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Home My WebLink AboutRESPONSE - RFP - P682 BENEFITS. 1700 North Desert Drive (� Express Scrs°. Value] P.O.Box 52161 ipt Phoenix, AZ 85072-2161 602-225-0005 hftp://www.express-scripts.com City of Ft. Collins http://www.valuerx.com Express Scripts/ValueRX--a focus on serving the middle market... Your Benefits Service and Management Partner • Formed in 1986 • Largest independently owned pharmacy benefit manager (pbm) • 23 million members nationwide • Rated #1 by PBMI survey for third straight year in overall customer satisfaction • Lowest "cost" pbm --- drug mix focus • Largest purchaser of drugs in the United States (affiliated with Premier Hospital Group) • Dedicated sales and service team with Client Focus • Strong clinical management team (40+ Pharm.D.$) and reporting with Client Focus Programs • Pharmacy Benefit Management Network, Mal, Manual - Fully Integrated and Carve -out Programs Self -funded - Advanced Drug Utilization Review Programs Fapress Therapeutics - Preferred Drug Formulary and Switching Programs Express Preference • Demand Management - 24-hour informed decision counseling program HealthLine • Infusion Drug Therapy Management - IV drug and specialty drug distributor and manager IVTx • Disease management - True, comprehensive disease management Health ManagementlPPS • Vision Benefit Management - Discount provider access and materials allowance programs Cole Vision Services We are committed to providing outstanding, leading edge health care management programs and services to you, as your benefits management partner for today — and as we forge into the millennium! Pharmacy Benefit Management . Informed Decision Counseling . Disease Management Healthcare Information Management . Infusion Therapy Management • Eyecare Management �v express Scripts. Value]j� 1700 North Desert Drive P.O. Box 52161 Phoenix, AZ 85072-2161 602-225-0005 http://www.express-scripts.com http://www.valuerx.com Cost Containment Strategies • Plan Design • Discounted network provider rates • Mail service pharmacy • Drug Utilization Review • Express Preference formulary programs • Generic substitution • Therapeutic substitution • Disease management • Physician education programs • Starter prescription program • Prior authorization • Drug information service • Express Therapeutics Pharmacy Benefit Management . Informed Decision Counseling . Disease Management Healthcare Information Management . Infusion Therapy Management . Eyecare Management Michael E. Thomas, Pharm. D. Vice President, Scientific Affairs Mike Thomas, Vice President of Scientific Affairs, joined Express Scripts in 1994. He is responsible for all scientific affairs including communication and liaison with external scientific and pharmacy bodies and relationships with the managed care industry. In addition, Mike directs training activities for healthcare and pharmaceutical groups to increase awareness and understanding of the PBM industry. Prior to joining Express Scripts, Mike served as Senior Director for FHP in California and Utah. He also served as Executive Director of Pharmacy Services for Summit Health LTD in California. He has also managed chain and independent pharmacies in California. He has 30 years of experience in pharmacy care, with 20 years experience in pharmacy management and 13 years experience in managed care. Mike is a seasoned speaker at numerous pharmacy association meetings, seminars and conferences and has published many articles on managed care. He is also a member of at least seven pharmaceutical company advisory boards. Mike is a member of the St. Louis College of Pharmacy Dean's Advisory Board and is an Adjunct Professor for the University of Mississippi Pharmacy School. Mike earned a Doctor of Pharmacy degree from the University of Southern California and completed his undergraduate work in Chemical Engineering at the California State University at Long Beach Practice Patterns Science. 3. Is utilization review performed on all prescriptions? If not, what criteria are used to select the prescriptions reviewed? Yes, drug utlization review is performed on all prescriptions with our integrated on line claim adjudication system. 4. Please advise us as to what criteria are used to evaluate the prescriptions reviewed after they are selected. All prescriptions receive Drug Utilization Review. In the Express Scripts/ValueRx on-line, real-time electronic point of sale claims management system, the pharmacist will key pertinent data on the prescription and the recipient. These data are transmitted on-line to Express Scripts/ValueRx 's main computer and merged with eligibility and historical pharmacy data on the client. If there is a conflict regarding prescriptions written by multiple physicians, an on-line claims adjudication drug utilization review edit will be triggered. The pharmacist will 4 Express Scripts° Progressive Healthcare Management City of Fort Collins 7127198 69 receive an on-line message indicating that there is a problem associated with the prescriptions. This is an automatic system that picks up any drug alert at the point of service for the member. The pharmacist will intervene and resolve the potentially dangerous situation with the prescribing physician. For example, in the controlled substance module, when a member goes to more than two physicians and/ or two different pharmacies for a controlled substance in the same time period, the prescriptions will queue into a separate system that is reviewed by the clinical pharmacist. If there is a major problem associated with any prescriptions presented by the member, there will be a hard edit that will not allow the prescription to be processed through the system. If this is done through the mail service, Express ScriptsNalueRx pharmacists will contact the physician. If the prescription goes through the network pharmacy, Express ScriptsNalueRx will send a message via the claims adjudication process that will explain to the network pharmacists that there is a problem associated with the filling of the prescription. This concurrent drug utilization review system eliminates most of the errors, duplicate prescriptions, duplicate therapies and drug interaction problems. The advantages of Express ScriptsNalueRx 's Concurrent DUR include: ♦ Ensures quality of care by comparing each prescription with member prescription data, benefit plan data and pharmaceutical data ♦ Improves network pharmacist's customer service by providing an average .89 second on-line response time to orders ♦ Coordinates members' prescription information from both network pharmacies and the Express ScriptsNalueRx Mail Service Pharmacy to avoid duplicate prescriptions and potential drug interactions ♦ Assists members with chronic diseases in medication compliance for more successful treatment outcomes In addition to checking basic eligibility and formulary data, the following Concurrent DUR edits will be performed on-line in real-time: 1. Duplicate Prescriptions - Express ScriptsNalueRx 's computer system checks against the recipient's file for an identical prescription issued by that pharmacy or another pharmacy. If the same prescription is found, the pharmacist is alerted on-line with an appropriate message and the claim is rejected. 2. Therapeutic Duplication - Express ScriptsNalueRx 's computer system alerts the pharmacist to duplicate drug therapies (e.g., Inderal and Lopressor). Pharmacists 4 Express Scripts* Progressive Healthcare Management City of Fort Collins 7/27/98 70 clarify these orders with prescribers to preclude filling therapeutically duplicate prescriptions. 3. Incorrect Dosage - Express ScriptsNalueRx uses the MediSpan Data Base compilation of minimum and maximum dosages provided directly by the manufacturers according to their recommended use. When an incorrect dosage is flagged, the dispensing pharmacist is instructed to use professional judgment and to consult with the physician in determining the appropriateness of the therapy. 4. Too Early Refill - A parameter is set as a function of the percentage of the original prescription days supply. For example, if this is set at 75 percent of a 32 days supply, the claimant may obtain a refill after the 24th day, but not before. 5. Drug Interactions - Express ScriptsNalueRx 's computer system scans for severe drug interactions. A pharmacist evaluates the nature of the interaction and decides upon an appropriate course of action. In a case of a potentially dangerous interaction, the pharmacist routinely confers with the prescriber. In less critical cases, the pharmacist may confer with the prescriber or the patient. 6. Drug Allergies - Express ScriptsNalueRx 's patient profile data base includes listings of drug allergies. The computer system scans new orders against the allergy data base and alerts the pharmacist to the potential for an allergic reaction. When an allergy is detected, the pharmacist contacts the prescriber to determine a course of action. 7. Drug -To -Age Conflict - Patient profiles and drug files allow for the analysis of appropriate prescriptions for various age groups. If a potential drug -age conflict is found, a message is sent to the pharmacist for appropriate intervention. 8. Drug -to -Medical Condition Conflict - The Medi-Span Drug -Disease Monitoring System, licensed by Express Scripts, consists of a series of files that relate diseases treated by drug products, products contraindicated in certain disease states, messages to specify the disease state, a description of the disease state, and the disease states for which each drug is most commonly prescribed. Using this system, and previous prescription history, the pharmacist is alerted when the potential for a drug -disease conflict is indicated. The pharmacist can then contact the prescribing physician for appropriate action. 9. Compliance Check - On a refilled prescription, a comparison is made of the expected number of days since the last fill and the actual number of days elapsed. If the actual number of days exceeds the expected number by more than 14 days (on a Express Scripts® VProgressive Healthcare Management City of Fort Collins 7/27/98 71 90 day prescription), a message is sent to the pharmacist that the patient may be non- compliant. 10. Duration of Therapy - Many drugs have an FDA established guideline for minimum or maximum length of therapy needed for a positive therapeutic effect. If the prescribed drug has a maximum or minimum length of therapy identified in its drug records, and the days of therapy fall below or above the set parameters, a message is sent to the pharmacist that consultation with the physician may be appropriate. 11. Drug -to -Sex Conflict - Certain drug products, by nature of their action or indications, are normally administered to either males or females, but not both. If the prescribed drug has been profiled as one of these, and the patient's sex does not agree with the sex type profiled on the drug, an informational message is sent to the pharmacist. 12. High Dose - If a prescription has been written for more than 200 percent of the maximum recommended FDA adult dose or the pharmacist enters an inaccurate days supply which would result in a dosage more than double the FDA adult dose recommendations, the claim will be rejected. The Express ScriptsNalueRx 's DUR program provides immediate feedback to the pharmacist on up to 160 different edit fields, depending on the specific requirements of the plan. 5. How often are criteria updated? DUR is reviewed and updated quarterly by the P&T Committee and the Medical Advisory Board. Describe the educational material provided to plan members, prescribing physicians and network pharmacies. Provide samples. At the time of enrollment, Express ScriptsNalueRx offers a wide variety of patient communications to educate members about the pharmacy benefit plan and appropriate utilization, compliance, generic medications, cost effective therapy, and formularies. The member enrollment packet includes a list of participating pharmacies and a welcome letter. This packet also contains the Express ScriptsNalueRx drug card that members present at network pharmacies. Based upon the plan design, additional items regarding claim processing and mail service pharmacy may be inserted. In addition, Express Scripts! Progressive Healthcare Management City of Fort Collins 7127198 72 we will partner with you to design communication materials to educate members about other specific aspects of the plan. Sample materials are attached as Exhibit 2. Based upon the plan design, Express Scripts/ValueRx can provide additional items regarding the mail order process. Express Scripts/ValueRx provides customized patient advisory leaflets with every prescription sent from the mail service pharmacy. We also provide drug specific brochures and videos. For companies that wish to promote appropriate mail service utilization, we can provide: ♦ Copay Coupons to new members which waive the co -payments for a specific period of time. ♦ Letters to Maintenance Drug Users detailing the significant savings that could be realized if they obtained their maintenance drugs through the mail service pharmacy instead of a network pharmacy. These personalized letters itemize the potential savings for the specific drugs being taken by the member. ♦ Videotapes which explain the benefits of utilizing our Mail Order Pharmacy To better serve the Senior population For our Senior customers, Express Scripts/ValueRx provides large print patient education leaflets, invoices, welcome letters, and mailers. Easy -open prescription vial tops are also available, and can be automatically provided to members, upon request, through our mail service. Communication via the Internet Express Scripts/ValueRx World Wide Web site (http://www.express-scripts.com) which has been in operation since the end of October, 1995, is popular with Internet users and is a valuable communication tool for our members. The site is also a resource for company information such as the latest news and headlines, corporate statistics, product information, and answers to frequently asked questions about Express Scripts. Additionally, Express Scripts can place information about your plan design and network pharmacies on our website. 7. Please describe your assessment and intervention procedures for dealing with prescribing physicians and pharmacies. Who is responsible for communication? To whom are these communications directed? Express Scripts/ValueRx currently conducts educational programs to inform physicians of preferred and cost-effective therapies. These programs have been proven to drive market share to specific drug products within a therapeutic category. Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 73 Among other things, our clinical pharmacy department publishes The Express newsletter on a quarterly basis with information on our formularies, preferred products and new medications. We also provide physician profiling that allows us to target prescribers for education and intervention strategies. We rank physicians within their specialties, identify those who are outside the norm and then report drug cost, generic utilization, top ten drug usage and formulary compliance. Our clinical staff can provide drug treatment protocols, prior authorization systems, case management, letters to physicians and letters to patients as needed. We can even allow all prescriptions written by an identified physician to be prior authorized, if desired by the plan. Drug utilization criteria are available to manage pharmaceuticals that have a high cost impact on your plan. Each plan identifies parameters to evaluate the performance of plan physicians. Some of these may include the percentage of generic prescribing, the average pharmacy claim amount, and the number of prescriptions written per thousand member months. Usually, individual prescriber data is compared to a norm for the physician's specialty. A plan may identify all physicians greater than 25 percent above the norm, for example, and schedule a meeting with a clinical pharmacist. The parameters are flexible and individualized to meet the goals of the plan. Physicians whose data significantly deviates from the norm in pharmacy costs typically also exceed the norm in laboratory, radiology and referrals. However, as the consulting clinical pharmacist, caution must be exercised in the discussion with the physician as increases in pharmacy utilization may translate into decreased hospitalization. It is imperative for the plan to recognize this fact, communicate it to physicians, and consider whether a meeting with a clinical pharmacist is appropriate. Our clinical pharmacists are individuals with doctorate level education, residency training, and experience in a wide variety of areas including physician consultation. With the prescriber's utilization data and in a collegial manner, the clinical pharmacist discusses opportunities for improvement in the individual physician's prescribing pattern. Topics to be discussed include the rational use of drugs, generic substitution, and the uses of over-the-counter agents, where appropriate. The pharmaceutical manufacturers' representatives may present information to physicians that does not illustrate the complete body of available literature. It is the clinical pharmacist's responsibility to counter these sometimes one-sided detail sessions and provide the physician with accurate, timely and balanced approaches to pharmacotherapy. 44 Express Scripts® VProgressive Healthcare Management City of Fort Collins 7127198 74 Express ScriptsNalueRx has developed a program to identify non -preferred prescriptions dispensed through network providers and contacts the physician and member through intervention letters and phone calls with suggested alternative drug products. Based upon a computer -automated protocol, this program includes a detailed rationale for the switch and incentives to the member (mutually agreed upon with the plan sponsor). A Business Management Report is generated for an individual physician that indicates PMPM costs, Utilization, top 10 drugs used, high cost product usage, alternate therapies available and missed opportunities for generic and preferred product usage. The physician is compared with his peers and benchmarked against the national norms. This report is either sent to the physician, sent to a medical director, physician management group, or a face to face intervention is done with the physician. In the retail and mail service setting, upon receiving a DUR message, the pharmacist should phone the physician concerning the DUR problem. We can also send a facsimile to the physician if the member can wait. Retrospective DUR reports are produced and reviewed on a quarterly basis and opportunities for interventions are identified. Intervention options for physicians who are writing too many DUR conflicts include the sending of letters to continuously offending physicians along with reference materials and educational awareness materials to help them prescribe more appropriately. Ninety percent of the physicians we interact with have been pleased with our service. Express ScriptsNalueRx offers our intervention program as a service to the doctors to improve their quality. Express Scripts/YalueRx Pharmacist Education Program Our voluntary performance of continuing education for our own mail service and clinical pharmacist staff exceeds any required in any state. Express ScriptsNalueRx I pharmacists fulfill a minimum of 20 hours of continuing education per year. The State of Missouri requires 10 hours of continued education per year for board certified pharmacists. In addition, once each month, our pharmacists' meeting includes a visiting guest speaker to discuss specific disease states or drug therapies. Objectives ofpharmacist interventions and formulary compliance The objectives of Express Scripts initiatives relative to pharmacist compliance and intervention s to reduce costs while maintaining or improving outcomes. This is accomplished by triaging Express Scripts on-line adjudication system, with communications to and training of providers, in conjunction with pharmacist friendly, easy to understand DUR messaging. We also periodically call pharmacies and verify their understanding and utilization of DUR messaging. Express Scripts® VProgressive Healthcare Management City of Port Collins 7127198 75 Express Scripts monitors several statistical indicators and produces and distributes Pharmacy Report Cards to all pharmacies which service your members. Specific pharmacy dispensing practices are brand/generic/multi-source dispensing rates, DAtWe odearates,rUCR percentage of reported, including claims paid, reversal percentages and percentage of formulary drugs dispensed. The results may be used to determine if a pharmacy audit is necessary. national average for our total network are discussed directlwiitth s the lts chain elow headquarters to mutually develop an improvement program. Performance measurements and parameters in retail pharmacist profiling reports Express Scripts reports brand/generic/multi-source dispensing rates as a percent of the total, of DAW code rates, UCR percent of claims paid, reversal percentages, and percent of formulary drugs dispensed, and missed o usage. pportunities for preferred product Pharmacist counseling/care education programs Express Scripts continuously updates network pharmacies electronically via our web site on the Internet, by fax, and mail with new client bulletins, Plan Sheets, and an Information Manual that is updated annually. Topics have included the Express Scripts on-line system, generic dispensing guidelines, preferred drug news, and other matters of interest to our clients. Our provider manual and newsletter, PERxNews, also convey information to support formulary understanding and compliance. Services provided by pharmacists to patients and/or physicians Express Scripts provider contracts require pharmacists to consult with patients at a minimum as per required by law and customary to cash and carry customers. Our Network pharmacies exceed this requirement by utilizing our on-line DUR messaging. Point of Sale compliance required by network pharmacists Network pharmacists are required to comply with the following parameters: ♦ NCPDP 3.2 utilization • DUR messages ♦ formulary compliance ♦ non-standard plan designs (i.e., direct paper program, limited refills) • acquisition NDC number pricing ♦ tracking compliance with U&C rate 40 ExPress Scr gpts- City of Fort Collins 7127198 76 NCPDP 3.2 utilization: Express Scripts requires the NCPDP Version 3.2 standard DAW codes for each claim transmitted. Should the provider transmit a claim in a format other than NCPDP 3.2, Express Scripts has the ability to reject that claim. DUR messages: Express Scripts can retrospectively monitor the reactions of the pharmacies to the on-line DUR messages through pharmacy specific reports. Thus, Express Scripts can analyze the performance of pharmacies independently and in relation to one another and take remedial action as needed. In addition, Express Scripts has a stringent pharmacy audit program that is ongoing. On-line responses are required and monitored. The original prescription and the prescription actually dispensed are recorded to enable proper tracking of the on-line DUR messaging system to the pharmacist. We have unique technology allowing the pharmacy to respond to our client's formulary programs, while not negatively impacting our clients' members. We limit the responses required, and combine our on-line messaging with retrospective programs, so as not to negatively impact member service, unless it is a serious medical reason (i.e., We monitor and require pharmacist intervention for excessively high dosing). The pharmacy report card identifies potential problem providers. Once a potential problem is identified, we create a customized report to further the review the specific provider. Global reporting is currently under development. Formulary compliance: Formulary compliance is monitored electronically. Non - formulary products are hard coded to prevent claim transmission and pharmacy payment in closed formulary cases. In voluntary formulary cases, providers receive an on-line point of service message reinforcing the use of preferred drugs over non - preferred drugs. The on-line message notifies the pharmacy with the name of the preferred product. Express Scripts analyses the performance of the pharmacy and targets outliers for training and/or audits. Our provider manual and newsletter, PERxNews, also convey information to support formulary understanding and compliance. The Pharmacy Help Desk is also available toll -free to answer questions and to help guide network pharmacies on new plans or programs. Express Scripts has a high percentage of generic utilization, coupled with a low percentage of missed opportunities. Our results have improved each year. Non-standard plan designs (e.g., direct paper program, limited refills): Express Scripts' flexible state of -the -art adjudication system allows for edits which limit the number of refills allowed, and our Express Direct program allows for a claim to be adjudicated on-line while the member is responsible to submit a paper claim. To Express Scripts° Progressive Healthcare Management City of Fort Collins 7127198 77 insure compliance, each member submitted claim is matched to the on-line pharmacy transaction. Outliers can thus be identified and Express Scripts can then take the appropriate action. Acquisition NDC number pricing: Express Scripts contractually requires the provider to transmit the NDC # from the package from which the prescription was filled. On - site audits verify package sizes utilized by the provider. Tracking compliance with U&C rate: Express Scripts adjudication system requires the pharmacy to submit their U&C price on every claim, and should they not transmit the U&C, the claim is rejected. Should a pharmacy be non -compliant the pharmacy is appropriately debited based on audit results. Pharmacies with less than acceptable audit results are put on an internal watch list. Pharmacy report cards are generated on a regular basis, whereas one of the targeted areas is the provider's U&C paid rate verses comparable providers and verses the Total Express Scripts U&C price average. A rate below comparable providers may trigger an audit. 