1. The State of New Mexico Group Benefits Plan Plan Year: January–December Prescription Drug Program

2. Who Is Express Scripts?
Express Scripts administers your prescription drug benefit and you automatically receive coverage when you enroll in a medical plan.
Express Scripts is the largest Prescription Benefit Manager in the country with more than 100 million people nationwide
Retail network includes 60,000 pharmacies
Provides administration for
Retail pharmacy program
Express Scripts Home Delivery program
Specialty drug program through Accredo
-Express Scripts partners with Accredo to dispense specialty medications

3. Express Scripts Formulary
Your plan covers a broad range of medications that fall into three categories:
First tier:
Generic drugs
Second tier:
preferred brand-name drugs
(lower cost)
Third tier:
Non-preferred brand-name drugs
(higher cost than First and Second tier)
Excluded: drugs that are not covered under your benefit

4. Express Scripts Home Delivery
Participating
retail pharmacies
Express Scripts Home Delivery
Retail (30-day supply)
Mail Order (90-day supply)
Out of Pocket
$3,500 single / $10,500 family
(accumulated with Medical OOP towards annual max)
Deductible**
$50 Individual / $100 Family only on Non-Generics
(applies to Medical annual OOP Max)
Generic $6
$17
Brand (Preferred)
30% ($35 min / $95 max)
$120
Brand (Non-Preferred)
40% ($60 min / $130 max)
$155
Specialty Medications (30 day supply) - must move to mail order after 2 fills at retail
$60 Generic
$85 Preferred Brand
$125 Non-preferred Brand
Prescription Costs
*** 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. This does not apply to specialty medications.
-deductible is a one-time charge on non-generic medications (including specialty). In a family situation, the maximum each member will pay is the $50 individual amount
-member continues to pay the applicable copay until they reach their individual out-of-pocket amount, where a max a member will pay out of pocket is
-reminder: fill limit for specialty medications at retail before members must move to Accredo mail or copay is 100% on 3rd fill at retail
-Specialty drugs are injectable and non-injectable drugs that require specialized clinical care (frequent dosing changes, intensive clinical monitoring, patient training) and/or specialized handling needs
-Specialty Drug list contains ~370 total medications and includes HIV and transplant drugs

5. Use Express Scripts Home Delivery for your Maintenance Medications
Receive up to a 90-day supply with free standard shipping
Take advantage of our Automatic Refill Program for added convenience!
State of New Mexico Home Delivery Program:
3 retail fills are allowed on maintenance medications before copay increases
On the 4th fill at retail the copay will increase to the mail order copay for that drug tier (for a 30 day supply)
Maintenance Drugs
Retail Copay (30-day supply)
Up to 3 fills
Starting on 4th fill
Generic $6
$17
Brand (Preferred)
30% ($35 min / $95 max)
$120
Brand (Non-Preferred)
40% ($60 min / $130 max)
$155
-(Reminder on home delivery program which was put in place on 1/1/16)
-Non-Specialty Home Delivery Program: maintenance drugs allowed to be filled three times at retail before copay increases to mail order copay on 4th fill (at 30-day supply). Reference chart
-Home Delivery is used for chronic medication needs (patient required to take medication regularly). This does not include controlled substances. Retail pharmacies are to be used for short-term medication needs.
-ALLOW days to initiate/process/receive FIRST mail order request. Afterwards refills take approximately 5 days to process and arrive to patient home
-Check status of your order on member website or by calling Express Scripts Customer Service

6. Get Started With Express Scripts Mail Order
E-Prescribe (electronic prescribing) - Have your physician send your prescription direct to Express Scripts pharmacy for processing
Phone – Call into Express Scripts customer service and request that your maintenance medication be moved to home delivery. We will consult your physician and take it from there!
Online – Register on express-scripts.com and transfer medications to home delivery with a click of a button
Mail – Complete a home delivery order form and submit it, along with a paper prescription, for processing
Payment Options - check card or credit card is the preferred method for online orders. ESI accepts Visa, MasterCard, American Express and Discover. Provide your check card or credit card information or choose to be billed later for mail in orders.
Express Scripts Pharmacy=99.996% accuracy rating
Worry Free Fill (automatic refill) experience for maintenance medications with proactive outreach to Dr when Rx is running out of refills
IMPORTANT for members to regularly consult their physician about their therapy to ensure that the correct medication is being dispensed via home delivery

7. Prior Authorization
Some medications require a Prior Authorization – a process to ensure the medication prescribed is appropriate for the patient and/or the condition and is covered by the prescription drug plan
Physician’s submit documentation for Prior Authorization on the patient’s behalf
Most Prior Authorizations expire after 1 year

