prescription drugs regularly to treat an
  ongoing medical condition, such as arthritis,
  asthma or high blood pressure. The program is one
  approach to getting you the prescription drugs
  you need, with safety, cost and most
  importantly your health in mind.
• How Step Therapy Works - the covered drugs you
  take are organized in a series of steps, with
  your doctor approving and writing your
  prescriptions.
• Step 1 drugs are always covered
• Higher step drugs are covered if there is
  previous claim history of a lower step
  alternative or with prior authorization

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ESI Overview Step Therapy

• Step Therapy Case Study
• HLC member. Prescription history of Nexium-40mg
  and Lipitor-20mg. Both drugs are subject to Step
  Therapy protocol. Claim history (180-day) did
  not indicate past utilization of step 1
  alternatives. Member notified of disruption in
  November.
• Member utilized Caremark mail service for 3 month
  supply of Nexium and Lipitor in Q-4 2007
• Member utilized Express Script mail service for 3
  month supply of step 1 alternatives in Q-1 2008.

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ESI Overview Step Therapy

• Step Therapy Case Study Results
• 1. Omeprazole is the generic of Prilosec.
  Prilosec and Nexium are both proton pump
  inhibitors.
• 2. Simvastitin is the generic of Zocor. Zocor
  and Lipitor are HMG-CoA Reductase Inhibitors
  (statins). Note the change in strength between
  prescriptions and refer to Exhibit A Comparison
  of HMG-CoA Reductase Inhibitors
• 3. Member costs reduced by more than 66.
  Overall drug costs reduced by 55.

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ESI Overview Q A and wrap-up