8. Do you offer any disease management programs? If so, for which conditions? Are you willing to offer these programs on a pilot basis at no cost to the City? The basis of disease state management does not lie in the reduction of drugs or services, but rather the optimal and appropriate use of drugs and services. This approach will lead to overall medical cost savings per treatment episode and improved patient outcomes. Express Scripts' clinical pharmacy staff can analyze prescription drug utilization data to identify members who may benefit from intervention. This is a fee base program which will cost the City $390 per member enrolled in the program per year. Express Scripts' disease state management program addresses the following: ♦ Asthma ♦ Diabetes ♦ Cardiovascular Health 0 Congestive Heart Failure 0 Ischemic Heart Disease 0 High cholesterol 0 Hypertension Express Scripts° 1WProgressive Healthcare Management City of For! Collins 7127198 78 Prescription Drug Benefit Cost Containment Strategies Plan Design - Active approach without unduly affecting members or quality of care - Critical elements included differential copays and deductibles Discounted network provider rates - ESI/VRx includes more than 98% of retail pharmacies across the country - Preferred product program offered Mail service pharmacy - Advantage of efficiencies and consequent cost savings of volume dispensing - Optimum use can greatly reduce the unit costs of prescription drugs - Convenient for maintenance medications Drug Utilization Review (DUR) - 5-8% savings for clients with no previous DUR history - 24% savings for client with previous history - Over 150 edits composed of prospective, concurrent and retrospective components Express Preference Formulary and Drug Management Programs - Our independence for pharma manufacturer ownership affords us to work for our clients' best interests - Preference programs revolve around more cost effective therapeutic equivalent brands (preferred) - A cornerstone of ESI/VRx revolves around the use of generic agents whenever possible - Generic drugs impact both plan costs and rebate income adversely - Key cost indicators of a plan include: generic fill rates mail service pharmacy utilization cost per prescription in each therapy class used cost per individual Top 20 drugs in each therapy class - Preference Program Savings Opportunities Full 15% Select 6-8% Physician 14% - MOST COST EFFECTIVE DRUG MIX WITHIN THE INDUSTRY PAGE 1 of 2 The HealthExpresssm program is a comprehensive disease management program using Express Health Line s'N an outbound call center staffed with registered nurses and pharmacists, to interact with members that have chronic diseases and compliance issues. The number and schedule of outbound calls will be based on each specific case. In addition to outbound calls, the Express Health Lines' call center will provide educational materials to be mailed or faxed to the patient's home, member satisfaction surveys, and member outcome surveys. A case management interface is also available. Our capabilities include: ♦ Computerized on-line health outcomes surveys ♦ Medical guideline interventions ♦ Follow-up member calls to verbally educate members and monitor health status ♦ Mailed member educational materials ♦ Mailed member progress reports to the attending physicians ♦ Utilization, health care status and financial impact reporting HealthExpress Health Management Counselors The health management counselor nurses have an average of 10 years nursing experience. These nurses have experience and expertise in a variety of areas including phone triage nursing services, managed care, precertification, concurrent review, discharge planning, catastrophic case management, geriatric care, orthopedics, medical/surgical, acute care, and home infusion services. With this broad and diverse background, these nurses are the key to the success of disease management using telephonic health education. To ensure excellent customer service, new nurses complete an extensive training period for four to six weeks. Nurses are added in proportion to the growth in the number of members added to the program. HealthExpress Pharmacists The HealthExpresssm program includes pharmacists to answer prescription drug questions and to conduct some of the intervention calls related to member prescription compliance. In the course of a year, 60 percent of all health plan members receive a prescription drug. Most physician office visits result in a prescription being issued. Eighty percent of the diabetic population and seventy percent of the asthmatic population use prescription medication. This high level of prescribing is not without significant side 46 Express Scripts® VProgressive Healthcare Management City of Fort Collins 7127198 79 effects and compliance issues. According to a study conducted by the Inspector General, drug non-compliance causes an estimated 125,000 unnecessary deaths each year in the United States at an excess of $100 billion. It is further estimated by the National Council on Patient Information and Education that 5kpercent of patients are non -compliant with their physician's orders, 55 percent of the elderly do not properly follow the medication regimens prescribed by their physicians, 15 percent of patients admit to prematurely discontinuing their medication, and 32 percentof patients do not follow their physicians orders to have their prescriptions refilled. The City members will benefit from the availability of a pharmacist to answer questions about their drug regimens. The HealthExpresssm nurses are able to bring a pharmacist into the call for consultation at any time. Disease State Management Program Outcomes ♦ Clinical Outcomes include: 0 Reduce exacerbations and minimize disease progression 0 Enhance quality of care 0 Improve patient drug compliance 0 Reduce incidence of adverse effects ♦ Economic Outcomes include: 0 Optimize total medical costs and decrease indirect costs 0 Optimize ER and out -patient visits 0 Minimize hospital admissions ♦ The City Outcomes include: 0 Enhance member satisfaction 0 Improve patient understanding 0 Improve provider relationships 0 Enhance the City's marketing image 0 Lower overall medical cost ♦ Humanistic Outcomes include: 0 Improve quality of life Clinical Development and Educational Guidelines A panel of physicians specializing in internal medicine, family practice, pulmonary medicine, endocrinology, and psychology combined with the Express Scripts' team of doctors of pharmacy, registered nurses, and outcomes researchers developed the 4 Express Scripts° VProgressive Healthcare Management City of Fort Collins 7/27/98 80 HealthExpresssm program. In addition, the teaching algorithms used in each telephone counseling session are reviewed by the medical director. All members initially receive an educational handbook and each telephone counseling session is followed with a mailed educational brochure. The brochure contains information relative to the topic discussed in the telephone counseling session. The on-line software creates a permanent on-line medical record including: ♦ Enrollment and health risk appraisal ♦ Concurrent, chronic, or acute illnesses ♦ Current prescription and over-the-counter medications ♦ Medication allergies ♦ Pregnancy status (if applicable based on age and sex of member) ♦ Availability of social support from family and friends ♦ Special reading needs for educational materials ♦ Members understanding of teaching topic(s) being discussed ♦ Teaching algorithm(s) discussed during call ♦ History of algorithms covered during previous calls ♦ Applicable disease state ♦ Applicable clinical data that the member is able to report — i.e.: peak flow reading, blood sugar, blood pressure, hemoglobin A1C, etc. ♦ Educational information sent to member ♦ Progress reports sent to physician and member Unique Services The HealthExpresss`N nurses and pharmacists will interact with the patients' physician. Using the total team approach with the member, physician, the City medical management staff, and the HealthExpresssM staff, we can make a significant impact on health education, prescription compliance, utilization, cost, and quality. The components of the HealthExpresssm program were developed from Express Scripts' PBM business. These components include call center operations, eligibility expertise, knowledge of the managed care industry, and strong information systems capabilities. Combined, these components make the HealthExpresss`N program a strong competitor in the Disease Management business. Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 81 Express Scripts offers a strong portfolio of healthcare services. Express Health Linesm Informed Decision Counseling, Health Expresssm disease management, Practice Patterns Science's analytical and targeted data, Express Scripts' PBM data, and ExpressTherapeuticssm modules make our services a dynamic combination. These programs can help the City meet the ongoing goals of improved quality of care, cost effectiveness, and decreased utilization. Do you correspond with prescribing physicians? On what percentage of prescriptions? What degree of success have you had in changing prescribing patterns? What are the cost savings generated through this practice? How is this cost savings calculated? Express Scripts pharmacists are in constant contact with physicians, calling out on approximately 30 percent of all new prescriptions received. When prescriptions are processed by our Drug Utilization Review system, many system edits are compared to the prescription being dispensed. A comparison is made against all prescriptions still within their utilization period in the patient's mail service prescription history and all network prescriptions. If a clinical concern is raised, the prescribing physician is contacted and a discussion of the situation occurs. Reasons for calls to physicians would include: ♦ drug interaction ♦ duplicate therapy ♦ drug allergy ♦ drug minimum/maximum dose ♦ drug vs. patient age ♦ acute/maintenance dose ♦ generic fill opportunities on DAW prescription ♦ drug therapy management ♦ duplicate side effects ♦ mail service starter dose program (ExpressTrial) ♦ Duration of Therapy ExpressPreference percentages Express Scripts/ ValueRx ;has had tremendous success in switching prescriptions changing prescribing patterns and increasing cost savings as the following chart outlines. The current ExpressPreference drug program product list comprises, on 4 Express Scripts® 6 Progressive Healthcare Management City of Fort Collins 7127198 82 average, approximately 10 percent of a client's claims and this in turn represents about 20 percent of their total drug spend. Express Preferences" Program Statistics June 1st, 1998 Enrolled Lives Full Preference 330,821 Select Preference 265,842 Physician Preference 3,843,641 Voluntary Preference 632,037 Total Enrolled Lives 5,072,341 Physician Approval Rate past month 64% past twelve months 63% Patient Switch Rate past month 93% past twelve months 68% Soft -Block Success 4.5% ExpressPreference Rx's as percent of 5% total scripts for the average ESUVRx client Percent No Response to Fax from 28% Physicians Physican Fax Numbers on file 50,165 Pharmacy Fax numbers on file 29,389 Member Non -Compliance Rate 45% 1 Q98 Average Admin Fee per switch 1Q98 $3.21 Average client savings per switch $13.25 Average Dept. Cost per patient $15.88 original switch 1Q98 Average Dept. cost per MD approval $5.86 1 Q98 Total Mail & Network Switched Rxs 113,624 past twelve months (prescriptions for preferred product due to intervention) 10. What ongoing quality assurance measures are taken? Express Scripts° Progressive Healthcare Management City of Fort Collins 7127198 83 Express ScriptsNalueRx 's quality initiative is handled by a "quality committee", composed of representatives from the major service areas in the company. This reflects the company -wide commitment to quality and the philosophy of empowering each area and each employee to take the steps necessary to produce the highest level of quality healthcare management that best meets the needs of our clients and their plan participants. Express Scripts Approach to Quality Account Installation Quality Points Quality 0 Client satisfaction tracked by Account Installation Account Managers 0 Installation of new groups measured by Eligibility Department. 0 PERz Card Issuance Turn Around monitored by Client Services. Account Administration Quality Points 0 Eligibility accuracy tested on-line. 0 Standard files are updated in two Quality to three days. Account Administration 0 Customer Service is evaluated on performance, quality and member satisfaction. I 0 Express Scripts' on-line system is available 99 percent of the time. I 0 Claims processing is tracked by type of claim. 7 -------- — — — — — 7 Mail Service Quality Points Retail Network Quality Points 0 Prescription processing time Quality in QUallty In 0 Express Scripts has an is tracked and call the Mail the Retail average.89 second on-line interventions are recorded. $efVlCe Phdfmacy response time. 0 Generic fill rate is monitored. PharmdCleS N2tWOf1( 0 Professional insurance 0 Intervention and change rate coverage is required of is tracked to show quality and network pharmacies savings. \ 0 Accuracy and quality is tracked through audits. 0 Customer Service is Total Quality monitored through surveys. Express Scripts Quality Points 0 Express Scripts is committed to continuous improvement in its operations to ensure excellentservice to clients and their plan participants. 0 Our an -line concurrent drug utilization review system checks for the safety of the prescription and ensures quality claims adjudication 0 Express Scripts ranked number one in overall customer satisfaction, in the 1996 Pharmacy Benefit Management Institute Customer Satisfaction Survey. Express ScriptsNalueRx is committed to continuous improvement in its operations to ensure excellent service to plan sponsors and participants. Senior management sets and monitors measurable standards for all operational areas, evaluating various measurements on a weekly basis. This Total Quality Management System (TQMS) is 46Express Scripts' VProgressive Healthcare Management City of Fort Collins 7127198 84 under constant development and new standards are established as quantifiable data is accumulated. Quality measures currently include: ♦ Client Services: This department is responsible for assuring that a client's needs and questions are satisfied in a timely manner. 0 Client Services Satisfaction - Client account managers are in contact with their assigned clients on a regular basis. Proactive calls to clients are logged and monitored according to date, person contacted, purpose of call, and follow-up action required. Corporate clients are surveyed on a number of areas relating to group setup, customer service, products and services provided, and implementation. Account managers will follow-up on all issues raised in the survey. All respondents are contacted by phone to discuss their responses. 0 Installation of New Groups - Express ScriptsNalueRx 's Eligibility Department measures the installation time for new groups, which may be installed via tape, remote file transfer, on-line file transfer, or manual entry. Installation time frames vary between three to ten days, according to the method of data transfer and the size and type of group involved. 0 Updating Eligibility Data - On-line files are updated immediately. Express ScriptsNalueRx updates standard data files within two to three days, which ensures proper control of claims. Non-standard files are updated within four to five days of receipt. 0 PERx Card Issuance Turn Around - The time frame to provide standard paper bi-fold cards for the members of new groups and the new members of existing groups is monitored. Standard paper cards are produced on average within three days. ♦ The Call Center —includes Customer Service, Help Desk and Mail Pharmacy Reorder —has a Training and Quality Assurance team who is responsible for consistent monitoring of representatives calls to ensure the service provided not only meets, but exceeds all customers expectations: The Call is evaluated on: 0 Average Calls Handled per Representative - Customer Service Units are staffed according to historical data to project the call volume for various membership types. Representatives are required to be available to take calls 90 percent of their time. 0 Average Calls Handled per Representative - Help Desk Representatives are staffed according to projected network claims. Representatives are required to be available to take calls 98 percent of their time. 0 Average Seconds to Answer (ASA) - Express ScriptsNalueRx has more than 114 toll -free lines to access for Customer Service and the Help Desk. Express Scripts® VProgressive Healthcare Management City of Fort Collins 727198 85 0 Percentage of Abandoned Calls and Call Blocking Rate - Lines are monitored to ensure that even during peak times, customers and pharmacist do not receive an initial busy signal. 0 Percentage of Calls Handled on Initial Contact - Customer Service and Help Desk Representatives follow through until the member/pharmacist is satisfied. ♦ Mail Service Pharmacy - Express ScriptsNalueRx 's mail service pharmacies are evaluated on the following: 0 Prescription Processing Time - Express ScriptsNalueRx tracks the time to fill prescriptions that do not require a call to the physician or further information. Call interventions are also recorded to show the impact of calls to physicians or others. 0 Generic Fill Rate - Express ScriptsNalueRx tracks the generic fill rate to demonstrate the percentage of generic medications dispensed in comparison to all prescriptions filled. Express ScriptsNalueRx maintains a high generic fill rate by: (1) calling physicians on prescription marked Dispense as Written; and (2) substitution whenever possible. Express ScriptsNalueRx also creates special programs for clients who have specific substitution objectives. 0 Intervention and Change Rate - Express ScriptsNalueRx tracks prescriptions identified for intervention and records the conversion rate to demonstrate the percentage of prescriptions for multi -source brand medications that are changed either to generic or lower cost therapeutically equivalent medications, with no loss of quality for the patient. With an average 30 percent intervention rate, a saving of $8.50 per prescription is expected. ♦ PERx Retail Pharmacy Network - Providers in Express ScriptsNalueRx retail pharmacy network, which includes more than 98 percent of pharmacies nationwide, are contractually bound to quality standards. The following areas are addressed: 0 Professional Insurance Coverage - As part of the credentialing process for pharmacies, Express ScriptsNalueRx requires a current copy of malpractice/liability insurance coverage showing $1 million coverage per occurrence. This summary sheet must come either from the insurance company or their agent. 0 Accuracy and Quality - A variety of audit programs are in place to monitor and manage network performance. These range from a daily review for appropriate dosing standards for all claims that were submitted on-line to an ad hoc on -site audit performed by an independent, nationally recognized accounting firm. Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 86 0 Customer Service at the Retail Pharmacy: Randomly selected members are contacted by mail to verify a prescription was dispensed to the member, the proper co -pay was charged, the signature log was signed, and to evaluate the quality of service. ♦ Client Services - The Client Services department is responsible for making sure that a client's needs and questions are satisfied by Express ScriptsNalueRx in a timely manner. 0 Client Services Satisfaction - Client account managers are in contact with their assigned clients on a regular basis. Proactive calls to clients are logged and monitored as to date called, person contacted, purpose of call, and follow-up action required. Corporate clients are surveyed on a number of areas relating to group setup, customer service, products and services provided, and implementation. Account managers will follow-up on any issues raised in the survey. All respondents are contacted by phone to discuss their responses. 0 Installation of New Groups - Express ScriptsNalueRx 's Eligibility Department measures the installation time for new groups, which may be installed via tape, remote file transfer, on-line file transfer, or manual entry. Installation time frames vary between three to 10 days, according to the method of data transfer and the size and type of group involved. 0 Updating Eligibility Data - Express ScriptsNalueRx updates standard data files within two to three days, which ensures proper control of claims. Non- standard files are updated within four to five days of receipt. 0 PERx Card Issuance Turn Around - The time frame to provide standard paper bi-fold cards for the members of new groups and the new members of existing groups is monitored. ♦ Operations - Our operations department, which includes claims administration and information systems, is monitored on: 0 Eligibility Accuracy - Quality is maintained on an on -going basis for all new and revised benefits through on-line testing. 0 Claims Processing Time - The number of days to process prescription claims is tracked by each type of claim. Approximately 95 percent of claims are processed on-line at the time of service. Member submitted claims are monitored closely so that all are processed within one week of receipt. 0 On -Line Response Time - This measures the average time to respond to on- line claims processing from network pharmacies. Express ScriptsNalueRx maintains an average .89 second response time to pharmacies with direct data link to a national pharmacy computer network. Express ScriptV Progressive Healthcare Management City of Fort Collins 7127198 87 0 System Downtime - Express ScriptsNalueRx 's systems are monitored to assure they are available in excess of 99 percent of the time, except for daily scheduled maintenance and third -party failure. The Express ScriptsNalueRx TQMS program is an ongoing company -wide commitment to excellence and performance, beginning with account implementation and continuing throughout the contractual agreement. 11. What is the expected percentage of total prescription plan cost savings that will result from the implementation of your DUR program? Express ScriptsNalueRx has a sophisticated Drug Utilization Review (DUR) program that is designed to ensure quality of care and enhance the cost containment features of Express ScriptsNalueRx 's comprehensive pharmacy benefit management program. The DUR program is composed of prospective, concurrent and retrospective components. Express ScriptsNalueRx 's DUR saves approximately 5-8 percent of total plan costs for those clients with no previous DUR history. For clients with a previous DUR program history, 2-4 percent of total plan costs may be saved. G. Formulary 12. Can your formulary be offered on a voluntary basis or must it be mandatory? Is it open or closed? Express ScriptsNalueRx can support all of these options. Express ScriptsNalueRx offers many different formulary options for the client to choose from and provides consultative advice on the impact each of the options will have on total benefit cost. Formulary types include the following: ♦ Open ♦ Restricted ♦ Closed Open Formulary Express Scripts/ValueRx begins with a Core Drug List which is a list of 500 contracted brand products (120 of which are preferred) and all generic products. The objective of the Core Drug List is to move market share in key categories. 4 Express Scripts' Progressive Healthcare Management City of Fort Collins 7/27/98 88 Prescription Drug Benefit Cost Containment Strategies Generic substitution - Supplement of telephone intervention with physicians with mailings, letters and brochures - Our 30% intervention rate through the Mail Service Pharmacy results in an average 11% savings Therapeutic substitution - Handled similarly Disease management - True disease management methodology integrating medical and drug information Physician education programs - Express newsletter to physicians informing of preferred and cost-effective therapies Starter prescription program - 30-day supply in mail for new prescriptions where side effects are more common. - 45% of all medications on the initial fill are either changed or discontinued Prior authorization - Proactive review of high cost medications with various purposes Drug information service - Guidelines that may be applied to specific medications and programs designed to control utilization. Express Therapeutics Program - "Case Management" of drug therapy - Includes both humanistic and economic benefits to plan and members PAGE 2 of 2 Express Scripts/ValueRx can assist a client with an open formulary that incorporates the efforts of the network pharmacist in helping to drive market share. This is accomplished via our on-line messaging system that informs the pharmacist of a preferred product within a therapy class. The pharmacist is prompted to phone the physician regarding the efficacy of the drug and the potential savings to the client and member. The Open Formulary covers all oral and topical drugs with approved FDA indications. Typically, plan designs will exclude OTC products, drugs used for cosmetic purposes, and injectable products. Exceptions to the injectable exclusion include insulin and those injectable products covered by a prior authorization process. Some plans choose to allow limited coverage of selected OTC products. Restricted Formulary The Restricted Formulary is the same as the Open Formulary, but uses a Preferred Product List that promotes the use of certain products. Most therapy classes will have specified products designated as preferred. The preferred drugs are those products that have the potential to provide the greatest level of savings for the plan through lower ingredient costs or higher market share incentive fee levels. Our ExpressPreferencesm program provides restrictive formulary options are available that range from minimally restrictive options to more restrictive options which limit drug coverage, but provide significant savings. Savings depends upon the size of the group, plan design, and the number and type of drugs included. The ExpressPreference'm program reduces bottom -line costs through proprietary programs offering clients a range of options to successfully increase utilization of preferred products through plan design and intervention strategies. This proactive strategy assists clients in controlling healthcare spending while addressing the trend toward more preferred product programs. Our independence from pharmaceutical manufacturer and medical provider ownership allows us to proactively assist our clients in controlling healthcare spending. The result is bottom -line savings for MedSpan. ExpressPreferencesm Program The four formulary programs offered by Express Scripts/ValueRx are: Physician Preference (Voluntary formulary) Physician Preference with 3-tier Copay (Voluntary formulary with 3-tier copay) Select Preference (Restricted formulary) Express Scripts' Progressive Healthcare Management City of Fort Collins 7127198 99 • Select 1 (Non -preferred products are • Select 2 (Non -preferred products are 4. Full Preference (Closed formulary) blocked on the first prescription) blocked on refills) The first three programs are based upon the following list of preferred products ("Preferred Product List"). The foundation of these Express ScriptsNalueRx 's ExpressPreferences' formulary programs are based upon member safety and plan sponsor savings through the interchange of the following types of drugs: ♦ Chemical equivalent drugs: those which contain identical active ingredients and are identical in strength or concentration, dosage form, route of administration, and have comparable bioavailability; or ♦ Therapeutic equivalent drugs: those which are composed of different drug products, but are expected to have the same clinical results and safety profile. Preferred Product List The following list indicates Express ScriptsNalueRx 's preferred products and the corresponding non -preferred products. These preferred therapeutic or chemical equivalent drugs were selected from a quality of care (not economic) perspective. Express ScriptslValueRx EXPRESSPREFERENCEsm List Effective 3rd Quarter, 1998 Albuterol Inhaler ProvenlilInhaler Albuterol Inhaler Ventolin Inhaler Atenolol Tenormin Beclovent Vancedl Beconase AQ Vancenase AQ Betimol Thoptic Cardizem CD Tiazac Cimetidine Ta amet Glyburide Micronase Glyburide Diabeta Humulin Novolin LotenslnlMono riRestril Vasotec Miacalcin Calcimar for plans coveting in'ectables Micronor Nor-QD Monoket IsmO Prenale Ultra Materna Prenale Ultra Zenate Nordette Levlen Ortho Tri-C clenl0rtho Novum 71717 Tri-Norio I Ortho-C clen Demulen 1135 Ortho-Novum Norio I Express Scripts' Progressive Healthcare Management City of Fort Collins 7127198 90 Prilosec Prevacid Procrit Epogen for plans covering in' ctables Ranilidine Zantac RanftidinalAxid Pe cid Rhinocort Nasacort Nolvadex Tamoxifen Barr Trandate Normod ne Tri- hasil Tri-levlen Volmax Provendl Repetab Zestoretic Vaseretic Zestoretic Prinzide Zestril Prinivil LI itorlPravachol Mevacor Li itorlPravachol Zocor LI itorlPravachol I Lescol Preferred product listing Is subject to change, from time to time, at the sole discretion of Express Scripts. ExpressPreferencesm Program Descriptions The ExpressPreference'm programs fit along the following continuum, offering our clients a full range of savings potential based upon how "managed" you desire the formulary program to be: Physician Preference with Rier Copay Voluntary Program W Physician 3-der coMy Preference Voluntary Program Full Preference Select Closed Form "y Preference Restricted Formulmy 1. Physician Preference is a voluntary program that proactively educates physicians and members about the opportunity to choose therapeutically or chemically equivalent drugs from the Preferred Product List. ♦ On an initial prescription for a non -preferred product, the pharmacist will receive a soft block (re -send to override) message about the availability of the preferred product. 4 Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 91 ♦ If there is no conversion to the preferred product, the claim is reviewed through Express ScriptsNalueRx 's drug utilization review check. Once the claim passes the DUR check, the availability of the preferred product is communicated to the physician. The physician must approve before a conversion is made. If the physician declines the use of the preferred product, no further attempts will be made. If approved, the member is notified either that the physician has sent a new prescription to the pharmacy, or that the pharmacist has been instructed to contact the physician (if the prescription was filled at a network pharmacy), or the preferred product has been mailed to the member (if the prescription was sent to the mail pharmacy service). ♦ The Plan Sponsor pays the network pharmacist an incentive for dispensing each preferred product. (The savings exceed the incentive). ♦ Express ScriptsNalueRx receives 35% of the first year's savings as administrative fees for facilitating the conversion. 2. Physician Preference with 3-tier Co pay: This is a voluntary program that incorporates a three-tier co -pay structure into our Physician Preference program. This co -pay structure provides members an incentive to utilize generic and preferred products. For example, a member may pay either a $5.00 co -pay for a generic product, a $10.00 co -pay for a preferred brand - name product, or a $25.00 co -pay for a non -preferred brand -name product. ♦ Savings to the plan sponsor are greater than Physician Preference due to the added element of the member incentive to utilize generic and preferred products via the three-tier copay structure. ♦ The plan sponsor pays the pharmacist an incentive for dispensing each preferred product. The savings generated from dispensing preferred products outweigh the incentive payment made to the pharmacy. ♦ The client will receive 65% of the first year's savings while Express Scripts/ValueRx will receive 35% an administrative fee for facilitating the conversion. 3. Select Preference is a restricted formulary program that provides coverage for products on the preferred product list. The corresponding non -preferred products are not covered. This can be implemented on the initial prescription or on the first refill. ♦ Select 2: If a member presents a prescription for a product on the non -preferred product list, the pharmacist will receive a "soft block" 4 Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 92 on the first prescription. An attempt to refill results in a rejected ("hard blocked") claim on the second prescription. 0 If the physician cannot be reached, the pharmacist simply adjudicates the non -preferred product. If the non -preferred product is dispensed, Express ScriptsNalueRx communicates with the physician and the member. An intervention fee is charged to the plan sponsor for informing the physician and member of the opportunity to convert the prescription to the preferred product before obtaining a refill. 