8. www.express-scripts.com One-Time Registration
Quick and easy steps
Register via web or mobile app using member ID number or SSN
Review and accept the Terms of Use
Preferences can be chosen now and updated at any time

9. Managing Prescriptions with Ease
Quick access to what members want most
Check order status
View all prescriptions and order refills and renewals
View savings and transfer retail prescriptions to home delivery
Enroll in and manage automatic refills
Receive medication-related safety alerts and take action
View important Benefit & Account Notifications

10. Transfer to Home Delivery
Quickly and easily view savings by transferring to home delivery service
Express Scripts will contact the doctor to obtain a new prescription on member’s behalf
Express Scripts will automatically deliver refill medication when the Automatic Refill option is chosen.
When the prescription is out of refills, Express Scripts will contact the doctor for a new prescription.
A closer look at the “Transfer to home delivery” section on the Home Page

11. Order Status Clear, detailed order status
Actionable self-service messages
Track shipping
Real-time order confirmation
Confirm the status of your mail order and track shipping

12. My Rx Choices explores options
Side-by-side drug comparisons showing plan and usual & customary (U&C) pricing via retail and home delivery pharmacies
Potential savings by drug and/or channel option
Helpful drug information
Ability to print for doctor review
Access to Consumer Reports Best Buy Drug information
Display 25+ possible lower-cost options
My Rx Choices explores options
Accessible from Price a Medication
THIS SLIDE FOCUSES ON My RX Choices
My Rx Choice provides easy comparison shopping that enables members to be in control.
Provides side-by-side drug comparisons showing plan and usual & customary (U&C) pricing via retail and home delivery pharmacies for brand name and generic-equivalent medications. If available, potential savings by drug and/or channel option appears.
Drug information provided
Print for doctor review
Access to Consumer Reports Best Buy Drug information
More than 25 possible lower-cost options could display increase in belief that ESI saves members money* (comparison shopping)

13. Express Scripts Mobile App
Responsive web design for variety of devices
Intuitive mobile app
Patient Care Advocates available via phone
Members choose how to connect
Easy to find information
Simple landing page
Easy access to “Contact Us” and FAQs
Encourages member feedback
Print forms and member ID cards
Track and print claims and history by month or year
Pay outstanding balances and obtain historical invoice summaries and detail
More ways to self-serve
Member Preferences
Connecting to Express Scripts is quick and easy, with multiple ways to register:
Patient Care Advocates can register members online when they call in
Or, members can choose to
register on the web or mobile app
Offering Flexible Services
We enhance the experience by providing members personal options.
Member Preferences – members decide how they want to be serviced and communicated with
Enables easy updating of account settings and communication preferences
Enables selection of how want to get communications – digital vs. paper copy
Ensures personal information accuracy
Payment and Billing: 10% of member calls are billing- or payment-related. We’re offering many options to ensure members don’t interrupt their therapy due to payment issues.
Extended payment plans splits 90 day copay into 3 payments
Increased authorization limits= can change credit limits at member’s request
Recurring payment enrollment
Cash option for non-covered Rx – access to prescriptions at discounted prices
Digital Wallet = Digital payment option offered via a mobile app to support payment on the go (not available until later 2016/2017)

14. ESI Therapeutic Resource Centers (TRC)
Engage with highly trained, highly trusted individuals who specialize in caring for those with complex conditions (Ex. Cardiovascular disease, diabetes, cancer, asthma, etc)
Staffed by specialized pharmacists, physicians, nurses, technicians, benefit specialists and other team members
TRC staff engage through a variety of channels, including web, , phone and mail
Access to the TRCs is free of charge to all members. Contact your member services team to request to speak to a specialized team member.
TRC access is available to members whether they fill maintenance prescriptions at an Express Scripts home delivery pharmacy or at a retail pharmacy
-Members are assigned to a Therapeutic Resource Center based on prescription claims processed by Express Scripts (retail and mail). Members are grouped based on condition so inbound calls from members who seek pharmacist counseling are routed to their Therapeutic Resource Center, which consists of professionals that specialize in that condition and can provide personalized care, conduct sophisticated safety and quality reviews, and offer the information and counseling members need to achieve healthier outcomes

15. Express Scripts Customer Service
Dedicated Customer Service Unit
Specially trained on the State of New Mexico benefit plan
Speak to a Pharmacist
Customer Service Number
(located on the back of your ID card):
Primary customer service contact center is located in Alamogordo, New Mexico