1 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Your Collaborative Planning Guide State of Oklahoma April 9, 2013

2 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Positioned to Accomplish Your Benefit Goals

3 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. We Are Express Scripts  National healthcare leader  Best-in-class pharmacy benefit manager serving more than 100 million members  Industry-leading home delivery and specialty pharmacy services  Pioneering research, analytics, and innovation  Independent business model, aligned with clients  Focus on driving better decisions and healthier outcomes through our unique approach: Health Decision Science SM  Solutions for greater care and cost control

4 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Using more-expensive and less-effective medications Failing to take essential medications as prescribed Using more-expensive and less-effective pharmacies Patients Caregivers Providers Bad Decisions Lead to Unhealthy Outcomes Unhealthy Financial Outcomes  $408 billion in annual pharmacy-related waste Unhealthy Clinical Outcomes  Significant gaps in care  Prolonged illnesses  Preventable ER visits and hospitalizations  Avoidable harm (pain and suffering, injury, disability, death) Waste: Any avoidable healthcare cost that provides no additional health benefit Source: Express Scripts 2011 Drug Trend Report

5 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Our Unique Approach

6 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Practical Solutions for Three Decision Areas Accessible and Affordable Pharmacy for Acute Care Higher Quality and More Cost-Effective Pharmacy for People with Chronic and Complex Conditions Improved Health and Safety Most Effective Care Coordination Safest, Most Cost-Effective Generics and Preferred Brands Proper Use, Selection, and Amount of Drug

7 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Plan Sponsor Landscape

8 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Top Line Performance Metrics  Plan Cost PMPM is $117.68, a 3.5% trend over the previous period  Generic Fill Rate (GFR) increased 3.9 percentage points to 78.9%  Specialty Plan Cost PMPM is $21.55, a 24.0% trend over the previous period

9 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Plan Performance  Total Plan Cost increased 3.8% to $231 million over the previous period  Effective Discount increased from 32.6% in 2011 to 42.5% in 2012  Cost Share decreased from 25.0% in % in 2012

10 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Plan Cost PMPM  Plan Cost per Member per Month (PMPM) increased 3.5% in 2012.

11 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Trend Components  Non-specialty Plan Cost PMPM trend is -0.2% while specialty is at 24.0%  Inflation is the largest cost driver of your non-specialty Plan Cost PMPM  Discount is the largest cost saver of your non-specialty Plan Cost PMPM Consider clinical and channel products like step therapy and Exclusive Home Delivery to improve utilization, inflation, drug mix and discount trend components Evaluate plan design to ensure appropriate member cost share

12 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Trend Components – Line of Business

13 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Trend Components Detail Utilization  Prevalence (patients per member) has increased 0.8%  Intensity (days per patient) has increased 2.6% Utilization (Days/Eligible Member) Intensity (Days/Patient) Prevalence (Patients/Eligible Member)

14 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Trend Components Detail Inflation  Drug inflation accounted for an increase of $9.24 in Plan Cost PMPM Reduce this impact by moving members away from highly inflated brands to generic therapeutic alternatives

15 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Upcoming Patent Expirations

16 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Historical Performance Increase To Drive Down GFR & Home Delivery Utilization

17 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Trend Components Detail: Member Cost  Overall Member Cost is 19.8% a 5.1 point decrease over previous period Previous Member Cost % Current Member Cost % Generic Preferred Brand Non- Preferred Brand Overall RetailHome DeliveryTotal

18 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Clinical Overview

19 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Plan Cost by Therapeutic Sub-Category

20 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Top 5 Therapeutic Classes  The Top 5 Therapeutic Classes for State of Oklahoma represent $161,754,659 or 69.9% of the 2012 Plan Cost

21 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Top 5 Therapeutic Sub-Classes & Top Drugs

22 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Top 25 Drugs by Plan Cost  The top 25 drugs represent $74,412,507 or 32.1% of the Plan Cost.  Among the top 25 drugs, Atorvastatin Calcium represented the largest increase in cost at 473.3% and Plavix represented the largest decrease in cost at 61.9%.  Among the top 10 movers, Atorvastatin Calcium, Cymbalta, Humira, and Januvia fall into the top 25 drugs.

23 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Plan Cost by Specialty Disease State

24 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Top 25 Specialty Drugs by Plan Cost  The Top 25 Specialty drugs represent 76.2% of Specialty Plan Cost for  Specialty Plan Cost represents 18.3% of the Total Plan Cost for  The Top 25 Specialty drugs represent 14.0% of the Total Plan Cost for 2012.