0 On a refill, if a physician elects not to switch to the preferred product, the member pays 100 percent of the prescription cost. If the physician agrees to the conversion, the member pays the appropriate co -pay. The non -preferred product may be overridden by a prior authorization from the Express ScriptsNalueRx 's Help Desk. 0 This program is typically used by Commercial and TPA clients that may not have a physician panel. ♦ Select 1: If a member presents a prescription for a product on the non -preferred product list, the claim is rejected ("hard blocked") on the first prescription. 0 The physician is contacted for conversion. If the physician elects not to switch, the member pays 100 percent of the prescription cost. If the physician agrees to the conversion, the member pays the appropriate co -pay. Also, the non -preferred product may be overridden by a prior authorization from the Express ScriptsNalueRx 's Help Desk. 0 There is no incentive fee paid to the pharmacist. 0 Up -front physician and member education is critical This program is typically used by MCOs with a physician panel to more aggressively enforce the Preferred Product List. 4. Full Preference is a closed formulary program that offers the highest potential plan savings and includes all generic products and approximately 500 preferred brand -name products. Prescriptions for preferred products are covered by the plan; non -preferred products are not covered by the plan. ♦ If a member presents a prescription for a medication that is not on the list of 500 preferred brands, the claim is rejected and not processed. A "hard block" is displayed to the pharmacy and only may authorization from the Express ScriptsNalueRx 's express Scripts® Progressive Healthcare Management be overridden by a prior Help Desk. City of Fort Collins 7/27/99 93 ♦ The member has the option to change to the preferred product or pay 100% for the non -preferred product. ♦ There is no incentive fee paid to the pharmacy. ♦ This plan offers the highest potential savings. ♦ This program is typically used by clients with a closed physician panel such as an MCO or a client that utilizes a PPO for all non -HMO members. ♦ The list of 500 preferred brand drugs with explanatory information encouraging compliance is provided to the panel of physicians in advance. 13. What is the total number of products included? Provide a complete list, including the name of the manufacturer of each drug product, with your proposal. As a general rule, medications are on the formulary if they are in the top 500 most prescribed brand drugs. The brands listed on the formulary are not necessarily the only brands available for dispensing. Physicians are encouraged to use these brands for the majority of their prescribing activity, subject to their professional medical judgment. The purpose of the formulary is to provide a reference list of safe, effective, high quality, cost-effective medications. A formulary listing is presented in Exhibit 10. 14. When was your formulary first established? The Express ScriptsNalueRx formulary was first established in 1990. 15. How often is it updated? How often do you communicate updates to physicians? Formulary changes are announced to participating pharmacies via our on-line messaging system, as well as through more conventional means, such as our clinical (The Express) and pharmacist (PERxNews) newsletters. These newsletters are updated and issued on a quarterly basis. The full formulary is printed by Express ScriptsNalueRx on an annual basis. 16. What is the title of the person or body within your organization which maintains and updates the formulary? The Express ScriptsNalueRx Health Management Services staff makes recommendations to the Express ScriptsNalueRx P&T Committee regarding the Express Scripts Progressive Healthcare Management City of Fort Collins 7127198 94 inclusion of new drugs and the elimination of certain drugs from the formulary. This Committee provides many functions, including: ♦ Evaluating drug benefit design policy ♦ Evaluating clinical intervention strategies ♦ Reviewing printed material related to drug benefit, educational material, and provider communications ♦ Providing recommendations for drug formulary policy and formulary language ♦ Providing medical and ethical oversight for clinical interventions The information review includes a detailed analysis of the "formulary kit' provided by the manufacturers, along with a complete literature review. Decision making criteria regarding drug selection includes, but is not limited to the following: ♦ Product status within a therapeutic class ♦ Therapeutic indications (are the indications new or the same as others in the therapeutic class?) ♦ Product characteristics such as dosage form, route of administration, and dosage regimen ♦ Cost -benefit of the product compared to other products in the same therapeutic class An illustration of the formulary review process is presented below: Express Scripts* VProgressive Healthcare Management City of Fort Collins 7127198 95 Formulary Addition/Review Process Express Scripts' Clinical Review Reject Recommendation to National P&T Committee Formulmy Addition/Revision Approved Recommendation to individual Plan P&T Committee The time for approval of a new drug varies based upon the amount of information available and the status of the drug in its class. Express ScriptsNalueRx believes that the combination of a strong clinical pharmacy staff, the Express ScriptsNalueRx P&T Committee, and the Plan's P&T Committee provides a balanced approach to formulary development and management. 17. What is the total number of covered persons currently using your formulary program? The Express ScriptsNalueRx formulary system, which includes the Express ScriptsNalueRx 's ExpressPreference formulary and custom client formularies, has been in place since 1990. There are 7,529 groups with approximately 9.5 million lives are currently covered by a formulary system. Under the Express ScriptsNalueRx 's ExpressPreference Formulary, 4.5 million lives are covered. 18. How often is the formulary printed and distributed to clients? Updates to the formulary are printed and distributed on a quarterly basis. The full formulary is printed and distributed on an annual basis. 44. Express Scripts° Progressive Healthcare Management City of Fort Collins 727198 96 19. What is the potential, average cost -savings to a client? Will you guarantee a specific dollar amount per dispensed prescription to be rebated to a client? If no, why not? If yes, state the amount. Does the guarantee apply to all prescriptions dispensed or just those that are on the formulary? Is the guaranteed amount the actual rebate to the client or would the client only receive a certain percentage of the guaranteed amount? Cost reductions associated with formulary options depend upon the size of the group and the plan designs chosen, benefit design, and the number and type of drug; member co -payment incentives; and, physician incentives. Open formulary program when combined with Express ScriptsNalueRx MAC program form basis for program savings. Restricted formulary options include maximizing usage of preferred product and generate greater savings as indicated below: "Full Preference 15% Select Preference 1 & 2 6-8% Physician with Co -pay 3-4% Physician Preference 1% * Actual results may vary The cost effectiveness of the formulary will be illustrated by the Executive Overview Report (EOR) and the Therapy Class Report which shows utilization and results of formulary programs, including: ♦ generic fill rates, ♦ mail order usage, ♦ cost per prescription in each therapy class; and ♦ cost per individual Top 20 drugs in each therapy class. 20. Describe the method used to develop and maintain your formulary. Please provide the credentials of the individual(s) involved in the ongoing development of the formulary. 4 Express Scripts® 6 Progressive Healthcare Management City of Fort Collins 7127198 97 Express ScriptsNalueRx 's Pharmacy and Therapeutics Committee is composed of ten physician and pharmacist representatives from Express ScriptsNalueRx 's larger clients including Alliance Blue Cross/Blue Shield, NYLCare, Harris Methodist, Mercy, and Premier. Concerning changes to the formulary, the key decision makers include members of the Express ScriptsNalueRx 's Pharmacy and Therapeutics Committee. The Client Phy Express and Scripw herapeutics dinical Committee Phi The P&T Committee meets on a quarterly basis and oversees all activities related to the development and management of the Express ScriptsNalueRx formulary. The P&T Committee maintains, updates, and modifies existing formularies as new products enter the market and other products change to an over-the-counter status. The P&T committee has the following responsibilities: ♦ Objectively appraise, evaluate, and select pharmaceutical products for either addition to or elimination from the formulary and determine the relative status of each drug product. ♦ Conduct an ongoing review of all therapy classes to ensure an up-to-date formulary product evaluation. ♦ Evaluate drug utilization and outcomes information to monitor drug use and develop protocols and guidelines. Express Scripts' Progressive Healthcare Management City of Fort Collins 7127198 98 Basis of ExpressPreference'" Preferred Product Program The ExpressPreference" program is indicative of Express Scripts' commitment to providing our clients the flexibility they desire and deserve, even in the area of formulary design. Express Scripts has created five programs to meet the cost savings and managed care objectives of every client by successfully increasing the utilization of preferred products. Since our independence from pharmaceutical manufacturer ownership affords us the unique ability to work for our clients' best interest, this proactive strategy assists our clients in controlling healthcare spending while addressing the trend toward more restrictive formularies. The result should be bottom -line savings for Client Name. Our ExpressPreference" Physician Preference (Voluntary formulary), Physician Preference with 3-tier Copay (Voluntary formulary with 3-tier copay), and Select Preference (Restricted formulary) programs are based upon the following list of non -preferred products and the corresponding preferred products ("Preferred Product List"). The foundation of these Express Scripts' ExpressPreference" formulary programs is based upon member safety and plan sponsor savings through the interchange of the following types of drugs: Chemical equivalent drugs: those which contain identical active ingredients and are identical in strength or concentration, dosage form and route of administration, and have comparable bioavailability; and/or • Therapeutic equivalent drugs: those which are composed of different substances, but are expected to have the same clinical results and safety profile. ♦ Review educational materials and programs regarding appropriate use of drug formulary products for healthcare professionals. ♦ Develop and review generic and therapeutic substitution policies and procedures. ♦ Develop and review policies for utilization of non -formulary or excluded drug products. ♦ Report and disseminate the decisions of the committee and other pertinent drug information to the participating health plans using Express ScriptsNalueRx as a Pharmacy Benefits Manager (PBM). The P&T Committee reviews and approves all FDA -approved products. A drug monograph is prepared by the Express ScriptsNalueRx 's Health Management Services department. When a drug product is reviewed clinically, a monograph is developed which includes: ♦ Safety Profile: The Safety Profile contains all side effects, drug interactions, disease interactions, allergic reactions and all other safety precautions that are included with the drug. ♦ Efficacy Profile: The Efficacy Profile contains indications, cure rates, off -label indications and comparative studies. ♦ Pharmacokinetic Profile: Pharmacokinetic Profiles explain how this chemical reacts in the body, which pathways, excretion pathways and composites, degradation, and other physical chemistry relationships. ♦ Biopharmaceutical Profile: The Biopharmaceutical Profile explains how the body works on the drug, what the half life is, metabolites created, volume of distribution and other biological relationships. ♦ Pharmacoeconomic Profile: Pharmacoeconomic Profiles contain cost analysis, effect on medical costs, comparative cost studies, outcome studies and any other material concerning the value or cost of the product. Under the direction of the National Pharmacy & Therapeutics Committee, Express Scripts/ValueRx makes recommended formulary updates on a quarterly basis. These changes are summarized and provided to the Plan approximately 30 days prior to the start of a new quarter. The Plan, with analysis assistance provided by Express Express Scripts° Progressive Healthcare Management City of Fort Collins 7/27/98 99 Scripts, is requested to review the proposed changes. Only upon receipt of approval will the changes be incorporated into the Plan Sponsor's processing system. 21. Describe the process you used to encourage physicians to prescribe the drugs listed on your formulary if a client wishes it to be voluntary for its employees. Express Scripts/Valuer currently conducts educational programs to inform physicians of preferred and cost-effective therapies. These programs have been proven to drive market share to specific drug products within a therapeutic category. Among other things, our clinical pharmacy department publishes The Express newsletter on a quarterly basis with information on our formularies, preferred products and new medications. We also provide physician profiling that allows us to target prescribers for education and intervention strategies. We rank physicians within their specialties, identify those who are outside the norm and then report drug cost, generic utilization, top ten drug usage and formulary compliance. Our clinical staff can provide drug treatment protocols, prior authorization systems, case management, letters to physicians and letters to patients as needed. We can even allow all prescriptions written by an identified physician to be prior authorized, if desired by the plan. Drug utilization criteria are available to manage pharmaceuticals that have a high cost impact on your plan. Each plan identifies parameters to evaluate the performance of plan physicians. Some of these may include the percentage of generic prescribing, the average pharmacy claim amount, and the number of prescriptions written per thousand member months. Usually, individual prescriber data is compared to a norm for the physician's specialty. A plan may identify all physicians greater than 25 percent above the norm, for example, and schedule a meeting with a clinical pharmacist. The parameters are flexible and individualized to meet the goals of the plan. Physicians whose data significantly deviates from the norm in pharmacy costs typically also exceed the norm in laboratory, radiology and referrals. However, as the consulting clinical pharmacist, caution must be exercised in the discussion with the physician as increases in pharmacy utilization may translate into decreased hospitalization. It is imperative for the plan to recognize this fact, communicate it to physicians, and consider whether a meeting with a clinical pharmacist is appropriate. 22. How often do you receive formulary rebates from pharmaceutical manufacturing companies? �Aw Express Scripts' Progressive Healthcare Management City of Fort Collins 7/27P98 100 Express ScriptsNalueRx submits a list of claims to manufacturers at the close of a given quarter per the manufacturer's specific requirements. All participating plan sponsors are included in these submissions to the manufacturer. Market share incentive fees are paid to clients on a quarterly basis, typically within 150 days after the close of a given quarter, along with a statement of the drugs and market share incentive fee amounts. Express ScriptsNalueRx will retain a small percentage to support manufacturer negotiation and contracting efforts and formulary development, administration and management. 23. When can the plan sponsor expect the first formulary rebate check? After the first check, what is the ongoing frequency of formulary rebate checks? Rebate checks are typically received 150 days after the close of the quarter. 24. Are you willing to guarantee in the contract the timing of formulary rebate checks? No, Express ScriptsNalueRx does not guarantee the timing of formulary rebate checks. If your company is owned by a prescription drug manufacturer, answer the following questions. Otherwise, skip to Section H. 25. What percentage of the drugs included in your formulary are manufactured by your parent company? If greater than 50%, explain why the drugs manufactured by your owner predominate the formulary. 26. How do you guarantee to clients that you can avoid the inherent conflict of interest resulting from your managed prescription drug program being owned by a drug manufacturer? 27. How do you guarantee to clients that in developing your formulary you continue to include the drugs, regardless of manufacturer, that not only have the desired therapeutic outcomes but are also most cost-effective? H. Fees 1. Explain how maximum allowable charges are determined geographically. a. By the location of the plan, or pharmacy? Other? �Aw Express Scripts' Progressive Healthcare Management City of Fort Collins 7127198 101 b. How are specific areas delineated (e.g., five digit zip, 3 digit zip, county)? Express ScriptsNalueRx does not determine MAC geographically. More than 650 drugs are included on our MAC list. All network pharmacies are obligated to accept the MAC price and are required to dispense MAC drugs whenever called for by the plan design. MAC reimbursement is automatically handled through the on-line system to preclude any possibility of fraud. All DAW options are available through our MAC program. Express ScriptsNalueRx chooses only multi -source brand products, FDA "A" and "AB" rated, readily available to retail pharmacies in the network for inclusion on the MAC list. Products selected are those products which do not pose a therapeutic equivalency problem for patients when substituted. Drugs that are subject to MAC pricing, brand or generic, are grouped by generic class number (GCN) in the First DataBank database. The First DataBank database groups pricing by generic class number (GCN) as a source to determine the appropriate discount and MAC ceilings. Express Scripts/YalueRx 's MAC price analysis reveals that our prices generally equate to an average discount of 45 - 55 percent below AWP, depending on market conditions and drug mix. This estimate can vary slightly based on individual client requirements, however, it is obvious that adopting Express ScriptsNalueRx 's program will create significant savings for your participants in pharmaceutical ingredients alone. Are there any additional fees other than those specified above which might be charged to the client? If so, please identify them in detail. Please refer to the Cost Quotation for additional services and programs offered at an additional fee. 3. For the retail program please indicate your pricing formula for the ingredient component. Does the price formula include maximum allowable costs (MAC), average wholesale price (AWP), formulary or usual, reasonable and customary charges? What discount is applied for generic drugs, for brand drugs? Is there a dispensing fee? (Please list dispensing fee individually for each state.) For what period of time is this formula guaranteed? If MAC pricing is used, please provide the current percentage off AWP equivalent. (Please exclude the value of any "lesser of provisions, MAC savings and rebates.) �& Express Scripts* Progressive Healthcare Management City of Fort Collins 7/27/98 102 PERxSelectsm Network (50,583 + pharmacies) Reimbursement shall be the lower of: • Usual and Customary • Brand Drugs: Average Wholesale Price Less 12% • Generic Drugs: Average Wholesale Price Less 12% or MAC Dispensing Fee per Prescription $2.25* Administrative Fee per Prescription $0.60 *Express ScriptsNalueRx has applied $0.25 of the market share incentives (rebates) to reduce the dispensing fee to $2.25. If rebates are discontinued or materially changed by pharmaceutical manufacturers or if City of Fort Collins elects to not enroll in the ExpressPreferences' program, the administrative fee (dispensing fee) reverts to $2.50. PERxCare'm Network (41,000 + pharmacies) Reimbursement shall be the lower of: • Usual and Customary • Brand Drugs: Average Wholesale Price Less 14% • Generic Drugs: Average Wholesale Price Less 14% or MAC Dispensing Fee per Prescription $2.25* Administrative Fee per Prescription $0.60 *Express ScriptsNalueRx has applied $0.25 of the market share incentives (rebates) to reduce the dispensing fee to $2.25. If rebates are discontinued or materially changed by pharmaceutical manufacturers or if City of Fort Collins elects to not enroll in the ExpressPreferences' program, the dispensing fee reverts to $2.50. Express ScriptsNalueRx 'MAC is approximately 45 - 55 percent below Average Wholesale Price. 4. For the mail order program please indicate your pricing formula for the ingredient component. Does the pricing formula include maximum allowable costs (MAC), formulary, average wholesale price (AWP), or usual, reasonable and customary charges? What discount is applied for brand name and for generics? If MAC pricing is used, please provide the current percentage off AWP equivalent. Is there a dispensing fee? If so, what is it? What is your mail order fee? For what period of time is this formula guaranteed? 0^8 Express Scripts® VProgressive Healthcare Management City of For! Collins 7127198 103 Reimbursement shall be the lower of: • Brand Drugs: Average Wholesale Price Less 14% • Generic Drugs: Average Wholesale Price Less 48% Dispensing Fee per Prescription $1.75* Administrative Fee per Prescription $0.00 *Express ScriptsNalueRx has applied $0.50 of the market share incentives (rebates) to reduce the dispensing fee to $1.75. If rebates are discontinued or materially changed by pharmaceutical manufacturers or if City of Fort Collins elects to not enroll in the ExpressPreferences'N program, the dispensing fee reverts to $2.25. 5. What percent of your network pharmacy contracts will include the "lesser of retail price, MAC price or discounted price" provision? % How do you determine that plan members always receive this lowest price? What procedures are established to ensure that the pharmacy is in compliance with this provision? All network pharmacy contracts include the "lesser of retail, MAC or discountede price" provision. If the City decides to utilize Usual and Customary pricing as part of the drug benefit plan with Express Scripts, members will always be charged the U & C price as the copay when it is lower than the plan copay but higher than your plan's contracted rate. The system will reject any claim missing the U & C price. A pharmacy report is generated on a quarterly basis comparing the provider's U & C paid rate against a comparable provider and against the Total Express ScriptsNalueRx average. A rate significantly below average may trigger an audit. Because many pharmacies have several drugs that are considered loss leaders, (drugs the pharmacy sell at or below the acquisition cost to increase business) adding usual and customary pricing to the client's pricing will result in an overall discount of one to three percent off AWP, depending on the discount given in the price quote. 6. Does your firm set the professional dispensing fee or will you permit the City to set this fee? What fee do you recommend? Express ScriptsNalueRx charges a per perscription dispensing fee. 7. When are fees due and what is the grace period for payment of fees under your policy? If fees are paid subsequently, is a penalty and/or interest charge assessed? If yes, please explain in detail. Are there any options available with �A Express Scripts Progressive Healthcare Management City of Ford Collins 7127198 104 respect to the grace period? If so, please explain the option(s) and any charge that is made for them. Express Scripts' billing options are extremely flexible. Separate billing dates can be set up for different services (network, mail service, or self pay) and for various group and sub -group structures. Billing options can include: ♦ Specific day(s) of the week ♦ Specific day(s) of the month ♦ Specific weeks within the month. ♦ End of the month Express ScriptsNalueRx offers different billing and payment methods from the following options: ♦ Draft Authority: Sponsor will provide Express ScriptsNalueRx with draft forms and authority to deposit them for Express ScriptsNalueRx's program fees less copayments. Sponsors utilizing the draft authority option agree to pay Express ScriptsNalueRx within twenty four (24) hours of Sponsor's receipt of Express ScriptsNalueRx's billing. ♦ Wire Transfer: Sponsor will give Express Scripts/ValueRx the phone number and contact person to wire transfer or ACH Express ScriptsNalueRx program fees less copayments. Sponsors utilizing the wire transfer option agree to pay Express ScriptsNalueRx within twenty four (24) hours of Sponsor's receipt of Express ScriptsNalueRx's billing. ♦ Payment by Check: Express ScriptsNalueRx bills sponsor at least monthly by the twentieth (20th) day of each month for services rendered during the preceding month. All billings received by sponsor shall be paid upon receipt of said billing. Any amounts not paid by the due date set forth shall bear interest at the rate of 18% per annum (1.5% per month) or, if lower, the highest interest rate permitted by law. I. Contractual Issues 1. Will your contract have a hold harmless provision that indemnifies the plan sponsor against liability that arises as the result of negligent acts, errors, omissions, fraud and other criminal acts committed by your network providers, officers, employees and agents of the organization? Will you agree to such a provision? 1*6 Express Scripts° Progressive Healthcare Management City of Fort Collins 7127198 105 Express Scripts agrees to indemnify and hold harmless Sponsor, its officers, directors, employees, and agents from and against any demand, liability suit, damage, loss, judgment or other claims of whatever nature, equitable or otherwise, arising directly from or in connection with Express Scripts' performance under our Agreement; provided, however, that in no event shall Express Scripts be liable for any act or failure to act on the part of a Participating Pharmacy. Sponsor agrees to indemnify and hold harmless Express Scripts, its officers, directors, employees, and agents from and against any demand, liability suit, damage, loss, judgment or other claims of whatever nature, equitable or otherwise, arising directly from or in connection with Sponsor's performance under our Agreement. 2. Please provide a sample contract for an integrated retail and mail order prescription program. Please see Exhibit l for a sample integrated retail/mail order prescription program contract. 3. What is the term of your contract and what are its termination provisions? Express ScriptsNalueRx will provide a 3 year agreement or a term that is mutually acceptable. Please refer to SECTION VII of the Managed Prescription Drug Program Agreement found in Exhibit I for the terminiation provisions. 4. The plan sponsor wishes to include in the contract the right to cancel the contract at any time should it find performance of the organization paying claims [or performing non -claims paying functions] to be unsatisfactory. In addition, the plan sponsor wishes to include a clause to the effect that, upon contract termination, the cost of any work required by a new administrator to bring records in unsatisfactory condition up-to-date shall be the obligation of your firm and such expenses shall be reimbursed by your firm. Do you agree to include these provisions in your contract? Please refer to SECTION VII of the Managed Prescription Drug Program Agreement found in Exhibit I for the terminiation provisions. 5. Does the contract provide the plan sponsor the right to audit the performance of the plan and services provided? Indicate what services, records and access will be made available to the plan sponsor at no additional charge. Also indicate frequency and notice requirements that are part of the right to audit provision. �A Express Scripts' Progressive Healthcare Management City of Fort Collins 727198 106 Express Scripts' current contracts contain a provision giving clients the right to inspect records relating to the client's prescription drug program. The client's auditors will be allowed to interface with designated Express Scripts personnel. Reasonable advance notice is required. 6. Do you agree that the fees, rates, performance guarantees, provider credentialing, provider access, quality assessment and monitoring responses you provided in this proposal are legally binding? For what period of time are these responses valid. The responses submitted in this proposal are valid for 180 days after submission of the proposal. Do you agree during the duration of any contract, and for 12 months after termination, that any direct contact, direct marketing, educational material, and other communication made to plan participants, other than responses to individual member inquiries regarding individual medical claim or member services issues, are strictly prohibited without the authorization and approval of the plan sponsor? Yes, Express ScriptsNalueRx agrees that during the duration of any contract, and for 12 months after termination, that any direct contact, direct marketing, educational material, and other communication made to plan participants, other than responses to individual member inquiries regarding individual medical claim or member services issues, are strictly prohibited without the authorization and approval of the plan sponsor. 