The Rx for Rx Savings Breaking the Status Quo! August 15, 2018 www.RxResults.com

Employers’ Choice Rx RxResults, LLC Sales/Marketing Account management Rx claims processing Pharmacy network(s) Specialty pharmacy Drug coverage initiatives Prior authorizations Rebate administration RxResults, LLC

About RxResults, LLC

About RxResults Evidence-based recommendations Partnership with UAMS College of Pharmacy Non-biased peer-reviewed literature/studies We don’t recommend chasing rebates Plans shouldn’t sacrifice lowest net cost to maximize rebates Plans should get rebates where they make sense Exclusive formularies are often not as good as they seem RxResults, LLC

About RxResults Our only revenue is from administrative fees We don’t make more money for preferring one drug over another We make no revenue from PBMs or Pharma We continuously look at the industry’s drug mix to protect plans from new marketing trends RxResults, LLC

Risk Management Strategies Evidence-based medicine based on non-biased independent review Peer-reviewed literature used for comparison of therapy choices Application of national practice guidelines A focus on outcomes of care not just individual cost components Reference pricing, prior authorization, step therapy, quantity limits, and exclusions RxResults, LLC

Specialty Drug Prior Authorization Non-biased prior authorization reviews Many PBMs have a conflict of interest Coverage not approved simply because a patient has a condition for which the drug has an FDA-approved indication Existing patients are grandfathered Smooth handoffs to specialty pharmacy for medication delivery once approved Internal appeals handled by RxResults RxResults specialty PA approval rate is 68% compared with many PBMs’ approval rates of 83-93% RxResults, LLC

Pharmaceutical Manufacturer (Pharma) Trends RxResults, LLC

Pharma Trends Combination Drugs Combination of older generic drugs to make new patentable brand drugs Examples: Duexis® - $2,394 per 30-day supply Combination of ibuprofen (Advil®) and famotidine (Pepcid®) Single ingredients per 30 days Ibuprofen: <$10 Famotidine: <$5 RxResults, LLC

Pharma Trends Combination Drugs More examples: Vimovo® - $2,462 per 30-day supply Combination of naproxen (Naprosyn®, Aleve®) and esomeprazole (Nexium®) Single ingredients per 30 days Naproxen: <$5 Nexium 24HR® : <$18 Treximet® - $791 per 30-day supply (9 tablets) Combination of naproxen (Naprosyn®) and sumatriptan (Imitrex®) Single ingredients Sumatriptan: <$14 RxResults, LLC

Pharma Trends Packaging (Kits, Paks, etc.) Packaging drugs with other products or other drugs Examples: Tretin-X® - $256 per 30-day supply Tretinoin cream, cleanser and moisturizer Tretinoin cream: $10 Low-cost cleanser and moisturizer available without prescription Lansoprazole/amoxicillin/clarithromycin therapy pack $397 per 14-day supply Lansoprazole (OTC): $16 Amoxicillin: $6 $48 Clarithromycin: $26 RxResults, LLC

Pharma Trends Delivery methods Using older generic drugs to make new brand drugs with different delivery methods Examples: DermacinRx® LexitralTM PharmaPak- $3,289 for 30- day supply Diclofenac and capsaicin applied as drops Diclofenac tablets: $18 Capsaicin cream: $6 Intermezz0® - $243 per 30-day supply Zolpidem (Ambien®) as a sublingual tablet Zolpidem tablets: <$3 RxResults, LLC

Pharma Trends Delivery methods More examples – tablets vs. capsules: Generic venlafaxine ER (Effexor XR®) Tablets: $253 for 30-day supply Capsules: $19 Generic tizanidine (Zanaflex®) Capsules: $75 for 30-day supply Tablets: $14 RxResults, LLC

RxResults Performance with ECRx (2011 – 2018) RxResults, LLC

ECRx Employer Plans Targeted Drug Classes Only 2010 2011 2018 Avg Mbr Paid/Rx $13.09 $12.19 $11.96 Avg Plan Paid/Rx $48.90 $36.59 $20.00 Drug Cost/Rx (Avg Rx) $66.91 $48.78 $31.96 Generic Utilization % 71.51% 76.21% 96.17% RxResults, LLC

ECRx Employer Plans All Drugs/Claims 2010 2011 2018 Avg Mbr Paid/Rx $12.04 $11.49 $13.15 Avg Plan Paid/Rx $50.21 $44.74 $45.18 Drug Cost/Rx (Avg Rx) $62.25 $56.23 $58.43 PMPM without Specialty $74.60 $49.28 $31.47 PMPM with Specialty $82.52 $60.22 $45.29 RxResults, LLC

Average Plan Paid per Rx All Drugs/Claims Projected without ECRx 2010 - $50.21 (actual) 2018 - $72.42 (assumes 5% annual growth) Actuals 2010 - $50.21 2018 - $45.18 - $27.24/Rx less than projected - At 10 Rxs per member, $23.70 PMPM / $272 PMPY savings - At 2 members per employee, $45.40 PMPM / $545 PEPY savings RxResults, LLC

Thank You RxResults, LLC