25 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Program Performance New Program Opportunities

26 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. RationalMed Summary 1Q2013 Rule Category DSCRule DSC Total RMED Alerts Total RMED Successes 1Q13 Total Program Savings (Plan Cost) Adverse Drug RiskAdverse Drug Disease Consideration9,59899$120,772 Adverse Drug RiskAdverse Drug Interaction3,42027$25,974 Adverse Drug RiskDuration Consideration3,1150$15,030 Omission of Essential Care Omission of Essential Drug Related Testing67110$14,570 Adverse Drug RiskExcessive Dosing1,36818$7,143 Adverse Drug RiskDrug Age Consideration2,11035$4,966 Adverse Drug RiskDose Duration Consideration1866$4,188 Omission of Essential CareUnder Dosing1288$431 Omission of Essential CareOmission of Essential Therapy2,90073$384 Adverse Drug RiskQuantity Considerations70$53 Adverse Drug RiskDrug Pregnancy100$2 Coordination of Care OpportunityMisuse/Abuse3490$0 Omission of Essential CareSuboptimal Patient Drug Adherence2890$0 Adverse Drug RiskDrug Therapy Duplication4380$0 Omission of Essential CareOmission of Essential Diagnostics1,64429$0 Coordination of Care OpportunityPolypharmacy3,1930$0 29,426305$193,513

27 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Coverage Management Savings 2012 PA Rule Category 2012 Total Program Savings (Plan Cost) UROLOGICALS$3,659,294 AUTONOMIC & CNS DRUGS, NEUROLOGY & PSYCH$2,465,472 MUSCULOSKELETAL & RHEUMATOLOGY$1,668,820 IMMUNOLOGY, VACCINES & BIOTECHNOLOGY$1,050,144 ENDOCRINE/DIABETES$895,384 ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS$873,361 RESPIRATORY, ALLERGY, COUGH & COLD$595,275 GASTROENTEROLOGY$589,282 CARDIOVASCULAR, HYPERTENSION & LIPIDS$256,261 ANTI - INFECTIVES$155,299 DERMATOLOGICALS/TOPICAL THERAPY$126,983 OPHTHALMOLOGY$46,849 OBSTETRICS & GYNECOLOGY$11,312 DIAGNOSTICS & MISCELLANEOUS AGENTS$8,795 VITAMINS, HEMATINICS & ELECTROLYTES$3,502 UNASSIGNED$872 EAR, NOSE & THROAT MEDICATIONS$516 $12,407,422

28 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Preferred Drug Step Therapy (PDST) Savings 2012 PDST Rule Category Total Rx Requiring Action 2012 Total Program Savings (Ingredient Cost) HEADACHE THERAPY949$676,881 INTRANASAL STEROIDS2,253$669,789 PROTON PUMP INHIBITORS879$303,691 ANTIDEPRESSANT AGENTS212$214,755 HYPNOTIC AGENTS593$192,628 OSTEOPOROSIS THERAPY150$98,402 $2,156,146 TOTAL COVERAGE MANAGEMENT SAVINGS 2012 $14,563,568

29 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Medical Channel Management  Addresses safety and trend challenges common among medically billed specialty drugs  Covers specific specialty drugs under the pharmacy benefit 47% of all specialty drug spend is billed through the medical benefit Medically Billed Specialty-Drug Challenges Medical Channel Management Solution  Lack of program control  Limited reporting and utilization management  Inconsistent clinical protocols between pharmacy and medical  J-code billing format  Delays in billing  Better visibility and control of specialty spending  Increased savings from coverage and therapy management  Real-time adjudication  Tracks spending at NDC level  Improved reporting

30 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. ScreenRx SM  Early detection and tailored interventions  The industry’s first actionable adherence screening tool to forecast future nonadherence  Proprietary predictive models identify patients at risk for nonadherence  Tailored interventions aimed at patient-specific obstacles 98% accurate in predicting nonadherence a year in advance Up to 20% reduction in adherence gaps

31 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. ScreenRx SM Identify Adherence Obstacle 15% Clinical 16% Cost Behavior-Related Obstacles Clinical ObstaclesCost Obstacles 20% Late Renewals 39% Missed Dose 10% Late Refill Tailor Interventions solution: specialist pharmacist consultation solution: home delivery, generics solution: renewal assistance solution: medication reminders solution: home delivery, auto refills

32 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Appendix

33 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Key Statistics - Total

34 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Key Statistics - Commercial

35 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Key Statistics - Medicare

36 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Key Statistics - Specialty

37 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Key Statistics - Specialty

38 PROPRIETARY AND CONFIDENTIAL © 2013 Express Scripts Holding Company. All Rights Reserved. Key Statistics - Specialty