8. Do you agree that all data specific to this Plan shall be the property of and shall be used exclusively for this Plan at the direction of the plan sponsor? Your proposal must specifically answer this question. Yes, SECTION 5.1of our standard agreement describes the Ownership and Use of Prescription Drug Records: (a) All records and other data provided to ESI by Sponsor, other than records that ESI is required to maintain by law (including, but not limited to, records required to be maintained by the Mail Service Pharmacy) shall remain the property of Sponsor; provided, that Sponsor irrevocably grants ESI permission to use both during and after the term of this Agreement and/or transfer to third parties the drug and related medical data collected by ESI or provided to ESI by Sponsor for research, cost analyses, cost comparison or other business 0^0 Express Script Progressive Healthcare Management City of Fort Collins 7127198 107 purposes of ESI, all without charge to ESI. ESI shall retain full ownership rights over all compilations, analyses and reports prepared by ESI under this Agreement. In any case, ESI shall maintain Member confidentiality to the extent required by law, and shall not provide to any third party information identifiable as relating specifically to any Member without such Sponsor's consent. (b) Sponsor, at its own expense, may inspect ESI's records relating to Sponsor's Plan not more frequently than once each year. Such inspection shall be conducted at ESI's offices and shall be subject to such limitations to protect the confidentiality of information relating to other prescription drug programs and the members thereof as ESI may reasonably determine. 9. Do you carry comprehensive general and professional liability insurance? For what amount? And with whom? Yes, Express ScriptsNalueRx presently carries $1,000,000 general liability and $5,000,000 excess insurance. Coverage is provided by TIG Specialty Insurance Company, Hartford Fire, Twin City Fire, and Hartford Casualty. Please refer to Exhibit 11 for a copy of our Certificate of Insurance. J. Implementation Provide a proposed implementation plan and timetable, beginning with the award of business to effective date of coverage. Include: — Steps required to implement the program. — Role played by the plan sponsor/vendor. — Eligibility feed. — Production and distribution of ID cards, directories, and enrollment materials. — Contacts and personnel assigned to each step of the implementation process. — Establishment of bank accounts, check stock, on-line plan information. 2. Describe how you will communicate the retail and mail order prescription drug program to employees. Please attach sample communication materials you have produced for your clients, in the appendix. Are the cost of these communication materials included in your regular fee for the use of the network? If not, what is the additional cost? Are customized communications available? What is the cost? Express Scripts° Progressive Healthcare Management City of Fort Collins 7127198 108 ExpressPreference' Program Descriptions The ExpressPreferences" programs fit along the following continuum, offering our clients a full range of savings potential based upon how "managed" you desire the formulary program to be: Physician Preference with 3-tier Copay Physician v 34WCq mnH✓ Preference VorGnumv Piogrmn Full Preference Select QaredFarmdmy Preference It®bicaadFornrd®� � Physician Preference: This is a voluntary program that proactively educates physicians and patients to encourage utilization of less -costly therapeutic or chemical equivalent drugs from the Express Scripts Preferred Product List. • On the first prescription for a non -preferred product, the pharmacist will receive a soft block (re -send to override) notifying the pharmacist of the opportunity to convert to the preferred product. • If conversion to the preferred product does not take place on the first prescription, the requested conversion to the preferred product is communicated via fax, mail, or phone call to the physician for approval. The physician must agree before a conversion is made. If the physician denies the requested conversion, this will be recorded by our system and no further attempts will be made; if approved, the non -preferred product will be hard blocked. • The member is notified by mail to obtain a new prescription since the old prescription is void (i.e., will be hard blocked). • Plan Sponsor pays the pharmacist an incentive for dispensing each preferred product. (The savings generated from dispensing preferred products will outweigh the incentive). • Express Scripts receives 35% of the first years savings as administrative fees for facilitating the conversion. Physician Preference with 3-tier Copay: This is a voluntary program that incorporates a three-tier copay structure into our Physician Preference program (see description above). A three-tier copay structure further encourages members to utilize generic and preferred products. For example, a member may pay a $5 copay for a generic product; a $10 copay for all brand -name products, except for non -preferred products; and a $25 copay for a brand -name product on the non -preferred product list. In addition to the benefits of our Physician Preference program, as described above, the three-tier copay structure adds the following benefits: • After member is notified of either an alternate generic or preferred product, the member determines which product is dispensed, based upon which copay he/she elects to pay. • Savings to plan sponsor is greater than Physician Preference, due to the added element of the member incentive to utilize generic and preferred products via the three-tier copay structure. • Plan Sponsor pays the pharmacist an incentive for dispensing each preferred product. (The savings generated from dispensing preferred products will outweigh the incentive). • Express Scripts receives 35% of the first years savings as administrative fees for facilitating the conversion. The member communication booklet, that will be provided to the City employees at no additional cost is found in Exhibit 2. Express ScriptsNalueRY will work with the City to customized additional pieces to include in the implementation packet. We will determine the cost of customized pieces, if applicable, during discussions with the City. 3. Is your organization willing to contribute an allowance to an outside vendor for communicating any program changes? If so, what is the maximum allowance available? Express ScriptsNalueRx will communicate all program changes to members through our Member Information Booklet. If additional communications are necessary, we will discuss the approach with the City. 4. Identify separately any start-up costs and how you proposed to recover them. Describe any other charges not included in proposed fees (e.g., toll -free lines, printing). Can they be amortized over several years of the contract? Be sure to address: Initial set-up charges No additional charge Development of communication materials No additional charge Participation at employee education meetings No additional charge Other charges (please specify) No additional charge Total first year start-up fees No additional charge 5. Please identify the individual responsible for the account in the event of claim disputes, service problems, etc. LeeAnn Dale, Director of Client Services at the Tempe, Arizona facility, is responsible for overseeing these team members and all individuals assigned to your account. 6. In the event the City desires employee meetings to present your proposed plan, are representatives from your company available to make presentations? If "yes", are there any additional costs associated with these services? The Account Manager responsible for the City will be available to conduct presentations at employee meetings detailing the prescription drug benefit implemented by the City. There is not additional cost for this. Express Scripts* Progressive Healthcare Management City of Fort Collins 7127198 109 5. Do you agree that if this proposal results in your company being awarded a contract and if, in the preparation of that contract, there are inconsistencies between what was proposed and accepted versus the contract language that has been generated and executed, that any controversy arising over such discrepancy will be resolved in favor of the language contained in the proposal or correspondence relating to your proposal? Express ScriptsNalueRx understands that sometimes during the preparation of the contract there are changes agreed to by the parties which may be inconsistent with the proposal and the correspondence relating to the proposal. It also is possible that issues addressed in the proposal are handled differently in the contract (whether deliberately or not). Accordingly, it is to the benefit of both parties that we recognize the contract as the controlling document for the services and obligations of the parties described therein. It is incumbent upon both parties to ensure that the contract negotiated and signed represents each of their desires and expectations. 6. Are there any outstanding legal actions pending against your organization? If so, please explain the nature and current status of the action(s). Express ScriptsNalueRx is, from time to time, party to legal or administrative proceedings arising in the ordinary course of its business. Any proceedings now pending are not, in Express ScriptsNalueRx ' opinion, material either individually or in the aggregate. Express ScriptsNalueRx has not been the target of any investigations, probes or formal inquiries by financial institutions, government agencies, or private organizations. 7. Please state the time line your company intends to follow to commence work as of January 1, 1999. Please refer to Exhibit S for a detailed timeline for a January 1, 1999 implementation of the City's prescription drug benefit. 8. What is your perspective on the health care industry in five years? What changes do you foresee? Express ScriptsNalue Rx believes that healthcare's reliance on pharmaceutical therapy will continue to grow. Through our own analysis, we estimate that annual drug costs will grow 10 to 15 percent. This was illustrated in Express Scripts/Value Express Scripts° Progressive Healthcare Management City of Fort Collins 7127198 110 Rx Drug Trends Report 1993-1996, released in June of 1997. The report analyzes pharmacy costs and shows the variety of factors that constitute pharmacy cost trends. By examining these factors, it is possible to devise better strategies to both contain the cost and improve the value of pharmaceuticals. The report stated that per -member per -year average wholesale drug ingredient costs rose by 35 percent from 1993 to 1996. One-third of the increase came from medications introduced after 1993. We remained committed in 1997 and today to finding new and better ways to help our clients manage these costs. We offered them powerful tools, such as ExpressPreferences', our drug therapy management program that reached a total of 4.7 million lives and ExpressTherapeuticss", our advanced clinical drug utilization review module, which was introduced late last year and now covers nearly 500,000 lives. Our clinical pharmacists continue to develop tailored programs to address the management needs of our clients. 11. If you have obtained national accreditation, please state through which agency and when it was obtained. IVTx, our home infusion therapy division owns and operates seven sites which are all accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). VExpress Scripts! Progressive Healthcare Management City of Fort Collins 727198 111 Exhibit `B' Year 2000 COMPLIANCE CERTIFICATION AND INDEMNITY Section 1. Contractor hereby certifies that all information resources or systems to be provided or used in connection with the performance of this Agreement are "Year 2000 Compliant", except as otherwise expressly described in Section 2, below. "Year 2000 Compliant" shall mean that information resources meet the following criteria: a. Data structures (e.g. databases, data files) provide 4-digit date century recognition. For example "1996" provides date century recognition; "96" does not. b. Stored data contains date century recognition, including (but not limited to) data stored in databases and hardware/device internal system dates. c. Calculations and programs logic accommodate both same century and multi - century formulas and date values. Calculations and logic include (but are not limited to) sort algorithms, calendar generation, event recognition, and all processing actions that use or produce date values. d. Interfaces (to and from other systems or organizations) prevent non -compliant dates and data from entering any state system. e. User Interfaces (i.e., screens, reports; etc.) accurately show 4 digit years. f. Year 2000 is correctly treated as a leap year within all calculation and calendar logic. Section 2. Contractor has identified the following information resources or systems that will be provided or used in connection with the performance or this Agreement that are not, or will not by December 1, 1998, be Year 2000 Compliant: Express Scripts! Progressive Healthcare Management City of Fort Collins 7127198 112 Section 3. a. Contractor hereby certifies that the instances of information resources or systems not Year 2000 Compliant identified in Section 2, above, will be Year 2000 Compliant no later than December 1, 1998, and that Contractor shall notify the City of the status of Year 2000 Compliance for such resources and systems upon the earlier of the date Year 2000 Compliance is achieved or on June 30, 1999. b. Contractor hereby certifies that the instance of information resources or systems identified in Section 2, above, as not Year 2000 Compliant, and for which Year 2000 Compliance is or will not be achieved by December 1, 1998, are not related to and do not impair the performance by Contractor of the terms of this Agreement, and do not produce new non -compliant information resources or systems. Section 4. Contractor agrees to notify the City immediately of any information resources or systems that are not Year 2000 Compliant upon encountering the same in connection with the performance of the Agreement, including without limitation any information resources or systems in use by Contractor in the performance of the Agreement or information resources or systems of the City regarding which Contractor obtains information in the course of its performance of the Agreement. Section 5. Contractor agrees to permit examination, by the City or agents thereof, of any and all information resources and systems in use in connection with this Agreement, and related Year 2000 Compliance implementation plans, in order to evaluate Year 2000 Compliance and potential implications of the same for the City and for performance of the Agreement. Section 6. The Contractor shall indemnify and hold harmless the City, and its officers, agents and employees, from and against all claims, damages, losses, and expenses, including attorneys fees, arising out of or resulting from the Contractor's failure to disclose instances of information resources of systems that are not Year 2000 Compliant, or failure to comply with the terms of this Exhibit C. Express ScriptsNalueRx will not include an indemnification or hold harmless provision in conncetion with Year 2000 compliance. By virtue of other provisions in the agreement relating to the processing of claims and dispensing of prescriptions, we have a contractual obligation to be able to perform those functions whether before or after January 1, 2000. We would agree to include language to the effect that we have a team committed to Year 2000 compliance planning and testing and that we have taken all reasonable steps towards Year 2000 compliance. Express ScriptsNalueRx will be Year 2000 compliant 1-1-99; the problem will be with clients who are unable to deliver or receive eligibility, billing and other data which will reflect a four digit year code. �A* express Scripts' VProgressive Healthcare Management City of Fort Collins 7127198 113 Express Scripts/ValueRx is the largest independent and one of the fastest growing Pharmacy Benefit Managers (PBMs) in the United States. A focused, tested, and proven competitor in managing the pharmacy benefit, Express Scripts was nationally recognized in the 1997 Pharmacy Benefit Management Institute (PBMI) Customer Satisfaction Survey. The PBMI is an independent organization - - it is not affiliated with any PBM, drug manufacturer, or any other benefit organization. Express Scripts received the highest average ranking overall for the second consecutive year of all vendors when comparing the average ranking for all functions. In addition, Express Scripts received the highest ranking relative to the competition in nine specific areas: zz> Lowest Cost of Drugs => Benefit Management Consulting Services =, Management Reports => Generic Substitution => Eligibility Data Management => Pharmacy Network and Quality Size =:> ID Card Production and Distribution => Concurrent DUR => Retrospective DUR This was the third year in a row Express Scripts received a top rating for the Lowest Cost of Drugs. Express Scripts also received the second -highest ranking for: Value for Administrative Cost, Plan Implementation, Member Services, Claims Processing, Disease Management, Formulary Management, Amount of Rebates, Promised Savings, and Promised Services. • Because Express Scripts/ValueRx is the largest PBM not owned by a pharmaceutical company, PBMs offering higher discounts often cannot compete with Express Scripts/ValueRx's ability to achieve the most cost- effective drug mix for its clients. Although PBMs can be compared on discounts, it is drug mix, not discounts, that most dramatically impacts your company's bottom line. Integrated Managed Care Solutions* (IMS) data ranks Express Scripts #1 among our major competitors in the therapeutic categories of calcium channel blockers, cholesterol reducers, H2 antagonists and anti -arthritics for each of the following cost savings factors: => Highest Generic Share => Highest Share of Lowest Cost Drug => Highest Share of Lowest Cost Brand name Drug => Lowest Average Prescription Cost * IMS data, October 1996 - March 1997 Savings can be further maximized with a formulary, or preferred product list. Cost containment strategies such as drug mix and formularies impact bottom line pharmacy benefit costs more dramatically than any discount program. Our expanded ExpressPreferencesm program combines Express Scripts/ValueRx formulary options into one convenient plan. Our Clinical staff and Pharmacy and Therapeutics Committee evaluate drugs, seeking both generic and therapeutic interchange opportunities to optimize quality and cost-effectiveness. 146 Express Scripts® W Progressive Healthcare Management City of Fort Collins 7127198 1 Express Scripts/ValueRx takes an active approach to ensure quality patient care and provide a plan design that allows maximum cost containment for both members and their employers. The following elements are included in the proposed pricing schedule: • Plan setup No additional charge • On-line eligibility management No additional charge • Standard drug utilization review No additional charge • Electronic claims adjudication No additional charge • Educational information/employee communications No additional charge • On-line eligibility transfer No additional charge • Standard ID card production, if required No additional charge • Mail service member information packets No additional charge • Shipping costs of material to the plan sponsor's location No additional charge • Paper Reporting Package No additional charge • Pharmacy reimbursements No additional charge • Network development upon request No additional charge • Software and training for access to our on-line system No additional charge • Customer service for members No additional charge • Pharmacy help desk No additional charge • Guaranteed contractual prescription pricing No additional charge • Consultative services from professional staff No additional charge • Prior Authorization* No additional charge Express ScriptsNalueRx provides prior authorization for the following seven (7) drugs at no additional charge: • Growth Hormone (Protropin, NuTropin, NuTropin AQ, Humatrope) • Octreotide (Sandostatin) • Alglucerase (Ceredase) • Erythropoetin (Epogen) • Filgrastim (Neupogen) • GM-CSF (Leukine) • Fertility Medications (Pergonal, Profasi) PERxSelect" Network (50,583 + pharmacies) Reimbursement shall be the lower of • Usual and Customary • Brand Drugs: Average Wholesale Price Less • Generic Drugs: Average Wholesale Price Less Dispensing Fee per Prescription Sales Tax Administrative Fee per Prescription 12% 12% or MAC* $2.25** as applicable in the state of purchase $0.60* * * Express ScriptsNalueRx' MAC is approximately 45 - 55 percent below Average Wholesale Price. **Express ScriptsNalueRx has applied $0.25 of the market share incentives (rebates) to reduce the dispensing fee to $2.25. If rebates are discontinued or materially changed by pharmaceutical manufacturers or if City of Fort 4. Express Scripts® V Progressive Healthcare Management City of Fort Collins 712 7/9 8 2 Collins elects to not enroll in the Expresspreferencesm program, the administrative fee (dispensing fee) reverts to $2.50. PERxCare` Network (41,000 + pharmacies) Reimbursement shall be the lower of • Usual and Customary • Brand Drugs: Average Wholesale Price Less 14% • Generic Drugs: Average Wholesale Price Less 14% or MAC* Dispensing Fee per Prescription $2.25** Sales Tax as applicable in the state of purchase Administrative Fee per Prescription $0.60** * Express ScriptsNalueRx' MAC is approximately 45 - 55 percent below Average Wholesale Price. **Express ScriptsNalueRx has applied $0.25 of the market share incentives (rebates) to reduce the dispensing fee to $2.25. If rebates are discontinued or materially changed by pharmaceutical manufacturers or if City of Fort Collins elects to not enroll in the ExpressPreferencesm program, the dispensing fee reverts to $2.50. Mail Service Pharmacy Reimbursement shall be the lower of • Brand Drugs: Average Wholesale Price Less 14% • Generic Drugs: Average Wholesale Price Less 48% Dispensing Fee per Prescription $1.75 Sales Tax as applicable in the state of purchase Administrative Fee per Prescription $0.00 **Express ScriptsNalueRx has applied $0.50 of the market share incentives (rebates) to reduce the dispensing fee to $1.75. If rebates are discontinued or materially changed by pharmaceutical manufacturers or if City of Fort Collins elects to not enroll in the ExpressPreferenceSM program, the dispensing fee reverts to $2.25. The quoted pricing structure is contingent upon the adoption of one of the ExpressPreferencesm programs City of Fort Collins acknowledges that drug manufacturers have the right to discontinue market share incentive fee programs at will, which would affect Express Scripts/ValueRx's ability to provide market share incentive fees to City of Fort Collins as quoted herein. In addition, prescriber dispensing patterns and state laws governing substitution of prescription drug products may also impact market share incentive fee amounts to City of Fort Collins. Finally, applicable laws may make market share incentive fees illegal, and in that event, Express ScriptsNalueRx will not be responsible for market share incentive fees, and therefore, any guaranteed amount will be void. A fee of $5.00 per prior authorization will apply for drugs, other than the seven (7) indicated above, for those drugs that require prior authorization. $1.50/claim for each member -submitted prescription claim received from members who elect not to use the network or the mail service options and for Medicaid Subrogation Claims. This fee includes adjudicating the claim using all of the on-line technology, preparing an Explanation of Benefits (EOB), cutting a reimbursement check if appropriate and mailing the EOB and check to the claimant's address or to the State. Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 3 • Express ScriptsNalueRx retains 20 percent of recoveries derived from on -site and written pharmacy audits as a fee for conducting the audits. • Fees for RxReports On -Line Reports (includes one standard hierarchy with master carrier/client level, sub carrier, group, and subgroup; and Enhanced Summarization with the full set of available reports): On-line Reporting $.03/script • Laminated and Plastic ID Cards Priced upon Request • Express Health LineSM Priced upon Request • Disease Management Program Priced upon Request • ExpressTherapeuticssm program Charges: 1 $.02* 2 $.04** 3 $.06** 4 $.08** 5 $.09** 6-8 $.10** Uw r,casc Inter w proposal ror an explanation of available modules. * If either the step therapy module or the therapy duration module is included, add $.01/Rx ** If either the step therapy module or the therapy duration module is included, add $.02/Rx Express ScriptsNalueRx and City of Fort Collins will agree upon those specific ExpressTherapeuticssm programs to be implemented. Where intervention fees apply and if a specific program is selected, Express Scripts/ValueRx will monitor the savings and guarantee savings at least equal to the incremental charges. ExpressPreferencesm program fees: * Physician Preference and Physician Preference with 3-tier Copay options: Plan Sponsor pays $.50 per prescription filled using a Preferred drug and Express Scripts/ValueRx retains 35 percent of savings generated (first year only) * Select 2 option: $3 administrative fee per non -preferred drug claim $1.00/address for mailing membership packets to homes. There is no charge for mailing these materials directly to the plan for distribution to members. $1.00/entry for manual eligibility. There is no charge for "clean" eligibility data transmitted electronically or via tape or diskette. Basis of ExpressPreferencesm Preferred Product Program ExpressPreferencesm reduces bottom line costs through proprietary programs offering clients a range of options to successfully increase utilization of preferred products through plan design and intervention strategies. This proactive strategy assists clients in controlling healthcare spending while addressing the trend toward more restrictive formularies. The foundation of the ExpressPreferencesm formulary program is: • Providing flexibility in formulary design • Meeting the cost savings and managed care objectives of every client • Proactively assisting our clients in controlling healthcare spending • Ensuring member safety and plan sponsor savings through the interchange of the following types of drugs: Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 4 Chemical equivalent drugs: those which contain identical active ingredients and are identical in strength or concentration, dosage form, route of administration and have comparable bioavailability; and/or Therapeutic equivalent drugs: those which are composed of different drug products, but are expected to have the same clinical results and safety profile ExpressPreferencesm Continuum The ExpressPreferencesm programs fit along the following continuum, offering our clients a full range of savings potential based upon how "managed" you desire the formulary program to be: Physician Preference with 3-tier Copay { oluntary Program W/ Physician 3- ier Cry Preference Voluntary Program Multiple Options to Meet Your Needs Full Preference Select GasedFormrlary Preference Restricted Formulary • Physician Preference is a voluntary program that proactively educates physicians and members about the opportunity to choose less -costly therapeutically and chemically equivalent drugs from the preferred product list. A three -tiered copay structure can be added to provide a financial incentive to the member. Select Preference is a restricted formulary program that provides coverage for products on a preferred list; the corresponding non -preferred products are not covered. This can be implemented on the initial prescription or on the first refill. • Full Preference is a closed formulary program that offers the highest potential plan savings, includes all generic products and approximately 500 preferred brand -name products. Prescriptions for preferred products are covered by the plan; non -preferred products are not covered by the plan. "InEWIRIBI [REV This price quotation is subject to an acceptable credit review, and Express Scripts/ValueRx reserves the right to amend the price quotation set forth herein if there is a material change in the number of persons included in the prescription drug program or any material change in the benefit plan from that originally presented to Express Scripts/ValueRx and upon which this price quotation is based. Quoted fees and services are valid for 180 days from the date of the proposal; such fees are thereafter guaranteed for the term of the written contract or as otherwise provided in the contract. Express Scripts® Progressive Healthcare Management Cifrj of Fort Collins 7/27/98 Preferred Product List The following list indicates, by therapy class, non -preferred products and the corresponding Express Scripts preferred product: Therapy Class— Allergy Non-Preierred Product— Nasacort Preferred Product(s)- Rhinocort Therapeutic Allergy Seldane Alle ra Therapeutic Allergy Vancenase Beconase Chemical Allergy Vancenase AO Beconase AQ Chemical Allergy Vanceril Beclovent Chemical Anti -Anginal Ismo Monoket Chemical Asthma Aerobid Azmacort Therapeutic Asthma Aerobid-M Azmacort Therapeutic Asthma Proventil Inhaler Albuterol Inhaler Chemical Asthma Slo-Bid Theo-Dur Therapeutic Asthma Ventolin Inhaler Albuteroi Inhaler Chemical Blood Modifier E o en Procrit Chemical Diabetes Diabeta Glvburide Chemical Diabetes Micronase GI buride Chemical Diabetes Novolin Insulin Humulin Insulin Chemical GI Pepcid Cimetidine Therapeutic GI Ta amet Cimetidine Chemical GI Zantac Cimetidine Therapeutic Glaucoma Timo tic Betimoi Therapeutic H ercholesterolemia Mevacor Lescoi / Pravachol uticH ercholesterolemia Pravachol 10m & 20m utic Hypercholesterolemia Zocor 20m Pravachol 40m utic Hypertension Norm a Trandate l Hypertension Prinivil Zestril Chemical Hypertension Prinzide Zestoretic Chemical Hvnertension Tenormin Atenolol Chemical Hypertension Vaseretic Lotensin HCT Therapeutic Hypertension Vasotec Lotensin / Mono rii Therapeutic Hypertension & Angina Procardia XL Norvasc Therapeutic Oral Contraceptive Demulen 1/35 Ortho-C clen Therapeutic Oral Contraceptive Genora Norethin Chemical Oral Contraceptive Levien Nordette Chemical Oral Contraceptive and Ortho Tri-Cyclen Therapeutic Osteoporosis Calcimar Miacalcin Chemical Prenatal Vitamin Matema Natalins Rx Therapeutic Prenatal Vitamin Zenate Natalins Rx Thera eutic Tri-Norinvi Ortho-Novum 7-7-7 Zocor 5mg & 1 Omg IlLescol 20mg & 40m Our ExpressPreferences' Full Preference (Closed formulary) program is based upon 282 Preferred Brand drugs and all generic drugs. Claims for these drugs will be adjudicated, while claims for all other non -preferred brand drugs will be rejected. The ExpressPreference'" Preferred Product list is subject to change on a periodic basis. Mery Name 711"7 7 No Text Performance penalties will apply only to periods commencing after execution of the definitive contract. Implementation action steps and key dates Standard Express ScriptsNalueRx guarantees program implementation substantially in accordance with a mutually agreed upon written schedule, subject to timely performance of client's scheduled obligations. The client must provide all necessary information at least 30 days before the implementation date. Program implementation includes: • Contract delivery • ID card production • Plan startup • Initial reporting • Initial billing Guarantee Express ScriptsNalueRx places 5 percent of the administrative fee at risk. System Downtime Standard Express ScriptsNalueRx guarantees 98 percent availability of the point -of -sale adjudication system, except for daily scheduled maintenance and telecommunications failure. This standard will be measured and reported quarterly. Guarantee Express ScriptsNalueRx places 5 percent of the administrative fee at risk if the stated standard is not met. 4*11 Express Scripts° Progressive Healthcare Management City of Fort Collins 1 Mail Service Guarantees Mail Service Prescription Accuracy Standard Whereas Express ScriptsNalueRx strives for 100 percent accuracy, Express ScriptsNalueRx guarantees 99.8 percent accuracy in dispensing the correct drug, at the correct strength and at the correct dosage, unless the error is a prescriber error. This standard will be measured quarterly. Guarantee Express ScriptsNalueRx places 5 percent of the administrative fee at risk, if performance is below the stated standard. Clauns Processing; Guaran • l l t I• � Standard Express ScriptsNalueRx guarantees 99 percent claim adjudication accuracy. This standard will be measured quarterly. Guarantee Express ScriptsNalueRx places 5 percent of the administrative fee at risk if the stated standard is not met. Terivis and Conditions Within 45 business days after the end of each calendar quarter, Express ScriptsNalueRx shall provide Sponsor with a report (a) assessing Express ScriptsNalueRx' performance under each performance guarantee, and (b) in the event Express ScriptsNalueRx did not meet a performance guarantee, calculating the applicable amount due to the Sponsor, along with a check for any amounts due to Sponsor for such quarter. In no event shall the sum of the payments to Sponsor as a result of Express ScriptsNalueRx failure to meet any performance guarantees in any quarter exceed 20 percent of the amount of Express ScriptsNalueRx' administrative fees payable by Sponsor to Express ScriptsNalueRx for such quarter. Express Scripts IV Progressive Healthcare Management City of Fort Collins 2 THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR (i) Covered Drugs dispensed by the Mail Service Pharmacy, less applicable Copayments and Deductibles; (ii) Covered Drugs dispensed to Members by Participating Pharmacies, and, if applicable, for Member Submitted Claims, less applicable Copayments and Deductibles; and (iii) for all other fees specified in Exhibit C of this Agreement. Sponsor agrees to pay ESI according to the method designated on Exhibit C. Sponsor shall be responsible for all costs of collection, and agrees to reimburse ESI for such costs and expenses, including reasonable attorneys' fees. Any amounts not paid by the due date thereof shall bear interest at the rate of 18% per annum (1.5% per month) or, if lower, the highest interest rate permitted by law. If Sponsor disputes any item on any invoice, Sponsor shall state the amount in dispute in writing within 30 days of the date of the invoice. No interest or late charges shall be imposed during any period on any amounts that Sponsor is disputing in good faith. SECTION V OWNERSHIP AND ACCESS TO RECORDS; CONFIDENTIALITY 5.1 Ownership and Use of Prescription Drug Records. (a) All records and other data provided to ESI by Sponsor, other than records that ESI is required to maintain by law (including, but not limited to, records required to be maintained by the Mail Service Pharmacy) shall remain the property of Sponsor, provided, that Sponsor irrevocably grants ESI permission to use both during and after the term of this Agreement and/or transfer to third parties the drug and related medical data collected by ESI or provided to ESI by Sponsor for research, cost analyses, cost comparison or other business purposes of ESI, all without charge to ESI. ESI shall retain full ownership rights over all compilations, analyses and reports prepared by ESI under this Agreement. In any case, ESI shall maintain Member confidentiality to the extent required by law, and shall not provide to any third party information identifiable as relating specifically to any Member without such Sponsor's consent. (b) Sponsor, at its own expense and upon not less than 10 business days' prior written notice, may inspect prescription drug claim data and billing records relating to Sponsor's Prescription Drug Program not more frequently than once each year. Such inspection shall be conducted at ESI's offices and shall be subject to such limitations to protect the confidentiality of Member information as ESI may reasonably determine. 5.2 ESI Proprietary Information. Sponsor agrees that all confidential and proprietary information of ESI, including, but not limited to, ESI's reporting packages, system formats and 0 THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR other system information, proprietary software and related user documentation, clinical and other manuals, prior authorization and prescription drug evaluation criteria, information and documents related to the Preferred Product List, drug pricing information, and Participating Pharmacy agreements (collectively, "ESI Proprietary Information"), are confidential and proprietary to ESI. Sponsor shall not use ESI Proprietary Information, or disclose it to any third party, at any time during or after termination of this Agreement, except as specifically contemplated by this Agreement or upon ESI's prior written consent. Upon termination of this Agreement, Sponsor shall cease using all ESI Proprietary Information, and all such information, along with any other ESI systems, manuals, procedures or equipment provided to Sponsor shall be returned to ESI immediately upon ESI's request. 5.3 Confidentiality Regarding Members. The parties shall maintain the confidentiality of any information relating to Members in accordance with any applicable laws and regulations. Sponsor shall insure that there is an adequate release from each Member permitting ESI to release information relating to the Member to Sponsor, or that release of information relating to Members is otherwise proper. All records, reports and other data provided by ESI to Sponsor under this Agreement are solely for Sponsor's use in managing its employee benefit plans, and ESI disclaims all liability arising out of Sponsor's use or dissemination of such records, reports or data. Sponsor shall indemnify, defend and hold EST harmless from any and all claims, penalties, liabilities, losses, damages, settlements or costs which may arise (i) from ESI's provision of Member information to Sponsor, or (ii) from Sponsor's use of Member information. 5.4 Trademarks. Each party acknowledges each other party's sole and exclusive ownership of its respective trade names, commercial symbols, trademarks and servicemarks, whether presently existing or later established (collectively "Marks"). No party shall use the other parry's Marks in advertising or promotional materials or otherwise without the owner's prior written consent; provided, however, that the parties may publicize the fact that ESI provides this Prescription Drug Program to Sponsor. SECTION VI LIABILITY INSURANCE; COMPLIANCE WITH LAW 6.1 Liability Insurance. ESI shall maintain such policies of general liability, professional liability and other insurance of the types and in amounts customarily carried by businesses such as ESL Copies of such policies shall be available to Sponsor upon request. ESI agrees, at its sole expense, to maintain during the term of this Agreement or any renewal hereof, comprehensive general liability insurance coverage in an amount of not less than $2,500,000 per occurrence, and in the aggregate, including pharmacist's professional liability protection from such claims for bodily injury as may arise from operation of the Mail Service Pharmacy under this Agreement. EST does not maintain liability insurance on behalf of any Participating Pharmacy, but does require in .. ,.. .,._,_ .. .. ,. . c>„ ,. , s .,. ,, �.'aiain .4o c�ct1n1 ,...,.,,. ,. , ,.. .... ... , '✓tiiY THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR such Pharmacies, to maintain adequate commercial insurance, when deemed acceptable by ESI, or to have in place a self-insurance program. 6.2 Compliance with Law: Change in Law. Each party shall be responsible for ensuring its compliance with any laws and regulations applicable to its business, including maintaining any necessary licenses and permits. Sponsor shall ensure that its activities in regard to the Prescription Drug Program are in compliance with the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq. C ERISA'), and ESI shall. not be deemed to be a fiduciary of the Prescription Drug Program under ERISA. Sponsor shall be responsible for any governmental or regulatory charges imposed upon this Prescription Drug Program, other than taxes based on the net income of ESI. If ESI's performance of its duties under this Agreement is made materially more burdensome or expensive due to a change in federal, state or local laws or regulations or the interpretation thereof, the parties shall negotiate an appropriate adjustment to the fees paid to ESI. If the parties cannot agree on an adjusted fee, then ESI may terminate the Prescription Drug Program on 30 days' prior written notice to Sponsor. 6.3 Disclosure of Certain Financial Matters. From time to time ESI may receive market share incentive payments and other fees from pharmaceutical manufacturers with respect to certain Covered Drugs dispensed to Members by Participating Pharmacies and by ESI's Mail Service Pharmacy. In addition, ESI contracts with Participating Pharmacies at various rates that are renegotiated from time to time, and charges Sponsor at a uniform rate that may be greater or less than the average rate paid to Participating Pharmacies. Except as may be expressly provided otherwise in this Agreement, Sponsor acknowledges and agrees that ESI will retain all such payments from pharmaceutical manufacturers and all such provider discounts, if any, in addition to any administrative and other fees paid by Sponsor, as ESI's compensation for administering the Prescription Drug Program described herein. Sponsor acknowledges that, except as may be expressly provided herein, it has no right to receive, nor possesses any beneficial interest in, any such discounts or payments. SECTION VII TERM AND TERMINATION; DEFAULT AND REMEDIES 7.1 Term. The initial term of this Agreement shall begin on DATE. and end on DATE. and may be terminated earlier or extended in accordance with the terms hereof. Not less than 90 days prior to the end of the initial or any renewal term of this Agreement either party may notify the other party that it wishes to terminate this Agreement. If no such notification is given this Agreement shall continue with the same terms and conditions as set forth herein for additional one-year terms, subject to the right of termination as otherwise provided herein. 7.2 Termination for Breach or Default. If either party is in default under any provision of this Agreement, the other party may give written notice of such default. If the defaulting party has not THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR used good faith efforts to cure such breach or default within 30 days after it receives such notice, or if good faith efforts to cure have begun within 30 days but such cure is not completed within 60 days after receipt of the notice, the other party shall have the right by further written notice (the "Termination Notice") to terminate this Agreement as of any future designated date which is at least 60 days after the Termination Notice was sent. In addition, (i) ESI may terminate or suspend its performance hereunder immediately and cease providing or authorizing provision of Covered Drugs to Members without any written notice if Sponsor fails to pay ESI in accordance with the terms of this Agreement; (ii) if ESI has reasonable grounds for insecurity as to the ability of Sponsor to meet its financial commitments hereunder, ESI may require adequate assurance of Sponsor's performance, which may include the requirement that Sponsor provide security to ESI; and (iii) ESI may suspend service to a Member who is in default of payment of any Copayments or Deductibles. 7.3 Termination for Insolvency. To the extent permitted by applicable law, ESI may terminate this Agreement, or suspend performance hereunder, upon the insolvency of Sponsor, and Sponsor may terminate this Agreement upon the insolvency of ESI. The "insolvency" of a party shall mean the filing of a petition commencing a voluntary case against such party under the United States Bankruptcy Code; a general assignment by such party for the benefit of creditors; the inability of such party to pay its debts as they become due; such parry's seeking or consenting to, or acquiescence in, the appointment of any trustee, receiver or liquidation of it, or any material part of its property; or the commencement against such party of an involuntary case under the United States Bankruptcy Code; or a proceeding under any receivership, composition, readjustment, liquidation, insolvency, dissolution, or like law or statute, which case or proceeding is not dismissed or vacated within 60 days. 7.4 Remedies. (a) A party's right to terminate this Agreement under this Section VII shall not be exclusive of any other remedies available to the terminating party under this Agreement or otherwise, at law or in equity. (b) ESI shall not be liable in any manner for any delay or failure to perform its obligations hereunder which are beyond ESI's reasonable control, including, without limitation, any delay or failure due to strikes, labor disputes, riots, earthquakes, storms, floods or other extreme weather conditions, fires, explosions, acts of God, embargoes, war or other outbreak of hostilities, government acts or regulations, or the failure or inability of carriers, suppliers, delivery services, or telecommunications providers to provide services necessary to enable ESL to perform its obligations hereunder. (c) ESI's liability to Sponsor hereunder shall in no event exceed the actual proximate losses or damages to Sponsor caused by ESI's breach of this Agreement, up to the amount of administrative fees paid to ESI by Sponsor hereunder for the one-year period preceding the date on 12 .. � .� ...� ..w C4 4 ...� � ♦� ..: �Q� .:uY41.1�"veil%.ail'�i�YlA�ii:�.�a:iw"".n.1..Si'�yA�^."�i . �-..�-,. . ,. ...i.p1,-cZ.'.: THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR which the claim arose. In no event shall ESI or any of its affiliates, directors, employees or agents, be liable for any indirect, special, incidental, consequential, exemplary or punitive damages, or any damages for lost profits, however caused or arising, whether or not ESI has been informed of the possibility of their occurrence. 7.5 Survival. The parties' rights and obligations under Sections 3.2(d) (last sentence), 3.3 (last sentence), 3.7 (last sentence), IV, V, 6.2 and 7.4(c) shall survive the termination of this Agreement for any reason. SECTION VIII MISCELLANEOUS 8.1 Notice. Any notice or document required or permitted to be delivered pursuant to this Agreement must be in writing and shall be deemed to be effective upon receipt and must be either (i) deposited in the United States Mail, postage prepaid, certified or registered mail, return receipt requested, or (ii) sent by recognized overnight delivery service, in either case properly addressed to the other party at the address set forth below, or at such other address as such party shall specify from time to time by written notice delivered in accordance herewith: Express Scripts, Inc. Attn: President 14000 Riverport Drive Maryland Heights, Missouri 63043 NAME AND ADDRESS OF SPONSOR Attn: 8.2 Independent Parties. No provision of this Agreement is intended to create or shall be construed to create any relationship between ESI and Sponsor, other than that of independent entities contracting with each other solely for the purpose of effecting the provisions of this Agreement. Neither party, nor any of their respective representatives, shall be construed to be the partner, agent, employee, or representative of the other and neither party shall have the right to make any representations concerning the duties, obligations or services of the other except as consistent with the express terms of this Agreement or as otherwise authorized in writing by the party about which such representation is asserted. 8.3 Successors and Assigns. This Agreement will be binding upon, and inure to the benefit of and be enforceable by, the respective successors and permitted assigns of the parties hereto, 13 THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR provided that this Agreement may not be assigned by Sponsor without the prior written consent of ESL 8.4. Integration: Amendments. This Agreement constitutes the entire understanding of the parties hereto and supersedes any prior oral or written communication between the parties with respect to the subject matter hereof. No modification, alteration, or waiver of any term, covenant, or condition of this Agreement shall be valid unless in writing, signed by both parties or the agents of the parties who are authorized in writing. 8.5. Choice of Law. This Agreement shall be construed and governed in all respects according to the laws in the State of Missouri, without regard to the rules of conflict of laws thereof. 8.6 Waiver. No waiver of a breach of any covenant or condition shall be construed to be a waiver of any subsequent breach. No act, delay or omission done, suffered, or permitted by the parties shall be deemed to exhaust or impair any right, remedy or power of the parties hereunder. 8.7 Severability. If any clause or provision of this Agreement (other than Section IV) shall be held to be unenforceable or ineffective, the validity or enforceability of any other clause or provision contained herein shall not be affected. 8.8 Third Party Beneficiary Exclusion. This Agreement is not a third party beneficiary contract, nor shall this Agreement create any rights on behalf of Members as against ESI. Sponsor and ESI reserve the right to amend, cancel or terminate this Agreement without notice to, or consent of, any Member. IN WITNESS WHEREOF, the undersigned have executed this Managed Prescription Drug Program Agreement as of the day and year first above written. EXPRESS SCRIPTS, INC. By: Printed Name: Title: f.M 1�7sN��i� By: Printed Name: Title: Phone: Fax: 14 EXHIBIT A SAMPLE FORM OF INCLUDWEXCLUDE DRUG COVERAGE INFORMATION Include/Exclude Drug Coverage Plan Number. Place an "I" on those items that are included, an "E" on those items that are excluded, and a "P" on those items that require a prior authorization. Include any plan limitation that may apply to the drug coverage. All legend drugs are included except those listed as excluded below. All over-the-counter drugs are excluded except those listed as included below. Formulary Open ❑ Closed' ❑ File #: ' Closed Formulary Basis ESI Generic Base ❑ ESI Closed ❑ Client Closed ❑ Note - Please complete only the sections below for any exceptions to the closed formulary. YES ❑ NO ❑ If NO, please indicate the dispensing limits for each benefit in the limitations section IF THE PLAN EXCLUDES INJECTABLES THEN ALL INJECTABLES WILL BE EXCLUDED UNLESS THEY ARE SPECIFICALLYINCLUDED FOR THOSE CATEGORIES THAT NAVE BOTH ORAL & INJECTABLE DOSAGE FORM. i nnual prescription drug sur- vey results are starting to sound reassuringly familiar. For more years than many of today's pharmacists have been on the job, total Rx volume has been up. And it's up again. Total Rx expenditures are ,:;). Again. Average Rx value is up. Again. Even the Food & Drug Administra- tion, a favorite whipping boy for taking an average of 30 months to approve every new drug in the 1980s, is on the move. Approvals of new molecular enti- ties (NMEs) are up in the'90s versus the '80s. New drug approval times are down, and there are no signs that the bloom is off the boom in either the gov- ernment or the commercial camps. By almost any measure, 1997 was a banner year for the Rx drug industry. The good news began in Washington, D.C., where the FDA nnr___a, ' nv_ a�ri 39 new drugs and 10 biological agents. The 1997 numbers were second only -to 1 "6, when t e agency roe regu story og- jam liytteari recor 3 NMEs.... The average approval time fell to 17 I`umths in 1997, down from the 1996 record of 20.5 months. The fastest ap- proval for the year was for a new pro- tease inhibitor, Viracept (nelfinavir mesy- late, Agouron Pharmaceuticals), cleared in just 2.6 months. Retail results were even more posi- tive. The total number of Rxs dispensed at the retail level hit a record 2.4 billion, up 4.1 % over 1996. Total Rx retail sales for the year (at drugstore acquisition cost) were $77.5 billion, a 15.7% in- crease over the prior year's total. The average Rx value was $32.87, an 11.1 % jump over 1996. .. 5, a1c Nnceu mgner, ex- plained James Charnetski, executive director for audit services at Scott -Levin Associates, Newtown, Pa. "The FDA ap- proval cycle is at an all-time high. Brand - name companies have the luxury of pric- ing their new products at a premium." Sales figures and almost all of the other data in this article were supplied by Scott -Levin, a division of PMSI Scott - Levin Inc. Data are based on Rxs dis- pensed from 36,000 retail outlets, strati- fied across 1,300 regions and projected to the nation's 56,000 retail pharmacy outlets. For data -collection purposes, retail pharmacies include chain stores, independents, grocery stores. macs -mar_ chandisers, and deep -discounters. Not included in the survey are mail-order Pharmacies, nursing home pharmacies, and hospital inpatient pharmacies. Charnetski expects the current Rx boom to follow the same broad outlines seen today over the next several years. Annual Rx volume should continue to grow in the 4%-6% range, as Rx dollar volume increases in double digits well into the next decade. One reason is a (MCOs) repeatedly trimmed their Rxs, going from 90 days to 60, then 30, and, in some cases, down to 21 days per fill, in an effort to reduce drug utilization and costs. Chametski noted that refills on chronic meds are creeping back to 30 days and beyond. MCOs are again recognizing the long -tern cost savings inherent in fewer, but larger, refills for patients who are like- ly to be on the same dose of the same chronic medication for years at a time. There are several less obvious changes at work in the industry as well. Not only is the FDA streamlining its approval Process, but drugmakers are finally start- ing to reap the benefits of having primed No Text No Text These are the exceptions that will be used for the baseldefault benefit that will apply at group level. Any other exceptions which should be used in certain conditions only, must be outlined in the Alternate Benefit Section of the ASF. ments This is a sample form only. An original will need to be requested via your Account Manager. THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR other system information, proprietary software and related user documentation, clinical and other manuals, prior authorization and prescription drug evaluation criteria, information and documents related to the Preferred Product List, drug pricing information, and Participating Pharmacy agreements (collectively, "ESI Proprietary Information"), are confidential and proprietary to ESI. Sponsor shall not use ESI Proprietary Information, or disclose it to any third party, at any time during or after termination of this Agreement, except as specifically contemplated by this Agreement or upon ESI's prior written consent. Upon termination of this Agreement, Sponsor shall cease using all ESI Proprietary Information, and all such information, along with any other ESI systems, manuals, procedures or equipment provided to Sponsor shall be returned to ESI immediately upon ESI's request. 5.3 Confidentiality Regarding Members. The parties shall maintain the confidentiality of any information relating to Members in accordance with any applicable laws and regulations. Sponsor shall insure that there is an adequate release from each Member permitting ESI to release information relating to the Member to Sponsor, or that release of information relating to Members is otherwise proper. All records, reports and other data provided by ESI to Sponsor under this Agreement are solely for Sponsor's use in managing its employee benefit plans, and ESI disclaims all liability arising out of Sponsor's use or dissemination of such records, reports or data. Sponsor shall indemnify, defend and hold ESI harmless from any and all claims, penalties, liabilities, losses, damages, settlements or costs which may arise (i) from ESI's provision of Member information to Sponsor, or (ii) from Sponsor's use of Member information. 5.4 Trademarks. Each party acknowledges each other party's sole and exclusive ownership of its respective trade names, commercial symbols, trademarks and servicemarks, whether presently existing or later established (collectively "Marks"). No party shall use the other parry's Marks in advertising or promotional materials or otherwise without the owner's prior written consent; provided, however, that the parties may publicize the fact that ESI provides this Prescription Drug Program to Sponsor. SECTION VI LIABILITY INSURANCE; COMPLIANCE WITH LAW 6.1 Liability Insurance. ESI shall maintain such policies of general liability, professional liability and other insurance of the types and in amounts customarily carried by businesses such as ESI. Copies of such policies shall be available to Sponsor upon request. ESI agrees, at its sole expense, to maintain during the term of this Agreement or any renewal hereof, comprehensive general liability insurance coverage in an amount of not less than $2,500,000 per occurrence, and in the aggregate, including pharmacist's professional liability protection from such claims for bodily injury as may arise from operation of the Mail Service Pharmacy under this Agreement. ESI does not maintain liability insurance on behalf of any Participating Pharmacy, but does require in THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR such Pharmacies, to maintain adequate commercial insurance, when deemed acceptable by ESI, or to have in place a self-insurance program. 6.2 ComRliance with Law: Change in Law. Each party shall be responsible for ensuring its compliance with any laws and regulations applicable to its business, including maintaining any necessary licenses and permits. Sponsor shall ensure that its activities in regard to the Prescription Drug Program are in compliance with the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq. ("ERISA'), and ESI shalt. not be deemed to be a fiduciary of the Prescription Drug Program under ERISA. Sponsor shall be responsible for any governmental or regulatory charges imposed upon this Prescription Drug Program, other than taxes based on the net income of ESI. If ESI's performance of its duties under this Agreement is made materially more burdensome or expensive due to a change in federal, state or local laws or regulations or the interpretation thereof, the parties shall negotiate an appropriate adjustment to the fees paid to ESI. If the parties cannot agree on an adjusted fee, then ESI may terminate the Prescription Drug Program on 30 days' prior written notice to Sponsor. 6.3 Disclosure of Certain Financial Matters. From time to time ESI may receive market share incentive payments and other fees from pharmaceutical manufacturers with respect to certain Covered Drugs dispensed to Members by Participating Pharmacies and by ESI's Mail Service Pharmacy. In addition, ESI contracts with Participating Pharmacies at various rates that are renegotiated from time to time, and charges Sponsor at a uniform rate that may be greater or less than the average rate paid to Participating Pharmacies. Except as may be expressly provided otherwise in this Agreement, Sponsor acknowledges and agrees that ESI will retain all such payments from pharmaceutical manufacturers and all such provider discounts, if any, in addition to any administrative and other fees paid by Sponsor, as ESI's compensation for administering the Prescription Drug Program described herein. Sponsor acknowledges that, except as may be expressly provided herein, it has no right to receive, nor possesses any beneficial interest in, any such discounts or payments. SECTION VII TERM AND TERMINATION; DEFAULT AND REMEDIES 7.1 Term. The initial term of this Agreement shall begin on DATE. and end on DATE, and may be terminated earlier or extended in accordance with the terms hereof. Not less than 90 days prior to the end of the initial or any renewal term of this Agreement either party may notify the other party that it wishes to terminate this Agreement. If no such notification is given this Agreement shall continue with the same terms and conditions as set forth herein for additional one-year terms, subject to the right of termination as otherwise provided herein. 7.2 Termination for Breach or Default. If either party is in default under any provision of this Agreement, the other party may give written notice of such default. If the defaulting party has not THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR used good faith efforts to cure such breach or default within 30 days after it receives such notice, or if good faith efforts to cure have begun within 30 days but such cure is not completed within 60 days after receipt of the notice, the other party shall have the right by further written notice (the "Termination Notie) to terminate this Agreement as of any future designated date which is at least 60 days after the Termination Notice was sent. In addition, (i) ESI may terminate or suspend its performance hereunder immediately and cease providing or authorizing provision of Covered Drugs to Members without any written notice if Sponsor fails to pay ESI in accordance with the terms of this Agreement; (ii) if ESI has reasonable grounds for insecurity as to the ability of Sponsor to meet its financial commitments hereunder, ESI may require adequate assurance of Sponsor's performance, which may include the requirement that Sponsor provide security to ESI; and (iii) ESI may suspend service to a Member who is in default of payment of any Copayments or Deductibles. 7.3 Termination for Insolvency. To the extent permitted by applicable law, ESI may terminate this Agreement, or suspend performance hereunder, upon the insolvency of Sponsor, and Sponsor may terminate this Agreement upon the insolvency of ESI. The "insolvency" of a party shall mean the filing of a petition commencing a voluntary case against such party under the United States Bankruptcy Code; a general assignment by such party for the benefit of creditors; the inability of such party to pay its debts as they become due; such party's seeking or consenting to, or acquiescence in, the appointment of any trustee, receiver or liquidation of it, or any material part of its property; or the commencement against such party of an involuntary case under the United States Bankruptcy Code; or a proceeding under any receivership, composition, readjustment, liquidation, insolvency, dissolution, or like law or statute, which case or proceeding is not dismissed or vacated within 60 days. 7.4 Remedies. (a) A party's right to terminate this Agreement under this Section VII shall not be exclusive of any other remedies available to the terminating party under this Agreement or otherwise, at law or in equity. (b) ESI shall not be liable in any manner for any delay or failure to perform its obligations hereunder which are beyond ESI's reasonable control, including, without limitation, any delay or failure due to strikes, labor disputes, riots, earthquakes, storms, floods or other extreme weather conditions, fires, explosions, acts of God, embargoes, war or other outbreak of hostilities, government acts or regulations, or the failure or inability of carriers, suppliers, delivery services, or telecommunications providers to provide services necessary to enable ESL to perform its obligations hereunder. (c) ESI's liability to Sponsor hereunder shall in no event exceed the actual proximate losses or damages to Sponsor caused by ESI's breach of this Agreement, up to the amount of administrative fees paid to ESI by Sponsor hereunder for the one-year period preceding the date on 12 THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR which the claim arose. In no event shall ESI or any of its affiliates, directors, employees or agents, be liable for any indirect, special, incidental, consequential, exemplary or punitive damages, or any damages for lost profits, however caused or arising, whether or not FSI has been informed of the possibility of their occurrence. 7.5 Survival. The parties' rights and obligations under Sections 3.2(d) (last sentence), 3.3 (last sentence), 3.7 (last sentence), IV, V, 6.2 and 7.4(c) shall survive the termination of this Agreement for any reason. SECTION VIII MISCELLANEOUS 8.1 Notice. Any notice or document required or permitted to be delivered pursuant to this Agreement must be in writing and shall be deemed to be effective upon receipt and must be either (i) deposited in the United States Mail, postage prepaid, certified or registered mail, return receipt requested, or (ii) sent by recognized overnight delivery service, in either case properly addressed to the other party at the address set forth below, or at such other address as such party shall specify from time to time by written notice delivered in accordance herewith: Express Scripts, Inc. Attn: President 14000 Riverport Drive Maryland Heights, Missouri 63043 NAME AND ADDRESS OF SPONSOR Attn: 8.2 Independent Parties. No provision of this Agreement is intended to create or shall be construed to create any relationship between ESI and Sponsor, other than that of independent entities contracting with each other solely for the purpose of effecting the provisions of this Agreement Neither party, nor any of their respective representatives, shall be construed to be the partner, agent, employee, or representative of the other and neither party shall have the right to make any representations concerning the duties, obligations or services of the other except as consistent with the express terms of this Agreement or as otherwise authorized in writing by the party about which such representation is asserted. 8.3 Successors and Assigns. This Agreement will be binding upon, and inure to the benefit of and be enforceable by, the respective successors and permitted assigns of the parties hereto, 13 THIS SAMPLE FORM OF PBM AGREEMENT IS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT REPRESENT THE FINAL TERMS AND CONDITIONS AGREED TO BY ESI AND PROPOSED SPONSOR provided that this Agreement may not be assigned by Sponsor without the prior written consent of ESI. 8.4. Integration: Amendments. This Agreement constitutes the entire understanding of the parties hereto and supersedes any prior oral or written communication between the parties with respect to the subject matter hereof. No modification, alteration, or waiver of any term, covenant, or condition of this Agreement shall be valid unless in writing, signed by both parties or the agents of the parties who are authorized in writing. 8.5. Choice of Law. This Agreement shall be construed and governed in all respects according to the laws in the State of Missouri, without regard to the rules of conflict of laws thereof. 8.6 Waiver. No waiver of a breach of any covenant or condition shall be construed to be a waiver of any subsequent breach. No act, delay or omission done, suffered, or permitted by the parties shall be deemed to exhaust or impair any right, remedy or power of the parties hereunder. 8.7 Severability. If any clause or provision of this Agreement (other than Section M shall be held to be unenforceable or ineffective, the validity or enforceability of any other clause or provision contained herein shall not be affected. 8.8 Third Party Beneficiary Exclusion. This Agreement is not a third party beneficiary contract, nor shall this Agreement create any rights on behalf of Members as against ESI. Sponsor and ESI reserve the right to amend, cancel or terminate this Agreement without notice to, or consent of, any Member. IN WITNESS WHEREOF, the undersigned have executed this Managed Prescription Drug Program Agreement as of the day and year first above written. EXPRESS SCRIPTS, INC. By: Printed Name: Title: NAME OF SPONSOR By: Printed Name: Title: Phone: - Fax: 14 EXHIBIT A SAMPLE FORM OF INCLUDE/EXCLUDE DRUG COVERAGE INFORMATION Include/Exclude Drug Coverage Plan Number. Place an "I" on those items that are included, an "E" on those items that are excluded, and a "P" on those items that require a prior authorization. Include any plan limitation that may apply to the drug coverage. All legend drugs are included except those listed as excluded below. All over-the-counter drugs are excluded except those listed as included below. Formulary Open O Closed' ❑ File #: " Closed Formulary Basis ESl Generic Base ❑ ESI Closed ❑ Client Closed ❑ Note - Please complete only the sections below for any exceptions to the closed formulary. Should all dispensing limits be tripled for the mail order benefit? YES ❑ NO ❑ If NO, please indicate the dispensing limits for each benefit in the limitations section IF THE PLAN EXCLUDES INJECTABLES THEN ALL INJECTABLES WILL BE EXCLUDED UNLESS THE Y A RE SPECIFICALL Y INCL UDED FOR THOSE CATEGORIES THAT HAVEB0THORAL & INJECTABLE DOSAGE FORM. No Text Cover Story the new product pipeline for the better part of a decade. The industry's research Table 1 and development budget has triple Rx marbret over t ars, according t—odw Phannaceutica esearch & Manufacturoverview, 1997 - ers of America. Pharmaceutical R&D Total retail market expenditures should top $20 billion this in dollar: --drugstore year, an 11% increase over records set acquisition cost. in 1997, PhRMA reported in its annual $77,554,056,000 +15.7% member survey. Average value per Rx— Better still, much of that R&D effort is drugstore acquisition going into new technology that merges cost $32.87 +,11.1 gene moping, genetic engineering, and Total Rxs dispensed at computer-contro Jed chemistry to prow retail: 2.359,614 +4.1 duce .more potential therapeutics than Refill Rxs dispensed: ever before, and gets more promising 1,023,488,000 +5.7 compounds into clinical trials faster than New Rxs dispensed: ever before. In a 1997 interview, Smith- 1,336,126,000 +2.9 Kline Beecham CEO Jan Leschly likened source: scon-ieidn's source Prescrrpdon today's pharmaceutical researchers to Aaudtt kids in a candy shop. He pointed out that technology is presenting companies just entering what Christina Heuer, drug with more choices, more potential drugs analyst for Smith Ban-ey, called the years and drug targets, than they ever had be- of peak drug consumption for chronic fore. The result is an unprecedented heart disease, arthritis, ulcers, cancer, . Flood of new products in besting and in depression, and other conditions. clinical trials, with no sign of a slow- Fears that MCOs would cut back on down. drug expenditures and utilization seem PhRMA president Alan Holmer said to be unfounded. Onl about one thi the product pipeline is bursting. Sidney of MCOs have close ormu apes in Taurel, PhRMA chairman and president rc pnce o individual drug prod - of Eli Lilly & Co., told a press confer- ucts becomes a significant issue, Char- ence, "We are at the dawn of a golden netski said. While the move toward age for pharmaceuticals, helped by new closed formularies is on an upward research tools such as genomics. We are rend, he added, managed care has be - opening up the opportunity to revolu- un to pay more attention to the global tionize health care and raise expects- cost of managing specific disease states Lions of patients throughout the world." than to drug pricing as a distinct bud - The pharmaceutical industry can raise getary item. its expectations a notch or two as well. Since even the most expensive phar- Innovator products have almost always macceuti Is area most d wache6Lxr entered the market at a hefty premium to n alternative theraPiZ. expel ay's existing drugs, and the current crop is no a ors or dri3l�sease state manaEemen—t to Auld exception, pushing 1997 earnings to to increased dnugittili5ntion, Some ana- near-record levels. The utilization side of Tysts are even predicting -that drug ex - the equation is just as rosy. penditures could rise from the current The population continues to age in the 7% of total health-care costs to nearly United States, Europe, Japan, and almost 109/6 over the next few years. every other major pharmaceutical mar- ket around the world. Thirteen percent of New ways to market Americans are already age 65 or older. A "It's a party in the pharmaceutical fifth of the country is between 45 and 64, industry these days," said J. P. Morgan typically the years when. accumulated drug analyst Carl Seiden. "Managed wear and tear begins to surface as in- care can't control anything, and there is creased morbidity and increased con- no evidence of its getting its act togeth- sumption of healthcare services, includ- er. Drug companies are finding totally ing Rx drugs. And it gets better. The bulk new ways of marketing." of the post -World War 11 baby boom is One of the most effective new mar- 72 DRUG TOPICS MARCH 16 1998 keting techniques is direct -to -consumer advertising, or DTC. Pharmacists and physicians may cringe when patients walk in demanding specific brand -name Rx products, but manufacturers are cashing in. Chametski said DTC adver- tising expenditures have been rowan v 5 o a year tor the past four vears. Consumer ad budgets show no signs of slowing. Seven of the top 10 disease states saw si nificant DIC spending i 1997. he added. The industry spent a record $596 million on DTC in 1997 and is expected to spend in the neighborhood of $950 million this year. "Mere is a direct corre- lation between DTC atta�paaduct sales," Cha e- s`aid: "Those products that are heavily advertised directly to consumers are the ones most often requested by patients." And, he could have added, the ones most often prescribed. In the antihistamine category, Clar- itin-D (loratadine/psuedoephedrine, Schering), Zyrtec (cetirizine HCI, Pfizer), and Allegra (fexofenadine HCI, Hoechst Marion Roussel) were the one -two -three top -sellers for 1997, with Claritin-D the market leader by a wide margin. It's no surprise that Claritin-D is also one of the most heavily promoted Rx products in the U.S. consumer market. "Schering is looking at Claritin beyond its brand life cycle to when it goes off patent," Char- netski said. "It's not sedating, which gives it a strong advantage." Heavy advertising and manufacturer commitment to the brand aren't neces- sarily bad things, at least in terns of con- tinuing sales volume. Consumer ads s. It's also gooa for pnysrcrans, because every new script requires yet another physician visit "While most physicians are nega- explained, "some see more patients coming into the office as a result of rnr, sumer advertisi." A decade ago, he added, physicians almost never wrote scripts for drugs requested by patients because most pa- tients didn't know enough to demand drugs by name or therapeutic class. Drug companies were forbidden to advertise to consumers, which meant that patients knew little or nothing about Rx products. As more medical infonma- No Text .IICJC are me exceptions that will be used for the baWdefault benefit that will apply at group level. Any other exceptions which should be used in certain conditions only, must be outlined in the Alternate Benefit Section of the ASR This is a sample form only. An original will need to be requested via your Account Manager. EXHIBIT B COPAYMENTS AND DEDUCTIBLES EXHIBIT C EXPRESS SCRIPTS PRESCRIPTION DRUG PROGRAM FEES phamxacy%oms\ fpc np.frm ABC GROUP Insert Logo (If Available) Important Benefit Update: Attention Member: This is your new Prescription Identification Card! It is important when filling prescriptions that you present your new card beginning 1/1/98 to your pharmacist before obtaining your prescription. If you have any questions about your new prescription benefit program, please contact Express Scripts' customer service, (800) 123-4567. IMPORTANT: Your new card MUST BE PRESENTED to your pharmacist every time you fill a prescription after 1/l/98. Please present this notice to your pharmacist. When calling in a refill for a prescription, please give the pharmacist the below information contained in the table for on-line claims processing. ------------------------------------------------------------------------ �Express Scripts PER Propreaalve H"rthcam Management Attention Pharmacist: As of 1/1/98, ABC Group prescription benefit program is being administered by Express Scripts. To simplify your prescription processing, please link the cardholder and all members of their family to Express Scripts. �� .. ..: v:^Y $k:�:,M}.. :. i, � ..��I�(•� .,'{F.:.:.: ..�p�aya j(�]\:: .}.}�++maayy�.. .. :i,J...4np :i Y-Y,.:::n'ii.`•�(%:Y.v ••t: �: e::yyni':::...........:i::i:`::::Y.} SS:}..::i . �:; ::SYi a� �Q 1■/:Cii::{}:'{.:�4.i`;.. r��.. n�'f.�tl �i::h�:.�:�.�::4Y}:ni:{:J'ii�:::�:}:}'i.�::�: ?:•:::::J:Y:�� '�� ':��)p� ::'F.inii::>..:}:ii ...�n. nY.:.n.. n{n.... m.W.... ......e�e�.��......y. ...9jii.. Step 1 Enter Bin # 003858 Step 2 Enter Processor Control XX Step 3 Enter Group #: XXX Step 4 Enter first 9 digits of the member's ID # Step 5 Enter person code 00 Step 6 Enter the member's date of birth NEED Pharmacist, if you have any questions while processing the ASSISTANCE? claim, please call the Express Scripts' Pharmacy Help Desk (800) 987-6543. PER HERE ARE YOURT The attached cards identify you as Dear Member: Welcome to the Express Scripts Pharmacy Program. It is importardW you to ret your Prescription Drug Plan. Enclosed you will find everything you need to begin Be sure to show your I.D. card to your participating pharmacist when you need a participating pharmacies or call the 800 number on your card for additional pharr Express Scripts is committed to doing our best to ensure your prescription drug plan is an Express Scripts° VProgressive Healthcare Management RUG I.D. CARDS fee Prescription Plan-PERx take full advantage of enclosed list of of your total health care. EPSMKMC001 W97 �� Express Scripts Progressive Healthcare Management FOR IMMEDIATE RELEASE Contact: George Paz Chief Financial Officer 314-770-1666, x7487 EXPRESS SCRIPTS REPORTS STRONG GAINS IN REVENUE AND INCOME FOR FIRST QUARTER Net Income Up 29.3 Percent on Revenue Growth of 41.8 Percent ST. LOUIS, April 23, 1998—Express Scripts, Inc. (NASDAQ:ESRX) today announced that revenues for first quarter 1998 increased 41.8 percent to a record $371.4 million from $262.0 million for the period in 1997. Net income for the first quarter of 1998 rose 29.3 percent to $9.9 million from $7.6 million the prior year and gained 28.3 percent on a diluted per share basis, rising to 59 cents from 46 cents. On April 1, Express Scripts completed the purchase of ValueRx, the pharmacy benefit management (PBM) business of Columbia/HCA Healthcare Corporation, creating the largest PBM independent of drug manufacturer ownership. Completing this acquisition expeditiously has put Express Scripts on track to achieve the benefits anticipated from the combination. A new organizational structure, which includes many of ValueRx's key managers, was in place upon the completion of the transaction. Express Scripts/ValueRx membership on a combined basis is estimated at 22.0 million lives as of April 1, 1998. "With the acquisition completed and an organizational structure in place, we will focus on client retention and sales, while integrating our contracting processes and computer systems," said Barrett Toan, Express Scripts' president and chief executive officer. Toan outlined Express Scripts' integration goals for each of the final three quarters of 1998, as follows: • Second quarter --Consolidation of executive, legal and other administrative functions; coordination of the two companies' sales, marketing and customer service strategies; completion of the computer systems integration plan for finance, billing and remittances, receivables and all clinical functions • Third quarter —Combining existing contracts and contracting procedures related to both suppliers and providers; implementation of finance systems, and the completion of the systems integration plan for all other systems, including knowledge systems, claims adjudication and mail service systems; consolidation of financial operations —more— Express Scripts Reports 1Q98 Earnings Add 2 Express Scripts, Inc. is a leading specialty managed care company and the largest independent pharmacy benefit management (PBM) company in North America. Following its recent acquisition of ValueRx, the company serves thousands of clients including managed care organizations, insurance carriers, third -party administrators, employers and union -sponsored benefit plans. Together, Express Scripts and ValueRx manage over $4.0 billion in annual drug spend. The company provides a full range of consultative PBM services, including pharmacy network management, mail service and formulary management. The company also offers disease management programs, informed decision counseling services, medical and drug data analysis services, and infusion therapy services. Express Scripts is headquartered in St. Louis, and has additional sites in Minneapolis; Philadelphia; Albuquerque, N.M.; Tempe, Ariz.; Troy, N.Y. and Farmington Hills, Mich. More information can be found at hitp://www.express-scripts.com and http://www.valuerx.com. This press release contains forward -looking statements, including, but not limited to, statements related to the company's plans, objectives, expectations (financial and otherwise), or intentions. These statements involve risks and uncertainties that may cause the company's actual results to differ significantlyfrom those projected or suggested. Factors that may impact these forward -looking statements include: risks associated with the consummation of acquisitions, including the ability to successfully integrate the operations of acquired businesses with the existing operations of the company, loss of clients in the transition process and risks inherent in the acquired entities' operations; lower than expected sales and revenue growth; heightened competition; changes in pricing or discount practices of pharmaceutical manufacturers; the ability of the company to consummate contract negotiations with prospective clients; competition in the bidding of proposal process; adverse results in certain litigation and regulatory matters; the adoption of adverse legislation or a change in the interpretation of existing legislation or regulations, risks associated with the development of new products; and other risks described from time to time in the company's public filings with the .Securities and Exchange Commission. Financial tables follow: EXPRESS SCRIPTS, INC. Balance Sheet ($ in thousands) (unaudited) March 31, December 31, March 31, 1998 1997 1997 Assets Current assets Cash and cash equivalents $84,556 $64,155 $11,034 Short term investments 59,272 57,938 54,937 Receivables, net 199,959 210,291 187,892 Inventories 26,721 28,935 27,658 Deferred taxes and prepaid expenses 3,848 2,649 2,994 Total current assets 374,356 363,968 284,415 Property and equipment (net) 27,850 26,821 25,777 Other assets 12,538 11,719 12,916 Total assets $414,744 $402,508 $323,108 Liabilities and Stockholders' Equity Current liabilities Claims payable Accounts payable Accrued expenses Total current liabilities Deferred income taxes Total stockholders' equity Total liabilities and stockholders' equity $139,948 $153,051 $114,264 23,849 17,979 16,841 35,327 26,876 20,347 199,124 197,906 151,452 690 901 1,575 214,930 203,701 170,081 �� express Scripts. Valuelj� STATEMENT OF CONFIRMATION 14000 Riverport Drive Maryland Heights, MO 63043 314-770-1666 800-332-5455 http://www.express-scripts.com http://www.vaLuerx.com Please accept this as confirmation that Express Scripts/ValueRx has adequate personnel and financial resources to provide services as a managed prescription drug provider under the obligations specified in the Managed Prescription Drug Agreement. Kurt Blumenthal Vice President of Finance Date Pharmacy Benefit Management . Informed Decision Counseling . Disease Management Healthcare Information Management . Infusion Therapy Management . Eyecare Management Cover Story tion has become available to pa- tients, they have begun demanding not only more data but more input into the therapeutic decisions that affect their lives. "Patients today want to know as much as they can about different drug therapies," Chametski noted. "More informa- tion helps when theyre seeing the physician and the pharmacist." Consumer advertising is the most visible source of information, he continued, but ads are dwarfed by the sheer volume of raw data, coherent information, misinforma- tion, and opinion that are avail- able for free on the Internet. ful DTC advertising is Fosamax (alen- dronate sodium, Merck & Co.), the lead- ing antiresorptive agent against osteo- porosis. Merck has invested heavily in consumer a vertisi was from a it: Baia. ine product rac ip a 58.1% increase in Rx vol- ume last year alone. 'That prescribing Pattern shows the role the patient really has in health care today," he said. "1 defi- nitely expect it to continue." If he's right, look for a major advertis- ing battle to rattle the osteoporosis mar- ket, starting sometime later this year. Procter & Gamble has a new osteo- porosis product close to launch, Char- netski reported, with Wyeth-Ayerst and Hoechst Marion Roussel waiting in the 74 DRUG TOPICS MARCH 16 1998 Table 2 1996 1997 rank rank Brand name 2 1 Premarin Tabs (Wyeth-Ayerst) 1 2 Trimox (Apothecon) 3 3 Synthroid (Boots -Flint) 4 4 Hydrocodone/APAP (Watson) 6 5 Prozac (Dista) NA 6 Lanoxin (Glaxo Wellcome) 12 7 Prilosec (Antra Merck) 7 8 Vasotec (Merck & Co.) 24 9 Zithromax (Pfizer Laboratories) 13 10 Norvasc Source: Scott-Levin's (Pfizer Laboratories) Source Presaipu n Awit Total Rxs I. ixlo) 40,043 39,499 32,477 27,780 22,204 20,778 19,074 17,895 17,881 17,773 wings with their own entries. Eli Lilly has already received FDA marketing approval for Evista (raloxifene HCq. "Consumer promotion is going to fuel a lot of products," Chametski predicted. "This market isn't the only one that needs to differentiate its products. The best marketers will achieve success." Market leaders The top drugs for 1997 were little changed from the 1996 list of market leaders, at least in terms of numbers of prescriptions written. Top honors for 1997 went to Premarin tablets (conju- gated estrogens, Wyeth-Ayersq, with 40 million Rxs, and Trimox (amoxicillin, Apothecon), with 39.5 million Rxs, according to Scott -Levin. It was a switch from 1996, when Trimox topped the list with 40.6 million scripts against Pre- marin with 39.7 million scripts_ late, Pfizer) climbed ftgn1131E1O Me —No. 10 spot. Procardia XI (rn a (pine, Pfizer) fell from ninth 127ao'$cott-Levin repotted. —vvnat Propelled Zithromax into the top 10? A pair of new oral for- mulations, a suspension and a solid, offered physicians increased treatment flexibility. At least as important was increased physician interest in extended -spectrum macrolide products as a class. That interest included Biaxin (clar- ithromycin, Abbott Laboratories), one of 1996's biggest movers. Pfizer, Abbott, and other macrolide makers are going after the Augmentin (amoxicillinklavu- lanate potassium, SmithKline Beecham) market in a big way, Chametski explained. Their efforts are producing some very positive results for everyone except SB. As a class, extended -spectrum macrolide Rxs were up 18.5% over 1996, topping 33.3 million in 1997. One major reason: Product education is Convincing a grrwsing number of ohvsicianc rn rum z� the newer extended -spectrum as first -line therapy in PULP of Older eructs. "You're seeing an increasing trend for physicians to use this class, usually in place of an amoxicillin or cephalosporin product," Charnetski said. "Zithromax and Biaxin have been very effective in eroding Augmentin's otitis media market. - That doesn't mean it's time to count Augmentin out. Amoxicillin Rx volume fell by 5.9% in 1997, to 69.5 million Rxs, but even those numbers put amox- icillin in the No. 5 slot on the top 10 list Of therapeutic classes, with 2.9% of the total Rx market, 69.3 million Rxs. No other antibiotic class even made the top 10 list. What happened to Procardia XL? For one thing, Pfizer aggressively switched its promotional efforts from Procardia to Norvasc, effectively sacrificing the older Product, Chametski said. Procardia XL fell 19.4% in Rx numbers, to 13.8 mil- lion Rxs, although new products from other manufacturers more than offset the drop. 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N o a O d p C _ry U U) m V y V F n n v j o m m u V an d a0 E a 0 LU w j ti c a n c LLJ n E o a to a Em ' n Kt Z o fo 3nm n6 pyy p yE a v m n o N a ooE z a U N A F � n q _ m E-L 0 4-1 § E a) lol }\ � w� {2 \� k= ±� R/ rx CO § § 00 d j ƒ co S S § § / § co k k § § § - § % \ 2 ( * { 0 & _ § k � IL j B - - } 0 2[z k j } § § ( / _ 21z ® k/ k -` $J 2 - - E § 22§ �2 o ° -� 3 2 § x )§%a E \ - ; q E E-L § k § E 0 � &� E\ 2= k� R/ )� U) ,2 §) z 2) S ) S S S S 2 S ) CD U) \ I] / _ } E kI\ 3 k ) 3f 2$: $\ ) fk { 00 C cu EL C 0 a=1 ca c a� N d LL � N N A N 7 C A v N N L N E � d U � N N N 1 N N E .- m � O Z m 9 O _ O u o O 0 0 N d N 1I E d n m m Z Z Z Z Z u w w w w w U_ U_ F o _U W m (n U U J m N a7 a' w w w U w w w ,L a rn rn rn rn m rn YI U1 E1�`O LL � m m m rn rn m m rn rn m N N N O O O C m a E N � N � E n o E a3: '2 N d a) a y '' n E E n o o = co :-..._ c E m m S `O u a c c E " d d U ? m ai LLJ E °—�� N 0 N E O. m m w w E J w E o E E O K 0 x U J a wt ry F V U) f 4 i °Jz; Win"* ,..CwT":rxsNIA Cover Story terms of Rx volume (81.7 million Rxs, up 0.4% over 1996) and increased 20/6 in Rx retail dollars, to $4.2 billion. Like Cardizem CD (diltiazem, Hoechst Marion Roussel), which was hit hard in 1996 by Dilacor XR (diltiazem, RhBne-Poulenc Rorer), Procardia is losing out to the likes of Tiazac (diltiazem HCl, Forest), up 2400/6, to 1.5 million Rxs; Cov- era-HS (verapamil HCl, Searle), up 464.4%, to 1.1 million Rxs; and Sular (nisoldipine, Zeneca), up 193.10/6, to one million Rxs. The three big gainers are all less expensive than Procardia XL, which appeals as much to the growing managed care market as it does to the shrink- ing number of self -paying patients. And what about the 1996 champ, Dilacor XRi' Rx volume for 1997 was off by 0.6%, to 3.2 million scripts. Hot properties Ue fastest -growing thera eutic c ass was the op t o mic, up a staggering 317.5go in 1997 over the prior year, acc�or 'Ing to oft ev n. a entire class was driven by just two relatively new products, Chametski explained, Xalatan (latano rost Pharmacia Table $ Top 10 firms total prescriptions, based on 1997 Total Rxs % (add 000) change American Home Products 156,240 4.3% Bristol-Myers Squibb 147,682 8.2 Mylan 127,456 10.8 Novartis 120,773 -6.3 Schering-Plough 107,464 16.5 Teva Pharmaceuticals 97,597 12.3 Pfizer Inc. 97,031 16.8 Watson Pharmaceuticals 96,065 2.9 Glaxo Wellcome 85,223 -8.9 Merck & Co. 81,210 5.2 .. 10 firms based acquisition on total dollars,pharmacy 1997 Total dollars % (add 0001 change Merck & Co. $5,172,527 12.4% Glaxo Wellcome 4,995,229 0.6 Pfizer Inc. 4,918,997 18.2 American Home Products 4,508,639 7.1 Bristol-Myers Squibb 4,461,865 22.6 Schering-Plough 4,112,360 28.7 Novartis 3,878,501 9.4 Eli Lilly 3,834,073 20.7 Johnson & Johnson 3,512,454 10.6 SmithKline Beecham 2,920,446 20.9 Source: Scott-Levin's Source Prescription Audit p & Upjohn) and Alphagan (brimonidine tartrate, Allergan). Unfortunately, Rx increases don't tell the whole story. Total ophthalmic sales account for just 0.2% of the pharmaceutical market. Protease inhibitors are a better zam le. The cafe ory was up 168.1 % in 1997, tueled by Epivir amlvu 1ne, Glaxo Well- come), Zerit (stavudine, Bristol-Myers Squibb Cincology/Immunology), Videx (didanosine, BMS Cincology/immunnlo- gy), and Viramune (nevirapine, Roxane). Annual Rx volume for the category is approaching the one million mark and should go higher this year, Chametski predicted. His optimism is based on t),ie growi anty o protease Inhibitor- 2coc c iT�os sc u 4aKong HIV len as we as thejr4hWgj0L From Charetski's perspective, the most important product launch of 1997 was Aricept (doneoezil HCI, izer), the newest and to date the most 1 e 76 DRUG TOPICS MARCH 16 199B product for Alzheimer's disease. It stole t e spotlight from Cognex (tacrine HCI, Parke -Davis), though there is no assur- ance that Aricept itself won't be sup- planted in the near future. "It's not really a treatment, but Ari- cept will significantly slow the progres- sion of the disease," Chametski said. Rx volume for the antisenility category was up 223.3% for the year, second best in the field after ophthalmics, hitting 1.3 million scripts and climbing strongly into 1998. Look for stiff competition from Exelon (6vastigim, Novartis), slat- ed for launch later this year. Chametski's best marketing award (or 199 goes to Lipitor (atorvastatin calci- um, amer-Lam s Varke-UaviSjl, the honest and most heavily promoted new c oh resterof reducer on the market This Wine product alone propelled the entire category to the top slot on Scott-Levin's list of fastest -growing therapeutic class- es, up 27.9"/o (12 million Kxs) last year over 1996, to 55 mil- lion scripts. Parke -Davis' high-powered marketing push for Lipitor left competitors Mevacor (lovastatin, Merck), Zocor (simvastatin, Merck), and Pravachol (pravas- tatin sodium, BMS) looking like the fabled tortoise, Chametski said. Zocor has already eclip catennry innnvatnr Mevarof. a�_ Merck moved marketing re- sources into the newer product As -a result, Mevacor sales le 1 24% in the fourth quartPr-of 97 while 7nrnr ealne in, creased 20% to Semen - tlon as a 19 7 omory leader. -C a-m-ets i is predicting that Lipitor will outpace Zocor early this year. "The Lipitor introduc- tion was sheer marketing," he said. "Any of the existing products can do the same thing, but the marketing muscle that Warner- Lambert and Pfizer put behind this product nobody else could quite match." The two firms are jointly marketing the drug. What's even more unusual about the campaign, Charetski added, is its focus. Parke -Davis is targeting physicians and phar- macists. Whether the prol sion- al focus will last has yet to be seen. A new product, Baycol (cerivastatin, Bayer Corp.), was just launched, said Charnel - ski. He is expecting fireworks now that Bayer's new HMG-CoA reductase in- hibitor has hit the market No need to wait for the fireworks in the ACE inhibitor market Cozaar losar- tan potassium�1v erck arxMiovan (vaL s1-r a1-n, Novartis) are al ftay wi esta d products -The two new angiotensin II receptor antagonists pushed the class to an 89.7% increase in Rx volume over 1996, 5.7 million Rxs. Angiotensin II inhibitors carved their 1.8% market share gains largely from sales that once went unquestioningly to Vasotec (enalapril, Merck), Monopril (fosinopril sodium, BMS), Accupril (quinapril HCI, Parke -Davis), and other existing ACE inhibitors without diuretics. Rx volume for the older class grew by Continued on page 83 v v v� a 3 .o 3� Cam! 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W® a l m a aa/ a d4 ,mot n gq aai ip. V 41 ri E)P'i ! 400 7 C1 67 0 a 0, W is 1.:, 0i � w N N O o fir+ 14 + N 6 W Q M - L 0 O a Cover. Story Continued from page 76 7.5% last year. By comparison, Hyzaar (hydrochlorothiazidellosartan, Merck), the only combination angiotensin II receptor antagonist, turned in an 86.2% increase for the year, 2.3 million Rxs. Chametski predicted increasing pressure on existing ACE inhibitors this year from Avapro (irbesartan, Sanoff) and Teveten (eprosartan, SmithKline Beecham). 'The main point [with the newer products] is the lack of [the side effectl cough," he said. 'That was always a problem with older ACE inhibitors." Survival of the strongest One of 1997's biggest surprises was the continuing strength of the estrogen/prog- estin crass. Not only did ma e-n ader Wyeth-Ayetst_ fight off_generic-Premarin (conjugated estrogens), the class main- tained a ea t� curve in Rx vol- ume, up 85 370oo,-fo- iTi.i— million f�xs The performance may ave been anemic compared with the 513.7% climb the esti,6 e&Vprogestins racked up in 1996, but the class consists -primarily of iusi two products, Prempro (coniueat- erst). Prempro is designed for a continuous regimen and Premphase for cyclic dosing. Analysts estimate that about half of all Premarin users still have an intact uterus. Current research suggests that for those patients, combination therapy with prog- estin could all but eliminate the risk of uterine cancer. Until —and unless — some generic version of conjugated es- trogens is approved, Chametski noted, Wyeth-Ayerst is likely to retain its lock on this lucrative market It's a franchise that seems sure to grow in both volume and value as baby boomers continue into menopause and beyond. Antiobesity drugs made their mark two years running. In 1996, the class was up 185.2%, thanks largely to the fen-phen craze that swept into physician offices as quickly as it attracted disciples in weight -loss clinics across the country. In 1997, the class collapsed. Adverse publicity resulting from new research findings that implicated fen-phen in heart valve disorders and primary pul- monary hypertension (PPH) and an FDA recall order effectively killed both the combination and the class. "Last year, we were predicting that fen-phen would place in the top three products for 1997. It didn't happen," Chametski said. Instead, Pondimin (fen- fluramine HCI, Robins), the "fen" of the combination, which was never ap- proved by the FDA, is languishing at No. 75 in Rx volume, with 5.6 million Rxs written in 1997. lonamin (phenter- mine, Fisons) and Adipex-P (phenter- mine HCI, Gate), the "phen" compo- nent, are both somewhere south of No. 250 on Rx-volume list, with fewer than 2.3 million Rxs each. Redux (dexfenfluramine HCI, Wyeth- Ayerst) fared no better. Although it car- ried a black=boz taming for PPH, Redux was also recalled in September because of health risks the FDA deemed to be unacceptable. Despite the recall, strong sales earlier in 1997 landed Redux in 136th place for overall volume with 3.4 million Rxs. Meridia (sibutramine, Knoll), a norepinephrine, serotonin, and dopa- mine reuptake inhibitor, was recently approved for the management of obesity. R.Ph. in the loop Chametski suggested that, in the long run, e fen- en craze an cras may actual- y have been Rood for a In ustryff not for the manufacturers and prescribers involved. There's no doubt ut t at t e problem raised public awareness of the entire class. "There was very probably overprescribing [of antiobesity prod- ucts];' he explained. "It was most certain - is a level of pharmacist has to get more involved in the entire process. "In many cases, the pharmacist knows more about the drug and its potential for interactions than the physician," he said. 'The pharmacist is in a unique position to educate the patient and even the physician. Money must be spent to address the issue." Table 4 In the antiulcer category, Prilosec (omeprazole, Astra Merck) is giving Tag- amet (cimetidine, SmithKline Beecham) and other older H. antagonists a tough time in the Rx market. Tagamet and its contemporaries are doing well in the OTC market, but Chametski has found that physicians are finally becoming as comfortable prescribing the newer proton - pump inhibitors as they were with HZ antagonists. Patients are the big winners. "Older products hid the symptoms," he said. 'This new class actually helps the ulcer. Prilosec is just a better drug." The serotonin-nore ine hrine reu - take inhibitor class is still m- Ing, f not as strong y as it once id. From a'4g:2% gain In 1996, SNRI vol- ume increased 16% in 1997, to 62.3 million Rxs; the second-largest gain in the industry after cholesterol -reducing drugs. The future still looks bright. Awareness of depression has been high since the appearance of Prozac (fluoxetine HCI, Dista) a decade ago. Cycles of adverse publicity don't seem to have impacted sales of Prozac, the best-selling drug in its class at 22 mil- lion Rxs, or its competitors. Even dogs and cats are getting antidepressants these days, a boon to the vanishing cash market, while managed care seems content with its continuing pref- erence for drug therapy over more ex- pensive psychotherapy. Rx margins and profits may not be to everyone's liking, but nothing short of a major economic disaster at home seems likely to derail the drug industry's continuing boom times. Fred Gebhart Total Rxs % Therapeutic class (add 000) change Cholesterol reducer, Rx 54,967 27.9% Specific neurotransmitter modulators 62,281 16.0 Diabetes, oral 50,430 19.2 Antihistamine cap -tab 36,918 23.9 Estrogen/progest. oral 15,096 85.3 'Classes are sorted on total Rx volume difference from 1997 to 1996. 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O r m 0 7 mN e� m L' E L"= Lw° 0 m m m 0 as W o o c c, 3 c a>IM 3 m m a o U C U m t u w.3 lEa m o u W a m S mot! c c r<:Ema ca >O1 C7 tvf e� m Im: m9^ m c c �w o5 > H:m F 044 mw°u m c C a m m C 0 0 oe o 0 0 0 CD t0 0 Y M N O O co d rn a a CD UM' m f7 N r �♦ Express Scripts® Progressive Healthcare Management July 27, 1998 City of Fort Collins' Purchasing Division 256 West Mountain Avenue Fort Collins, CO 80521 Re: City of Fort Collins - Proposal # P-682 14000 Riverport Drive Maryland Heights, MO 63043 314-770-1666 500-332-5455 http://www.express-scripts.com Express ScriptsNalue Rx offers the following proposal for a Pharmacy Benefit Program for City of Fort Collins. Our clients' members receive an improved quality of care from our services. Additionally, our plan sponsors experience great savings, not only in their pharmacy expenditures, but also in medical/surgical expenditures from our effective pharmacy benefit management capabilities. City of Fort Collins will benefit from our strength as a: • Recognized leader Express ScriptsNalue Rx covers more than 22 million lives in the United States and Canada through many satisfied managed care plans, self -insured programs, insurance carriers, and health and welfare plans. Express Scripts received the highest average ranking overall for the second consecutive year of all vendors, according to the Pharmacy Benefit Management Institute (PBMI) 1997 Customer Satisfaction Survey, when comparing the average ranking for all functions. In addition, Express Scripts received the highest ranking in Value of Administrative Cost; Lowest Cost of Drugs; Benefit Design Consulting; Retrospective DUR; and Disease Management. PBMI is not affiliated with any PBM, drug manufacturer or any other benefit organization. Sound partner in managing prescription expenditures Our consulting and administrative capabilities allow us to administer virtually any plan design feature. We offer comprehensive printed and on-line reporting that will allow City of Fort Collins to analyze utilization patterns, savings data, and other vital information. Our pricing is extremely competitive, with no standard monthly charges, advances or implementation fees. • Expert in clinical services Our 70 clinical pharmacy personnel are committed to providing state-of-the-art concurrent and retrospective drug utilization review and drug management services. • Comprehensive provider of services Our retail pharmacy networks include more than 50,200 chain and independent pharmacies. Our high quality mail service pharmacies dispense millions of prescriptions annually. Our retail and mail order services are integrated through a fault -tolerant on-line system for better service and patient safety at a lower cost. In addition, ESI Vision Care's newest value-added service, the ESI Vision Care Savings Program is available to all new clients at no additional charge. Members can save up to 55 percent on their eyecare needs. Should you need additional information, please contact me at (602) 225-0005. Sincerely, ®ryHatendorf Regional Marketing Director Pharmacy Benefit Management • Informed Decision Counseling . Disease Management Healthcare Information Management . Infusion Therapy Management . Eyecare Management 3 m Z CD O m U x W 0 ` O y N d e a R �+ y c O y+ 3 l0 0 O C y N w= O ay+ O. p, 'C a) 0 O. d N a tm f0 N a+ V Y O .c 3 R N �.— X y m O 07 L 0 = c y C1 '0 O, c w L o O >. O) y 0 0 0 e c .00 Cyl 'O N c o c c y d> o 0) p c m 0 E rn a (2 �° o m '� m o O •C�a1 Cc01 'CL 0 C •m C 9 c > _ N i O. c d E C N w R 0 W aRwa> >�ae y 0 N a L x c l6 O Y Z c0 N m n y p 0 N a T O p m `� 2 _ m y y c m a> '.2 N (`i 'O N E O 07 C Y > A� 0 L > Z . 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H O (9 C e I 0 L> C 0 N U C CL d � N 0 o m Cl! C) c a O � U r 10 I V m tU C N 0 CL li e 2 c S � ae a x o' � I e e e e e e C.CCD 0 O 7 N F,. Co Akron Brighton ORADO Akron Hardamon Drug 93 Main St. Akron, CO 80720 (970) 34 5 8828 Alamosa Alamosa Pharmacy 2111 Stuart St. San Luis Valley Medical Alamo::a, CO 81 lot (719) 589-1766 City Market Pharmacy #22 131 Market St. Mamma, CO 81101 (719) 589-6656 K-Mai t. Pharmacy 07533 157 Craft Dr. Alamosa, CO 81101 (719) 5894)444 Valley Wide Pharmacy 1847 Zrid St. Alamosa. CO 81101 (719) 589-3633 Wal Mail Pharmacy #0869 148 Craft Dr. Alamosa, CO 81 lot (719) 589A021 Arvada K-Mai t Pharmacy #4129 9891 W. 5861 Ave. Arvada. CO 80002 4228008 .. SoopersPharmacy #03 6350 Sheridan Blvd. Arvada, CO 80003 (303) 715-4048 King Soopers Pharmacy #22 9731 W. 581h Ave. Arvada, CO 80002 (303) 421 -1200 King Soopers Pharmacy #36 8031 Wadworth Blvd, Arvada, CO 80005 (303) 420-1377 King Soopers Phan acy #45 12350 W. 64th Ave. Arvada, CO 80004 (303) 422-1476 Lindy's Pharmacy Inc. 9950 W. 80th Ave. Arvada, CO Bt7005 (303) 422-4862 Payless Drug Store #5354 5187 W. 64th Ave. Arvada, CO 80003 (303) 4264)603 Safeway Pharmacy #0328 7561 W. 80th Ave. Arvada, CO 80003 (303) 4250371 Safeway Pharmacy #0330 9517 Ruston Rd. Arvada, CO 80002 (303) 425-7361 Safeway Pharmacy #1107 12h80 W. 64th Ave. . CO 80004 .23-6886 Walgreen Drug 03266 6395 N. Sheridan Blvd. Arvada, CO 80003 (303) 4207545 Walgreen Drug 03499 11602 W. 64th Ave. Arvada. CO 80004 (303) 421 Z237 Ward Road Pharmacy 5730 War Rd. Arvada. CO 80002 (303).4207979 Aspen Carts Pharmacy 306 E. Main St. Aspen, CO 81612 (970) 9253273 Tom's Clinic Pharmacy 100 E. Main, Ste. 102 Aspen. CO 81611 (970) 9258837 Aurora Albertson 90859 15220 E. 6th St. Aurora. CO 80011 (303) 340A399 Albertson #0888 16746 E. Smoke Hill Rd. Aurora, CO 80015 (303) 6932707 Aurora Community Pharmacy 1411 S. Potomac St, Ste, 190 Aurora, CO 80012 (303) 695 0723 Aurora Presbyterian Professional Pharmacy 750 Potomac, Ste. 100 Aurora, CO 80011 (303) 3632100 Family Pharmacy 1724 S. Chambers Aurora, CO 800 17 (303) 695-1702 K-Mart Pharmacy 03043 15200 E. Colfax Ave. Aurora, CO 80011 (303) 3417420 King Soopers Pharmacy 010 15250 E. Mississippi Aurora. CO 80012 (303) 6718701 King Soopers Pharmacy #14 655 Peoria St. Aurora, CO 80010 (303) 364 b 196 King Soopers Pharmacy #16 19711 E. Smokey Hill Rd. Aurora, CO 80016 (303) 7152525 King Soopers Pharmacy 030 1155 S. Havana Aurora, CO 80012 (303) 7554246 King Soopers Pharmacy #39 3190 S. Parker Rd. Aurora, CO 80014 (303) 7502452 King Sompers Pharmacy #49 17000 E. lliff Ave. Aurora, CO 80013 (303) 7524777 King Soopers Pharmacy 052 15109 E. Colfax Ave. Aurora, CO 80011 (303) 3433170 King Soopers Pharmacy 866 10400 E. Colfax Ave. Aurora, CO 8WI0 (303) 361 -9064 King Soopers Pharmacy 869 4257 S. Buckley Rd. Aurora, CO 80014 (303) 6808690 Payless Drug Store #5314 12303 E. Mississippi Aurora, CO 80012 (303) 364 3393 Payless Drug Store 05316 15355 E. Colfax Aurora. CO 8001 1 (303) 341-1216 Payless Drug Store 05318 10809 E. Colfax Ave. Aurora. CO 80010 (303) 340-2825 Payless Drug Store #5320 3184 S. Parker Rd. Aurora, CO 80014 (303) 750-6774 Payless Drug Store 05322 15453 E. Hampden Ave. Aurora, CO 80013 (303) 693-0495 Price Club Pharmacy #439 1471 S. Havana St. Aurora, CO 80012 (303) 7508405 Safeway Pharmacy #0136 10777 E. Colfax Ave. Aurora. CO 80010 (303) 340-2620 Safeway Pharmacy #0137 12200 E. Mississippi Aurora, CO 80010 (303) 696-1923 Safeway Pharmacy #0138 1730 S. Buckley Rd. Aurora. CO 80012 (303) 685-1694 Safeway Pharmacy #0139 16921 E. Quincy Aurora, CO 80010 (303) 693-9700 Senior Med Pharmacy 14707 E. Second Ave. Ste. 15 Aurora, CO 80011 (303) 343-6383 Spice Of life Pharmacy 13751 E. Yale Ave. Aurora, CO 80014 (303) 696-6301 The Prescription Store 1550 S. Potomac Aurora, CO 80012 (303) 369-1040 Wal-Mart Pharmacy #1492 14000 E. Exposition Aurora, CO 80012 (303) 368-1116 Wal-Mart Pharmacy #1689 4401 S. Buckley Rd. Aurora, CO 80015 (303) 6905272 Walgreen Drug i0501 16791 E. Iliff43. Bldg. Aurora, CO 80013 (303) 7524911 Walgreen Drug 02857 2727 S. Parker Rd. Aurora, CO 80014 (303) 6953049 *Walgreen Drug 93655 10501 E. Colfax Ave. Aurora, CO 80010 (303) 3433336 Walgreen Drug #4307 12051 E. Mississippi Blvd. Aurora, CO 80012 (303) 7554313 Avon City Market Pharmacy #26 260 Beaver Creek Pl, Avon, CO 81620 (970) 9495437 Wal-Mart Pharmacy #1199 220 Beaver Creek Pl. Avon, CO 81620 (970) 949-6544 Basalt Basalt Clinic Pharmacy 160 Midland Ave. Basalt. CO 81621 (970) 9273833 Bayfreld Mill St Drug Store 498 S. Church Bayfield, CO 81122 (970) 884 -9133 Bergen Park King Soopers Pharmacy #64 1173 Colorado Hwy. 74 Bergen Park, CO 80439 (303) 674 8246 Berthoud Berthoud Pharmacy 330 Mountain Berthoud. CO 80513 (970) 532-2034 Boulder Alpine Pharmacy 1000 Alpine Boulder, CO 80304 (303) 444-0448 Boulder Drug Rxplus 1647 Pearl St. Boulder. CO 80302 (303) 4425164 Boulder Medical Cu. Pharmacy 2750 Broadway Boulder. CO 80304 (303) 4403111 Broadway Drug & General 2700 Broadway Boulder, CO 80304 (303) 442-0589 Goose Creek Pharmacy 2880 Folsom Boulder, CO 80304 (303) 440A200 Jones Drug & Camera Co. 1370 College Ave. Boulder. CO 80302 (303) 443A420 K-Mart Pharmacy #4181 3325 28th St, Boulder, CO 80301 (303) 444 A890 King Soopers Pharmacy #28 6550 Lookout Rd. Boulder. CO 80301 (303) 530 0400 King Soopers Pharmacy #33 3600 Table Mesa Dr. Boulder, CO 80302 (303) 4994244 King Soopers Pharmacy #61 1650 30th St. Boulder. CO 60302 (303) 444 0164 Leevem Pharmacy 1 850 Thirtieth St. Boulder, CO 80301 (303) 786-7236 Ludwig Pharmacy 2626 Baseline Rd. Boulder, CO 80303 (303) 499-2121 Medical Arts Pharmacy 1136 Alpine Boulder, CO 80304 (203) 444-1022 Payless Drug Store #5364 4800 Baseline Rd. Boulder, CO 80303 (2,,02) 499-1919 Payless Drug Store #5366 3348 N. 28th St. Boulder. CO 80302 (303) 447-1111 Safeway Pharmacy #091 1 2798 Arapahoe Boulder, CO 80302 (303) 443-6142 Safeway Pharmacy #0919 4900 E. Baseline Rd. Boulder, CO 80302 (303) 4948851 The Apothecary University Of Co Cb 119 Boulder. CO 80309 (303) 4928553 Walgreen Drug #2482 1830 30th St, Boulder. CO 80301 (303) 4440407 Breckenridge Breckenridge Drug Store 111 Ski Hill Rd, Breckenridge, CO 80424 (970) 453-2362 City Market Pharmacy 030 400 N Pky. Breckenridge, CO 80424 (970) 453-0818 Brighton Beattie's Community Pharmacy 1295 Bridge St. Ste. 103 Brighton, CO 80601 (303) 655 -1500 Brighton Pharmacy 1929 Egbest St. Brighton. CO 80601 (303) 259-1900 ��express Scripts` 1! Pharmacy is open 24 hours �& Progr p e Heahhcam crip ent lone i lass Brighton Colorado Springs K Mart Pharmacy 03890 S E. Kuner Rd. ,,rton, CO 80601 (303) 6540996 Safeway Pharmacy #0917 1605 Bridge St. Brighton, CO 80601 (303) 659-0660 Village Pharmacy 2400 E. Bridge St. Brighton, CO 80601 (303) 6594311 Wal-Mart Pharmacy 01659 60 W. Bromley Lrr. Brigliton, CO 80601 (3(q 659;-510 Broomfield KMarl Pharmacy #7099 5(l05 W. 12011, Ave. Broomfield, CO 80020 (302) 469-1927 King Soolwis Pharmacy #08 5105 W. I Loth Ave. Bmomfield. CO 80020 (303) 466-1917 King Soolwrs Pharmacy #55 9983 Wadsworth Blvd. Broomfield. CO 80020 (303) 4 24 -7346 Payless Drug Store #5362 6500 W. 120111 Ave. Broomfield, CO 80020 (303) 469-1891 Pharmacy Corp Of America 557 Burbank St.. Ste. 1 Wield, CO 80020 460-9474 Safeway Pharmacy #1146 6775 W. 1201h Ave. Broomfield, CO 80020 (303) 4668449 Brush B itr B Pharmacy 210 Clayton St. Brush, CO 80723 (970) 842-2416 Park Keller Family Pharmacy 1705 Edison St. Brush, CO 80723 (970) 842-2661 Buena Vista City Market Pharmacy #37 438 S Hwy. 24 Buena Vista, CO 81211 (719) 3953149 Burlington Prescription Center 347 14th St, 0887 Burlington, CO 80807 (970) 346 7705 W b Drug Company Inc 390 14th St. Burlington, CO 80807 (719) 3468000 Byers Biggs Pharmacy 568 N Hwy. 36 F --O 80103 t .51-7385 Chase Pharmacy 568 N Hwy. 36 Byers, CO 80103 (303) 822.9371 Canon City Canon United 01714 3163 Eastridge Ln. Carron City, CO 81212 (719) 275AD350 City Market Pharmacy #17 1703 Fremont Canon City, CO 81212 (719) 2753319 Horizon Pharmacy #20 1337 Phay Canon City, CO 81212 (719) 275A666 Jewett Drug Center 121 N. 16th St. Canon City. CO 81212 (719) 2757466 Ream's Palace Drug 601 Main Canon City, CO 81212 (719) 2753375 Safeway Pharmacy #0728 1414 Main St. Canon City, CO 81212 (719) 2757511 Wal-Mart Pharmacy #1019 3105 Hwy. 50 Canon City, CO 81212 (719) 275-1641 Carbondale City Market Pharmacy 033 250 E. Valley Rd. Carbondale. CO 81623 (970) 9633730 City Market Pharmacy #35 1051 Hwy. # 133 Carbondale. CO 81623 (970) 9635727 Castle Rock Fox Drug 308 Wilcox St. Castle Rock. CO 80104 (303) 6883153 King Soopers Pharmacy 071 100 Founders Pity. Castie Rock, CO 80104 (303) 715-2535 Safeway Pharmacy #0033 100 S. Wilcox St. Castle Rock, CO 80104 (303) 688.6060 Wal-Mart Pharmacy #0984 880 S. Briscoe St. Castle Rock, CO 80104 (303) 6888335 Cedaredge Cedar Edge Pharmacy 215 Main St. Cedaredge. CO 81413 (970) 8563161 Clifton Payless Drug Store 05308 3227 1-70 Business Lp Clifton, CO 81520 (970) 4 34 -1383 Colorado City Jeffs Valley Pharmacy 4491 Bent Bros Blvd. Colorado City, CO 81019 (719) 6763333 Colorado Springs A Village Pharmacy 3277 W. Carefree Cit. Colorado Springs, CO M917 (719) 596-2141 Albertsorrs #0858 455 E. Cheyenne Mt. BI Colorado Springs. CO 80906 (719) 5764077 Broadmoor Drug Company Broadmoor Hotel Colorado Springs, CO 80901 (719) 6775740 Center Pharmacy 3207 N. Academy Blvd. Ste. 101 Colorado Springs, CO 80907 (719) 7763784 Centerpoint Pharmacy 1015 E. Pikes Peak Ave. Colorado Springs. CO 80903 (719) 6324122 College Pharmacy 833 N. Tejon Colorado Springs, CO 80903 (719) 6344861 Colorado Springs Medical 209 S. Nevada Colorado Springs. CO 80903 (719) 633-2762 Executive Park Pharmacy 2141 N. Academy Cit. Colorado Springs, CO 80909 (719) 5974080 Ivywild Pharmacy 1640 S. Nevada Ave. Colorado Springs. CO 80906 (719) 6345541 K-Mart Pharmacy #4088 701 N. Academy Blvd. Colorado Springs, CO 80909 (719) 4734631 K-Mart Pharmacy #4332 3020 N. Nevada Colorado Springs. CO 80907 (719) 4733822 K4v4art Pharmacy #7572 5885 Paltrier Park Blvd. Colorado Springs, CO 80915 (719) 5975044 King Soopers Pharmacy #06 1750 W. Unitah Colorado Springs, CO 80904 (719) 6365046 King Soopers Pharmacy #15 3175 S. Academy Blvd. Colorado Springs. CO 80910 (719) 390-9211 King Soopers Pharmacy #37 3650 Austin Buffs Pky. Colorado Springs, CO 80918 (719) 5983578 King Soopers Pharmacy #51 665 Murray Blvd. Colorado Springs, CO 80915 (719) 574-2075 King Soopers Pharmacy $53 6930 N. Academy Blvd. 1 1 Colorado Springs, CO 80918 (719) 5985191 King Soopers Phamracy #58 815 Cheyenne Meadows Rd. Colorado Springs. CO 80906 (719) 527-1694 Kohler Professional Pharmacy Rxplus 1715 N. Weber, #230 Colorado Springs, CO 80907 (719) 473-1823 Kohler's Apothecary 4020 Palmer Park Blvd. Colorado Springs, CO 80909 (719) 597-7998 Longs Drug Store 0220 1730 Dublin Blvd. Colorado Springs, CO 809I8 (719) 5488333 Longs Drug Store #231 4158 Austin Bif Pkw Colorado Springs. CO 80918 (719) 5488900 Longs Drug Store 0271 3960 Palmer Park Blvd. Colorado Springs, CO 80909 (719) 591-0225 Longs Drug Store 0288 3143 W. Colorado Ave. Colorado Springs. CO 80904 (719) 632-7112 Longs Drug Store #403 4315 Centennial Blvd. Colorado Springs, CO 80907 (719) 264 -9900 Medicine Shoppe #0014 3159 W. Colorado Ave. Colorado Springs, CO 80904 (719) 475-9030 Medicine Shoppe #0437 2439 N. Union Blvd. Colorado Springs, CO 80909 (719) 6303154 Medicine Shoppe # 1146 2306 N. Wahsatch Ave. Colorado Springs, CO 80907 (719) 4713600 Medicine Shoppe # 1404 1625 Medical Center Pt. Ste. 140 Colorado Springs. CO 80907 (719) 577-9800 Musick Drugs 309 E. Fontanero St. Colorado Springs, CO 80933 (719) 632-2634 Penrose Professional Pharmacy 2215 N. Cascade Ave. Colorado Springs, CO 80907 (719) 630-6486 Safeway Pharmacy #081 1 3335 N. Academy Blvd. Colorado Springs, CO 80907 (719) 574-1560 Safeway Pharmacy 00816 1920 Nevada Colorado Springs, CO 80907 (719) 6365257 Safeway Pharmacy #0832 3175 W. Colorado Ave. Colorado Springs, CO 80904 (719) 473-7221 Safeway Pharmacy 00835 5060 N. Academy Blvd. Colorado Springs, CO 80918 (719) 593-1474 Safeway Pharmacy #0839 840 Village Center Dr. Colorado Springs, CO 80919 (719) 548-1477 Safeway Pharmacy 01064 7655 N. Union Blvd. Colorado Springs, CO 80918 (719) 531-9537 Safeway Phammacy 01466 1121 N. Circle Dr. Colorado Springs, CO 80909 (719) 573-6061 Safeway Pharmacy 91499 2895 N. Powers Rd. Colorado Springs, CO 80922 (719) 573,1759 St Francis Health Ctr Phc 825 E. Pikes Peak Ave. Colorado Sprigs. CO 80903 (719) 7768371 Wal-Mart Pharmacy #1200 701 N. Academy Blvd, Colorado Springs, CO 80909 (719) 380-0808 Wal -Mart Pharmacy # 1434 525 S. 8th St. Colorado Springs. CO 80905 (719) 633-7511 Wal Mart Pharmacy #1896 S250 Razorback Rd, Colorado Springs, CO 80920 (719) 593-2305 Walgreen Drug #0284 1810 W. Uintah St. Colorado Springs, CO 80904 (719) 4738834 Walgreen Drug 90293 2730 S. Academy Blvd. Colorado Springs, CO 80916 (719) 390 7894 Walgreen Drug 90299 725 Citadel Dr. W. Colorado Springs. CO 80909 (719) 5973856 Walgreen Drug #2044 1825 S. Nevada Ave. Colorado Springs, CO 80906 (719) 473-7275 Walgreen Drug #2286 405 S Cir. Colorado Springs. CO 80910 (719) 4448569 Walgreen Drug #3583 2785 Dublin Blvd. Colorado Springs, CO 80918 (719) 5938940 Walgreen Drug #3584 2921 N. Nevada Colorado Springs. CO 80907 (719) 4713440 Walgreen Drug 03585 6820 Centennial Blvd. Colorado Springs, CO 80919 (719) 264-6234 Walgreen Drug #3596 3480 N. Academy Colorado Springs, CO 80917 (719) 380-9438 Walgreen Drug #3914 5755 Constitution Ave. C'blorado Springs, CO 80915 (715) 591-9929 *Walgreen Drug #4043 920 N. Circle Dr. Colorado Springs, CO 80909 (719) 4 73 -9090 * Pharmacy is open 24 hours Commerce City Denver r'•,mmerce City s Commerce City Drug 10 Monaco Commerce City. CO 80022 (303) 2883784 King Soopers Pharmacy #02 6040 E. 64th Ave. Commerce City. CO 80022 (303) 288-6629 Professional Pharmacy 6401 E. 72nd Ave. Commerce City, CO 80022 (3W) 2894505 Conifer Aspen Park Dnug 25797 Cordfei Rd. Conifer. CO B0433 (303) 674 -7745 Safeway Pharmacy 00011 10853 Us Rt 285 Conifer. CO 80433 (303) 1d38 9870 Cortez City Market Pharmacy #08 508 E. Main Cortez. CO 81321 (970) 565.6466 Professional Pharmacy 33 N. Elm Cortez, CO 81323 (970) 565 7368 Wal-Mart Pharmacy #0966 2220 E. Maui St, Cortez, CO 81321 5657038 ons Pharmacy, Inc. 2 W. Mar St Cortez, CO 81321 (970) 5658558 Craig City Market Pharmacy #15 505 W. Victory Way Craig, CO 81625 (970) 824-0449 K-Mai t Pharmacy 07560 1198 W. Victory Craig, CO 81625 (970) 824 4376 Safeway Pharmacy #0635 1295 W. Victory Way Craig. CO 81625 (970) 8248118 Crested Butte Crested Butte Drug Store 428 Elk Ave. Crested Butte. CO 81224 (970) 349-1033 Dacono Dacono Drug 901 Carbondale Dr. Dacono, CO 80514 (303) 833AO16 Delta City Market Pharmacy #04 122 Gunnison River Dr. De11a. CO 81416 174 5771 C ._et Drug 405 Main St. Delta. CO 81416 (970) 874 4481 Gibson Pharmacy 121 W. Gunnison River Dr. Delta, CO 81416 (970) 874-6757 Medicine Shoppe #0735 260 E Hwy. 92 Delta, CO 81416 (970) 8744465 Denver Albertson 00817 3125-S_ Sheridan Blvd. Denver. CO 80227 (303) 9854269 Albertson #0880 7475 E. Miff Ave. Denver, CO 80231 (303) 3693243 Alberisons #0885 323 S. Broadway Denver. CO 80223 (303) 7448660 Albertson 00987 3909 E. Evans Ave. Denver, CO 80210 (303) 7584474 American Pharmaceutical Sery 1385 S. Colorado Blvd. Ste. #306 Denver. CO 80222 (303) 7595335 Apothecare -Portercare 2535 S. Downing G-i0 Denver, CO 80210 (303) 778-2427 Belmar Pharmacy 12860 W. Cedar Dr., #210 Deriver. CO 80228 (303) 7635533 Byron's Pharmacy 1926 S. Federal Blvd. Denver, CO 80219 (303) 9364373 Capital Heights 1200 Madison St. Denver, CO 80206 (303) 3883679 Centura Senior Life Center Outpatient Pharmacy 1601 Lowell Blvd. Denver. CO 80204 (303) 8995263 Colorado Pharmacy 701 E. Colfom It 102 Denver. CO 80203 (303) 8637644 Cornell Pharmacy 2190 E. 18th Ave. Denver, CO 80206 (303) 3884674 Harkness Heights Pharmacy 4271 Lowell Blvd. Denver, CO 80211 (303) 4 55-2 171 Hodel's Drug 3100 S. Sheridan Blvd. Denver, CO 80227 (303) 9363479 Hodel's Drug Store Inc. 705 S. Colorado Blvd. Denver, CO 80222 (303) 7444039 Huan Pharmacy 633 S. Federal Blvd#203 Denver, CO 80219 (303) 9363230 Joy Pharmacy Rxplus 1302 E, 6th Ave. Denver. CO 80218 (303) 744-6219 K-Mart Pharmacy 04121 5051 Federal Blvd. Denver, CO 80221 (303) 4338991 K-Mart Pharmacy #4187 2770 W. Evans Ave. Denver. CO 80219 (303) 934 5819 K-Mart Pharmacy 04224 2150 S. Monaco Pky, Denver, CO 80222 (303) 7583520 K-Mart Pharmacy #7303 363 S. Broadway Denver. CO 80203 (303) 7338668 King Soopers Pharmacy #01 1331 N. Speer Blvd. Denver, CO 80204 (303) 571-1943 King Soopers Pharmacy 005 1370 Keamey St. Denver, CO 80220 (303) 388-1689 King Soopers Pharmacy #07 5125 W. Florida Denver. CO 80219 (303) 936 7403 King Soopers Pharmacy # 17 2223 S. Monaco Pky. Denver, CO 80222 (303) 758-9101 *King Soopers Pharmacy # 19 3100 S. Sheridan Blvd, Unit 2 Denver. CO 80227 (303) 93741404 King Soopers Pharmacy #21 825 S. Colorado Blvd. Denver, CO 80222 (303) 7225793 *Kmg Soopers Pharmacy 024 750 E. 104th Ave. Denver, CO 80233 (303) 4528661 King Soopers Pharmacy #26 6470 E. Hampden Ave. Denver, CO 80222 (303) 7580011 King Soopers Pharmacy 029 1155 E. 9th Ave. Denver, CO 80218 (303) 8325298 King Soopers Pharmacy #31 1927 S. Wadsworth Denver, CO 80227 (303) 9858797 King Soopers Pharmacy #35 890 S. Monaco Pky. Denver, CO 80222 (303) 333-1545 King Soopers Pharmacy #40 12043 W. Alameda Pky. Denver, CO 80228 (303) 9888058 King Soopers Pharmacy #54 7200 W. Alameda Pky. Denver. CO 80226 (303) 934 -2284 King Soopers Pharmacy 056 2727 W. Evans Ave. Deriver, CO 80219 (303) 936-2377 King Soopers Pharmacy #57 5301 W. 38th Ave. Denver. CO 80212 (203) 4257455 King Soopers Pharmacy #68 3801 E. 120th Ave. Denver, CO 80241 (303) 4519470 King Soopers Pharmacy #72 2700 S. Colorado Blvd. Denver, CO 80222 (203) 715AO57 Lo-Do Pharmacy 1730 Blake St. Ste #100 Denver, CO 80202 (203) 2948443 Medicine Shoppe #0147 4291 Federal Blvd. Denver, CO 80211 (303) 4338907 Midtown Pharmacy 2005 Franklin Denver, CO 80205 (203) 861 -7600 Morgan's Pharmacy R.plus 1200 E. Evans Denver. CO 80210 (303) 7773981 National Jewish Center 1400 Jackson St. Denver, CO 80206 (303) 398-1582 P/SI Professional Pharmacy 1601 E. 19th Ave. Ste. 4150 Denver. CO 80218 (303) 839-7007 Payless Drug Store #5338 4923 E. Colfax Ave. Denver. CO 80220 (303) 388�2118 Payless Drug Store #5340 2630 W. 38th St. Denver. CO 80211 (303) 455 0902 *Payless Drug Store #5344 2870 S. Colorado Blvd. Denver, CO 80222 (303) 7578347 Payless Drug store 05346 1320 S. Federal Blvd. Denver. CO 80219 (303) 935-9511 Payless Drug Store #5348 3112 E. 1 st Ave. Denver, CO 80206 (303) 399 7595 Payless Drug Store 06196 722 16th Street Mall Denver. CO 80202 (303) 534 -7802 Pencol-Medisave Pharmacy 3535 Cherry Creek N Dr. Denver, CO 80209 (303) 3883613 Raleigh Professional 4200 W. Conejos Pl. Denver. CO 80204 (303) 5735601 Rose Bidg.Pharmacy Rxplus 4 54 5 E. 9th Ave. Denver. CO 80220 (303) 320 a I I Rose Medical Ctr. Pharmacy Rxplus 4 500 E. 9th Ave. Denver, CO 80220 (303) 393-1555 Safeway Pharmacy 00018 1955 S. Sheridan Blvd. Denver, CO 80227 (303) 989-9894 Safeway Pharmacy #0029 4950 E. Hampden Ave. Denver, CO 80222 (.303) 691 0317 Safeway Pharmacy #0135 6_'.20 E. 14th Ave. Denver, CO 80220 (303) 3224772 Safeway Pharmacy 00141 4884 Chambers Rd. Denver, CO 80239 (303) 371-6645 Safeway Pharmacy #0201 4860 Pecos St. Dei iver. CO 80221 l303) 433-6083 Safeway Pharmacy #0244 3800 W. 44th Ave. Deriver, CO 80221 (203) 4588438 Safeway Pharmacy #0246 757 E- Wth Ave. Deriver, CO 80205 (303) 861-1212 Safeway Pharmacy #0342 11088 W. Jewell Ave. Denver. CO 80226 (303) 9898812 Safeway Pharmacy #0344 9160 W. Colfax Ave. Deriver. CO 80214 (303) 232-1259 Safeway Pharmacy #1038 1653 S. Colorado Blvd. Denver, CO 80222 (303) 691-2962 Safeway Pharmacy #1115 7150 Leetsdale Denver, CO 80224 (303) 377 7116 Safeway Pharmacy 01248 2660 N. Federal Blvd. Denver. CO 80211 (303) 477 -14 70 Safeway Pharmacy 01267 6460 E. Yale Ave. Denver. CO 80222 (303) 6918874 Safeway Pharmacy #3723 315 W. 2nd St. Denver, CO 81050 (719) 384 8616 Saigan Pharmacy 1005 S. Federal Blvd. Denver, CO 80219 (303) 7420760 Thrifty Drug Store 00183 2870 S. Colorado Blvd. Denver, CO 80222 (303) 759-2856 ♦ Pharmacy is open 24 hours Denver T^bins Pharmacy rs i W. Colfax Ave. Denver. CO 80204 (303) 623,0082 Todd's Professional Pharmacy Dba Todd's Prof Phcy 950 E. Harvard. # 170 Denver, CO 802 10 (303) 733,1755 Unicate Rx 103543 S. Federal Blvd. Denver, CO 80219 (303) 934 3306 Univ Hosp Outpatient Pharmacy 4200 E. 9th Ave. Denver. CO 80262 (303) L70-7064 University East Pavillion 4701 F_ 90h Ave. Denver, CC) 80262 (303) 372-1700 University Park Pharmacy 1919 S. University Denver. CC) 80210 (303) 744-2701 Wal-Mart Pharmacy 02125 440 Wadsworth Blvd. Denver, CO 8U226 (970) 2745214 Walgreen Drug #0347 7200 W. Alameda Ave. Deriver. CO 80226 (303) 936 7128 Walgreen Drag $0348 7400 Hampden Ave. =r, CO 8023.1 773 6154 Walgreen Drug 00356 801 16th St. Denver, CC) 80202 (303) 57I5314 Walgreen Drug 01344 1957 S. Federal Blvd. Denver, CO 80219 (303) 934-0858 Walgreen Drug # 1459 2040 S. University Denver. CO 80210 (303) 778-6069 *Walgreen Drug # 1769 2000 E. Colfax Denver. CO 80206 (303) 331-0917 Walgreen Drug #2084 6360 E. Evans Ave. Denver, CO 80222 (303) 7598853 Walgreen Drug #2843 120 Broadway Denver, CO 80203 (303) 722-0771 *Walgreen Dm ig 03190 l 11 I S. Colorado Blvd. Denver, CO 80222 (303) 7588083 Walgreen Drug #3500 950 S. Quebec Denver, CO 80231 (303) 388-1805 Walgreen Drug #3867 6' -.olfax L .. CO 80220 OW) 321 -0506 Walgreen Drug #4301 2975 Federal Denver, CO 80211 (303) 4338911 Windsor Garden Drug 9660 E. Alameda Ave. Denver, CO 80231 (303) 364 -9318 Yosemite Drug Corp. 8962 E Hampden Ave. Denver, CO 80231 (303) 7718151 Dillon City Market Pharmacy 020 300 Us Hwy. 6 Dillon. CO 80435 (540) 468-6369 Durango Albertson #0801 311 W. College Dr. Durango, CO 81301 (970) 3822228 City Market Pharmacy #06 Town Piz. S/c, 06 Durango. CO 81301 (970) 2472921 City Market Pharmacy #21 3130 Main Ave. Durango, CO 81301 (970) 247-9435 K Mart Pharmacy #9759 800 S. Camino Del Rio Durango. CO 81301 (970) 2592214 Payless Drug Store #5302 331 S. Camino Del Rio Durango, CO 81301 (970) 2594250 Payless Drug Store #6208 28 Town Piz. Durango. CO 81301 (970) 2475057 Plaza Pharmacy 28 Town Piz. Durango, CO 81301 (970) 2475057 Eagle City Market Pharmacy #34 103 Market St. Eagle. CO 81631 (970) 3284311 Eagle Pharmacy 3rd & Broadway Eagle, CO 81631 (970) 328-6875 Eaton Eaton Drug Store 122 Oak St Eaton. CO 80615 (970) 454-2110 Edgewater King Soopers Pharmacy 046 5505 W. 20th Ave. Edgewater. CO 80214 (303) 2388381 Edwards Edwards Med Ctr Pharmacy 320 Beans Creek Rd. Edwards. CO 81632 (970) 926-7476 El Jebel Jim's Pharmacy 52 Pottery Ln. El Jebel, CO 81628 (970) 963-9390 Elizabeth Country Pharmacy 34061 Forest Park Dr. Elizabeth, CO 80107 (303) 646-1445 Safeway Pharmacy # 1532 220 S. Elizabeth St. Elizabeth, CO 80107 (303) 6460656 Englewood Albertson #0884 8557 E. Arapahoe Rd. Englewood, CO 80112 (303) 773-9543 Anderson Pharmacy Rxplus 799 E. Hampden Ave. Englewood, CO 80110 (303) 788 7373 Captain Cenuum Pharmacy 8200 E. Belleview Ave. Ste. 1000 Englewood, CO 80111 (303) 6943764 Cystic Fibro_ds Services Inc 9 Inverness Dr. E. Englewood, CO 80112 (303) 294 s3824 Englewood Pharmacy Rx Phis 3601 S. Clarkson Englewood, CO Sol 10 (303) 7613860 Health One Prof Pharmacy 14200 E. Arapahoe Rd. Englewood, CO 80112 (303) 6993070 Health Script Pharmcy Services 9 Inverness Dr. E. Englewood, CO 80112 (303) 7993771 Heritage Drug 7475 E. Arapahoe Rd. Englewood, CO 80112 (303) 77OA011 K Mart Pharmacy 94131 200 W. Belleview Englewood. CO 80110 (303) 7940801 KMart Pharmacy 04918 9401 E Arapahoe Rd, Englewood, CO 130112 (303) 3974949 King Soopers Pharmacy #04 5050 S. Federal Blvd, Englewood, CO 80110 (303) 794-6397 King Soopers Pharmacy 048 4910 S. Yosemite Englewood, CO 80110 (303) 7733430 King Soopers Pharmacy $65 101 Englewood Pky, Englewood, CO 80110 (303) 7617817 Phar-Mor # 178 401 W. Girard Ave. Englewood, CO 801 10 (303) 7620622 Safeway Pharmacy #OW8 7375 E. Arapahoe Rd. Englewood, CO 80112 (303) 7795520 Safeway Pharmacy #0017 201 E. Jefferson Ave. Englewood, CO 80110 (303) 781 -7187 Safeway Pharmacy #1040 8200 S. Quebec Englewood, CO 80111 (303) 773-1649 Sherwood Pharmacy Rxplus 601 E. Hampden Englewood. CO 80110 (303) 788-6662 Swedish Professional Pharmacy 4990E Hampden, #150 Englewood. CO 80110 (303) 7888776 The Professional Phcy At 799 799 E. Hampden Ave. #120 Englewood, CO 80110 (303) 788 7997 Walgreen Drug 03091 8151 & Quebec Englewood. CO 801 12 (303) 694 -2136 Estes Park Estes Park Pharmacy 600 & St Vrain Ave. Estes Park, CO 80517 (970) 5863366 Rocky Mt Pharmacy Of Estes 453 E. Wonderview Estes Park, CO 80517 (970) 5865577 Evergreen Albertson 00815 30931 Stagecoach Blvd. Evergreen, CO 80439 (303) 6790403 Evergreen Drug Co. 3847 Evergreen Pky. Evergreen, CO 80439 (303) 674 3338 Mountain Pharmacy 30940 Stagecoach Blvd. Ste. E210 Evergreen, CO 80439 (303) 6743336 Federal Heights King Soopers Pharmacy #34 1575 W. 84th Ave. Federal Heights, CO 80221 (303) 427-9295 Fort Collins Albertson 00814 1636 N. College Ave. Fort Collins. CO 80524 (970) 416-6832 Albertson #0862 3660 S. Mason St. Fort Collins. CO 80525 (970) 223-1990 Albertson #876 731 S. Lemay Fort Collins. CO 80524 (303) 221 5845 Fort Collins Butlers Lemay Pharmacy 1009 S. Lemay Ave. Fort Collins, CO 80524 (970) 482 A 406 Choice City Drug 101 S. College Ave. Fort Collins. CO 80524 (970) 482-1234 K-Mart Pharmacy 04471 2535 S. College Ave. Fort Collins. CO 80525 (970) 484-2975 King Soopers Pharmacy #09 1015 S. Taft Hill Rd. Fort Collins, CO 80521 (970) 221 A940 King Soopers Pharmacy 018 2325 S. College Ave. Fort Collins, CO 80521 (970) 4 84 -14 10 Longs Drug Store 0226 743 S. Lemay Ave. Fort Collins. CO 60524 (970) 4823503 Payless Drug Store #5375 1103 W. Prospect Rd. Fort Collins. CO 80526 (970) 226-2513 Poudre Drug Co 1221 E. Elizabeth Fort Collins, CO 80524 (970) 484-2777 Safeway Pharmacy #0913 216O W. Drake Fort Collins. CO 80521 (970) 4842843 Safeway Pharmacy #1071 460 S. College Ave. Unit a Fort Collins, CO 80521 (970) 484-9534 Safeway Pharmacy # 1552 1426 E. Harmony Rd. Fort Collins, CO 80525 (970) 223-2556 Shopko 02124 135 Bockman Dr. Fort Collins. CO 80525 (970) 2230802 Spring Creek Pharmacy 2001 S. Shields. Bldg. H Fort Collins. CO 80526 (970) 224-1212 Steele's Pharmacy # l Rxplus 309 West Mtn. Fort Collins, CO 80521 (970) 482-1035 Steele's Pharmacy 02 Rxplus 200 W. Foothills Pkw Fort Collins. CO 80525 (970) 223-1510 Steele's Pharmacy #3 Rxplus Fort Collins, CO 80522 (970) 225-9355 Steele's Pharmacy #5 At Poudre Valley Hosp 1025 Lemay Ave. Fort Collins, CO 80524 (970) 4958040 Toddy's Pharmacy 2601 S. Lemay Ave. Fort Collins, CO 80525 (970) 2235678 * Pharmacy is open 24 hours Fart Collins Wal-Mart Pharmacy #I008 5 S. Mason St. Collins, CO 80526 (970) 22343162 Walgi een Drug # 1245 2I60 W. Drake Rd. Sp A5 Fort Grlhns, CO 80526 (970) 484 5841 Fort Lupton Associated Pharmacists Of Fort Lupton l I IS 2i d Sr Fort Upton, CO 80621 (303) 892-7114 Dale Professional Pharmacy 2W Denver Ave. Fort Lupton. CO 80621 (303) 857 fi266 Fort Morgan City Pharmacy 319 Main St. Fort Moigau. CO 80701 (970) 8675608 Gibson Pharmacy 1000 Platte Fort Morgan, CO 80701 (970) 8673576 Safeway Pharmacy #0341 620 Phtte Ave. Fort Morgan, CO 80701 (970) 867-1027 Fountain K k4ait Pharmacy 07082 Hwy. 8587 S. .rain, CO 80817 (719) 390-7880 Wal -Mai t Pharmacy # 1273 6510 Hwy. 8587 Fountain. CO 80817 (719) 391 -1505 Fraser Fraser Drug 535 Xeres, #A 101 Fob 1990 Fraser, CO 80442 (970) 726-IOW Frisco Wal-Mart Pharmacy #0986 840 Summit Blvd. Frisco, CO 80443 (970) 6685961 Fruita City Market Pharmacy #13 135 S. Plum Fruita, CO 81521 (970) 858-9508 Glenwood Springs K-Mart Pharmacy #9261 51027 Hwy. 6 Glenwood Springs, CO 81601 (970) 9455222 Payless Drug Store #5304 1412 Grand Ave. Glenwood Springs, CO 81601 (970) 945 7401 ry Pharmacy #1132 2. -Grand Glenwood Springs. CO 81601 (970) 945-I100 Wal-Mart Pharmacy 01095 3010 Blake Ave. Glenwood Springs, CO 81601 (970) 9455114 Golden Foss Drugs 1224 Washington Ave. Golden. CO 80401 (303) 278-9555 Safeway Pharmacy #0322 1701. Jackson St. Golden, CO 80401 (303) 2782284 Wal-Mart Pharmacy 02293 952 Swede Gulch Rd. Golden, CO 80401 (303) 5262334 Granby Granby Drug Store Inc 337 Agate Ave. Granby, CO 80446 (970) 8873745 Grand Junction City Market Pharmacy #01 2770 Hwy. SOS. Grand Junction, CO 81505 (970) 2454215 City Market Pharmacy #09 1909 N. First St. Grand Junction. CO 81505 (970) 241-9007 City Market Pharmacy #18 2830 North Ave. Eastgate Center Grand Junction, CO 81501 (970) 24SZ381 City Market Pharmacy #25 569 32nd Rd. Coronado Plaza Grand ]unction, CO 81504 (970) 434.9651 City Market Pharmacy #32 200 Rood Ave. Grand Junction, CO 81501 (970) 2412779 City Market Pharmacy #80 137 W. Main St. Grand Junction, CO 81501 (970) 2414)035 City Market Pharmacy #82 425 Patterson Grand Junction. CO 81501 (970) 241 0171 K-Mart Pharmacy 07000 2809 North Ave. Grand Junction. CO 81501 (970) 2434338 Orchard Pharmacy 1060 Orchard Ave., Ste. A Grand Junction. CO 81501 (970) 2433400 Payless Drug Store 05306 1834 N. 12th St. Grand Junction, CO 81501 (970) 2433195 Safeway Pharmacy #1533 2901 Y Rd. Grand Junction, CO 81050 (970) 248-9871 Wal-Mart Pharmacy #1280 2881 North Ave. Grand Junction, CO 8I501 (970) 2416652 Walker Drug 2241 N. 7th Grand Junction, CO 81501 (970) 243-9303 Grand lake Grand Lake Pharmacy 1123 Grand Ave. Grand Lake, CO 80447 (970) 6273465 Greeley Albertsons #0883 2325 23rd Ave. Greeley, CO 80631 (970) 330-6737 Alliance Pharmaceutical Group 822 7th St. Ste. 605 Greeley, CO 80631 (970) 3533316 K4vlart Pharmacy 04934 2400 W. 29th St. Greeley, CO 80631 (970) 330-1015 King Soopers Pharmacy # 1 1 2100 35th Ave. Westland Lake Village Greeley, CO 80632 (970) 339-1717 King Soopers Pharmacy #32 2712 1 I th Ave. Greeley. CO 80631 (970) 353-9780 King Soopers Pharmacy #95 1028 5th Ave. Greeley, CO 80631 (970) 395-9011 Longs Drug Store #248 3540 W. 10th St. Greeley, CO 80634 (970) 353,0330 Payless Drug Store #5371 10123 25 11 th St. Greeley, CO 80631 (970) 352 7395 Payless Drug Store #5373 2626 W. 10th St. Greeley, CO 80631 (970) 353-6748 Rocky Mountain Ltc Pharmacy 3005 W. 29th St., Ste, C Greeley. CO 80631 (970) 3308993 Safeway Pharmacy 00320 1122 11 th Ave. Greeley. CO 80631 (970) 353-0816 Safeway Pharmacy #0918 3526 W. 10th St. Greeley, CO 80631 (970) 351-8650 The Clinic Pharmacy 1900 16th St. Greeley. CO 80631 (970) 3502413 Toddys Pharmacy 2400 W. 16th St. Greeley, CO 80631 (970) 356-1177 Wal-Mart Pharmacy 00980 3103 23r1 Ave. Greeley, CO 80633 (970) 330-4557 Greenwood Village Longs Drug Store #420 8525 E. Arapahoe Rd. Greenwood Village, CO 80111 (303) 221 7391 Gunnison Black%tocks Pharmacy 300 N. Main St. Gunnison, CO 81230 (970) 641-1485 City Market Pharmacy # 19 880 N. Main Gunnison. CO 81230 (Oo) 000 O(M Wal-Mart Pharmacy # 1550 900 N. Main St. Building *a' Gunnison, CO 81230 (970) 641 -1 145 Haxtun Barnes Pharmacy li 105 E. Strohm Haxtun, CO 80731 (970) 774 A252 Highland Ranch Wal-Mart Pharmacy #1252 6675 Buisness Center Dr. Highland Ranch, CO 80126 (303) 850-7818 Highlands Ranch Albertson #0806 9449 S. University Highlands Ranch, CO 80126 (303) 791-9285 Horizon Pharmacy 026 206 W. County Line Rd. Highlands Ranch. CO 80126 (303) 791 -6318 King Soopers Pharmacy #27 9551 S. University Blvd. Highlands Ranch, CO 80126 (303)715AO71 Rite Aid #6236 8675 S. Quebec St. Highlands Ranch, CO 80126 (303) 470-8335 Safeway Pharmacy #1480 9255 S. Broadway Highlands Ranch, CO 80126 (303) 683-0511 Walgreen Drug 03489 9390 S. Colorado Blvd. Highlands Ranch, CO 80126 (303) 683-1159 Holly L M Drug 130 S. Main Holly, CO 81047 (719) 537-6541 Hotchkiss Service United #1709 142 Bridge St. Hotchkiss, CO 81419 (970) 8723250 Hugo Hugo Pharmacy 116 6th St. Hugo, CO 80821 (719) 743-2488 Lakvwnnrl Idaho Springs Clear Creek Pharmacy 2325 Miner Idaho Springs, CO 80452 (303) 5672496 Johnstown Johnstown Drug Company 1 N. Parish Ave. Johnstown, CO 80534 (970) 587A611 Keenesburg Keene Drug Store 35 S. Main St. Keenesburg, CO 80643 (303) 732 A330 Keystone Mountain View Drug 22869 Us Hwy. 6 Keystone, CO 80435 (970) 2627678 Krernmling Clark's United #1708 103 Park Ave. Kremmlhng. CO 60459 (970) 7242^05 La Junta Gibson Pharmacy/McCoy Rx Plus 27496 Frontage Rd. La Junta. CO 81050 (719) 3845205 Jeffers Loma Vista Pharmacy Rxplus 2201 San Juan Ave. La Junta, CO 81050 (719) 3845454 Opera House Pharmacy 223 Colorado Ave. La Junta, CO 81050 (719) 3842521 Wal-Mart Pharmacy 01384 27332 Hwy. 50 Frontage La Junta, CO 81050 (719) 3845954 Lafayette Albertson #0882 200 Waneka Pky. Lafayette, CO 80026 (303) 666-7962 Wal-Mart Pharmacy 01045 30D Waneka Pky. Lafayette, CO 80026 (303) 666,0434 Lakeside Walgreen Drug #1609 5801 W.44th Ave. Lakeside, CO 80212 (303) 480-1619 Lakewood K-Mart Pharmacy #7378 10555 W. Colfax Ave. Lakewood, CO 80215 (303) 2332880 King Soopers Pharmacy #59 1545 S. Kipling Lakewood. CO 80226 (303) 989 84 90 iR Pharmacy is open 24 hours �r Express Scripts° * Wuelje CITY OF FORT COLLINS Copyright © 1998, Express ScriptsNalueRx All rights reserved. This document is proprietary and confidential and cannot be copied or reproduced without prior written permission of Express Scripts/ValueRx. This document has been delivered to the recipient solely for the purpose of permitting the recipient to evaluate a potential relationship with Express ScriptsNalueRx. All other uses are prohibited. Express Scripts° Progressive Healthcare Management Lakewood King Soopers Pharmacy #60 Quail ;wood, CO 80215 (303) 233-1001 Marshalls Pharmacy 8805 W. 141h Ave., Ste, IGO Lakewood. CO 80215 (303) 232-7474 *Payless Drug Store #5326 7677 W. Jewell Ave. Lakewood, CO 80226 (303) 985-1587 Peoples Pharmacy 255 Union Blvd. Ste. I (x) Lakewood, CO 80228 (303) 987 0707 Philnor Pharmacy I t200 W. Colfax Lakewood, CO 80215 (303) 237 7719 Safeway Pharmacy #0041 13111 W. Alameda Pky. Lakewood, CO 80228 (303) 980 0283 Union Square Pharmacy 8015 W. Alameda Ste. loo Lakewood, CO 80226 (303) 274-7877 Walgreen Drug #1556 245 S. Sheridan Blvd. Lakewood, CO 80226 (303) 232 -754 9 Walgreen Dnmg #3299 6300 W. Colfax Ave. r vood. CO 80214 238-0488 Woodridge Pharmacy 2020 Wadsworth Lakewood, CO 80215 (303) 2372717 Las Animas Val ar Med Health Mart 159 Bent Ave. Las Animas, CO 81054 (719) 456-1691 Leadville Sayer -McKee Drug Co 615 Harrison Ave. Leadville. CO 80461 (719) 486-1847 Littleton Albertson 00866 9052 W. Ken Caryl Ave. Littleton, CO 80123 (303) 973 -64 73 Albertson #0871 161 W. County Line Rd. Littleton, CO 80126 (303) 795-1811 Albertson $0874 3615 W. Bowles Littleton, CO 80123 (303) 7948535 Apothecare Pharmacy 7780 S. Broadway, # 190 Littleton, CO 80122 (303) 7382662 ioe Pharmacy 7. i. Broadway Littleton. CO 80122 (303) 7954300 Costco 0468 8686 Park Meadow CV. Dr Littleton, CO 80124 (303) 7088571 Gem Pharmacy 191 E. Orchard Rd, Littleton. CO 80121 (303) 7953154 Horizon Ltc Pharmacy 8089 S. Lincoln St. Littleton, CO 80122 (303).7947507 KMart Pharmacy #3627 8500 W. Cresdine Ave. Littleton. CO 80123 (303) 9710917 Ken Caryl Pharmacy 8340 Sangre De Cristo Littleton, CO 80127 (303) 9797774 King Soopers Pharmacy 025 11747 W. Ken Caryl Ave. Littleton, CO 80127 (303) 9335119 King Soopers Pharmacy 939 5050 E. Arapahoe Rd. Littleton, CO 80122 (303) 7703402 King Soopers Pharmacy #41 6760 S. Pierce St. Littleton, CO 80123 (303) 9792180 King Soopers Pharmacy #47 7575 S. University Blv Littleton, CO 80122 (303) 7982491 King Soopers Pharmacy #50 9820 W. Beliview Littleton, CO 80123 (303) 978-9950 King Soopers Pharmacy #63 8200 S. Holly St. Littleton, CO 80122 (303) 7794242 Littleton Pharmacy 7750 S. Broadway Littleton, CO 80122 (303) 7970377 Payless Drug Store #5328 7951 S. Broadway Littleton, CO 80122 (303) 7950043 Payless Drug Store 05330 6780 S. University Blvd. Littleton, CO 80122 (303) 770-1300 Payless Drug Store #5332 6760 S. Pierce Littleton, CO 80123 (303) 979-1290 Payless DrugStore #5334 5150 E. Arapahoe Littleton, CO 80122 (303) 7734D097 Price Club Pharmacy #443 7900 W. Quincy Ave. Littleton, CO 80123 (303) 932-1505 Safeway Pharmacy #00o9 7500 S. Pierce St, Littleton, CO 80123 (303) 9728600 Safeway Pharmacy #0027 5025 S. Kipling St. Littleton, CO 80127 (303) 973,6795 Wal-Mart Pharmacy 91308 7900 W. Quincey Ave. Littleton, CO 80123 (303) 971 0624 Walgreen Drug #0546 6911 S. University Blvd. Littleton. CO 80120 (303) 7953213 Walgreen Drug # 1728 70 W. Littleton Blvd. Littleton. CO 80120 (303) 795-9933 Walgreen Drug 93298 3000 S. Broadway Cir. Littleton, CO 80110 (303) 761-1673 Walgreen Drug 03510 7496 S. Simms St. Littleton. CO 80127 (303) 904-1023 Walgreen Drug 03589 5870 S. Kipling St. Littleton. CO 80127 (303) 973-4800 Wise Pharmacy 6169 S. Balsam Way Littleton. CO 80123 (303) 9338181 Longmont Albertsons #0890 1750N. Main Longmont. CO 80501 (303) 7762168 Francis St. Pharmacy 1131 Franca St. Longmont. CO 80501 (303) 772-6411 KMart Pharmacy #3310 2151 N. Main St. Longmont, CO 80501 (303) 7722052 King Soopers Pharmacy 042 2255 N. Main St. Longmont, CO 80501 (303) 772 7552 Longmont Clinic Pharmacy 1925 Mountain View Ave. Longmont, CO 80501 (303) 7760709 Medicine Shoppe 01230 510 Coffman Longmont. CO 80501 (303) 772-1551 Safeway Pharmacy 00910 1632 Hover Rd. Longmont, CO 80501 (303) 776-0508 Safeway Pharmacy #1 116 1050 Florida Ave. Longmont, CO 80501 (303) 6820698 Shopko#2118 955 S. Hover Longmont. CO 80501 (303) 651-6771 Wal Mart Pharmacy #o905 800 S. Hover Rd. Longmont. CO 80501 (303) 678 0931 Walgreen Drug 01284 700 9th Ave. Longmont, CO 80501 (303) 772-11 It Walgreen Drug # 1287 1600 Hover Rd. Ste a Longmont. CO 80501 (303) 7760128 Louisville Albertson #0812 910 W. Cherry St. Louisvtlle. CO 80027 (303) 6730697 Apothecare Avista 100 Health Park Dr. Louisville, CO 80027 (303) 673-1234 King Soopers Pharmacy # 13 1375 S. Boulder Rd. Louisville, CO 80027 (303) 673-1818 Safeway Pharmacy #0909 707 S. Boulder Rd. Louisville, CO 80027 (303) 6652025 Walgreen Drug 01286 655 S. Boulder Rd. Louisville. CO 80027 (303) 666-6051 Loveland Albertson #0804 1451 Eisenhower Blvd. Loveland, CO 80537 (970) 667 5642 Columbine Drug 2295 W. Eisenhover Loveland. CO 80538 (970) 6634600 County Market Pharmacy 1325 E. Eisenhower Loveland. CO 80538 (970) 663-6365 Dougs Pharmacy 2033 Boise Loveland, CO 80538 (970) 669-7500 K-Mart Pharmacy #7329 2665 W. Eisenhower Loveland, CO 80537 (970) 6634044 King Soopers Pharmacy 044 253 E. 29th St. Loveland, CO 80537 (970) 669-6275 Medicine Shoppe #0139 1524 W. Eisenhower Loveland, CO 80537 (970) 6695308 Safeway Pharmacy #0914 2321 W. Eisenhower Loveland, CO 80537 (970) 669-1548 Safeway Pharmacy #0915 860 Cleveland Loveland, CO 80537 (970) 6634092 Shopko 02117 950 E. Eisenhower Blvd. Loveland, CO 80537 (970) 962-9388 Wal Mart Pharmacy #0953 3133 N. Garfield Loveland, CO 80537 (970) 6693891 Walgreen Drug #1285 550 Lincoln Ave. Loveland. CO 60537 (970) 6694444 Northglenn Lyons St Vratn Pharmacy Inc 440 Main St. Lyons, CO 80504 (303) 823 A 134 Mancos Old Frontier Pharmacy 136 N. Main Mancos, CO 81328 (970) 5334302 Monte Vista Burns Pharmacy 845 lsl Ave. Monte Vista, CO 81144 (719) 8522778 Centennial Merit Drug Inc 201 Adams St. Monte Vista, CO 81144 (719) 8525106 Montrose City Market Pharmacy #03 128 S. Townsend Montrose, CO 81401 (970) 2492665 City Market Pharmacy #40 16400 S. Townsend Montrose, CO 81401 (970) 2403236 Safeway Pharmacy # 1131 1329 S. Townsend Ave. Montrose. CO 81401 (970) 249-1160 Wal-Mart Pharmacy # 1058 2201 S. Townsend Ave. Montrose. CO 81401 (970) 249 7742 Monument Safeway Pharmacy 01440 624 Hwy, 105 Monument. CO 80132 (719) 488-1189 Nederland Nederland Pharmacy 20 Lakeview Dr., # 115 Nederland, CO 80466 (303) 258-0846 New Castle City Market Pharmacy $41 850 Castle Valley Blvd. New Castle. CO 81647 (970) 9842067 Niwot Steeles Pharmacy #6 7980 Niwot Rd. Niwot, CO 80544 (000) 00000W Northglenn Albertson #0881 500 E. 120th Ave. Northglenn, CO 80233 (303) 4504145 Apothecary Services 11678 Huron St. Northglenn, CO 80234 (303) 4522988 Payless Drug Store #5360 1020 W. 104th Ave. Northglenn, CO 80234 (303) 4572004 * Pharmacy is open 24 hours Northgienn Wheat Ridge Safeway Pharmacy #0935 Malley Dr. .hglenn, CO 80233 t303) 4514221 Nucla The Apothecary Shoppe 480 Main St. Nucia, CO 81424 (970) 864 21IX] Ordway Ordway Pharmacy 231 MainSt, Ordway. CO 81063 (719) 26734 11 Pagosa Springs City M:uke.t Pharmacy #45 63 N. Pagosa Blvd. Pagosa Springs, CO 81147 (970) 731 8006 Jackisch Drug 426 Pagosa Pagosa Springs. CO 81147 (970) 264 4166 Palisade Palisade Pharmacy 707 Elberti Ave. Suite b Palisade. CO 81526 (970) 4645668 Paonia Hays Drug 224 Grand Ave. ia, CO 81428 527 A 109 Parachute City Market Pharmacy #28 0071 Siperelle Dr, Parachute, CO 8 163 5 (970) 285-1651 Parker Albertson #0813 9571 S. Parker Rd. Parker, CO 80134 (303) 841 7120 K-Mart Pharmacy #7538 10901 S. Parker Rd. Parker, CO 80134 (303) 8408168 King Soopers Pharmacy 067 17761 Cottonwood Dr. Parker. CO 80134 (303) 6934804 Parker Drug Parker Square S/c Parker. CO 80134 (303) 841 2030 Safeway Pharmacy #0034 11000 S. Parker Rd. Parker. CO 80134 (303) 841-1866 Pueblo Albertson #0816 1601 Hwy. 50 W. Pueblo, CO 8iom (719) 5435921 :an Pharmaceutical Sery N. Grand Ave. Pueblo, CO 81003 (719) 5442146 Belmont Pharmacy Rxplus It 12 Bonforte Blvd, Pueblo, CO 81001 (719) 5453531 Blende Drug Inc 1910 Santa Fe Dr. Pueblo, CO 81006 (719) 5422477 County Pharmacy 1545 S. Prarie Ave. Pueblo. CO 81005 (719) 5614405 Grove Dnrg 2333 N. Grand Ave. Pueblo, CO 81003 (719) 5443696 J B Pharmacy Rxplus 915 W. Northern Pueblo, CO 81004 (719) 5454811 K-Man Pharmacy #3171 3900 Northern Ave. Pueblo. CO 81005 (719) 5644332 K-Mart Pharmacy #4453 3415 N. Elizabeth St. Pueblo, CO 81003 (719) 5450707 King Soopers Pharmacy # 12 3050 W. Northern Ave. Pueblo, CO 81004 (719) 5640491 King Soopers Pharmacy #43 102 W. 29th St. Pueblo, CO 81003 (719) 5440870 Medical Arts Pharmacy Rxplus 1925 E. Orman Pueblo, CO 81004 (719) 5640700 Mesa Pharmacy Rxplus 25140 Hwy. 50E Pueblo, CO 81006 (719) 5444371 Midtown Grove Drug Store 1000 W. 6th St. Pueblo, CO 81003 (719) 5453412 Payless Drug Store 05303 1801 S. Pueblo Blvd. Pueblo, CO 81005 (719) 5614022 Potter Pharmacy 1214 N. Elizabeth St. Pueblo, CO 81003 (719) 545-1217 Prescription Shop 1728 S. Prairie Pueblo, CO 81005 (719) 564-0220 Safeway Pharmacy #0714 617 W. 29th St. Pueblo. CO 81008 (719) 545.9634 Safeway Pharmacy #0715 1322 E. 8th St. Pueblo. CO 81001 (719) 5424801 Safeway Pharmacy #0729 1231 S. Prairie Ave. Pueblo. CO 81005 (719) 5614407 Seal Pharmacy Ii Inc. 1230 E. 8th St. Pueblo, GO 81001 (719) 5443315 Tom's Pharmacy 1216 S. Prairie Ave. Pueblo, CO 81005 (719) 5660070 Wal-Mart Pharmacy 00842 755 Desert Flower Blvd. Pueblo. CO 81001 (719) 5438348 WaI Mart Pharmacy # I001 4080 W. Northern Ave. Pueblo. CO 81005 (719) 5610951 Whiimans Drug Rxplus 1247 Berkley Ave. Pueblo, CO 81005 (719) 5422802 Rangely Rangely Kotner Drug 101 Main St. Rangely, CO 81648 (970) 6758830 Rifle Ben Rex Pharmacy 1430 Railroad Ave. Rifle. CO 81650 (970) 625-2222 City Market Pharmacy #07 1320 Railroad Ave. Rifle, CO 81650 (970) 62"420 Salida Laliier Pharmacy 147 7" St. Salida. CO 81201 (719) 5392591 Safeway Pharmacy #0817 232 G St. Salida. CO 81201 (719) 539-6933 Wal-Mart Pharmacy #0921 7865 West Hwy. 50 Salida. CO 81201 (719) 53945614 Security Walgreen Drug #1592 330 Main St. Security. CO 80911 (719) 390-9123 Steamboat Springs City Market Pharmacy #14 1825 Central Park Dr. Steamboat Springs, CO 80477 (970) 8797317 Lyon Drug 840 Lincoln Ave. Steamboat Springs. CO 80487 (970) 879-1I15 Safeway Pharmacy 90637 37500 Hwy. 40 E. Steamboat Springs, CO 80477 (970) 8972503 Wal-Mart Pharmacy # 1808 1805 Central Park Dr. Steamboat Springs, CO 80477 (970) 8798688 Sterling Barnes Pharmacy 210 Main St. Sterling. CO 80751 (970) 522,0190 Croft Pharmacy 430 Main Sterling, CO 80751 (970) 522-10% Wal-Mart Pharmacy #0924 102 N. 12th Ave. Sterling, CO 80751 (970) 5228340 Walker's Sterling Pharmacy 410 W. Main St, Sterling, CO 807 S 1 (970) 522-1302 Telluride Sunshine Pharnacv 236 W. Colorado Telluride, CO 81435 (970) 7283001 Thornton Albertson #0851 8978 Washington St. Thornton. CO 60229 (303) 2894355 City View Gateway Medical 8989 N. Huron Thomton, CO 8G2_ 1 (303) 427-0606 K-Mart Pharmacy $4411 1400 E. 104th Ave. Thornton, CO 80229 (303) 252-9150 Payless Drug Store 05358 9171 N. Washington Thornton. CO 80229 (303) 4 51-7046 Safeway Pharmacy #0237 9131 N. Washington St. Thornton. CO 90229 (303) 4510873 Safeway Pharmacy 00242 3904 E. 120th Ave. Thornton. CO 80233 (303) 4572562 Wal-Mart Pharmacy #1231 550 E. 102nd St. Thornton, CO 80229 (303) 451-6404 Walgreen Drug 00358 500 E. 84th Ave. Thornton. CO 80229 (303) 2862953 Walgreen Drug #3207 4001 E. 120th Ave. Thornton. CO 80229 (303) 4515562 Trinidad Caring Unlimited Pharmacy 328 328 Bonadventure Trinidad, CO 91082 (719) 8462386 Horizon Pharmacy # 19 100 E. Main St, Trinidad. CO 81082 (719) 8462201 Safeway Pharmacy #0722 457 W. Main St. Trinidad, CO 81082 (719) 8463086 Wal,IAart Pharmacy $0962 2202 Freedom St Trinidad, CO 810E (719) 8463358 Vail City Market Phamia•-; 442 Vail Apothecary 2099 N. Frontage Vail, CO 81657 (970) 4763762 Eagle Valley Phamac 181 W. Meadow Vail, CO 81657 (970) 479-7253 Walsenburg Star Drug, Inc Rxplus 628 Main Walsenburg, CO '.:::? (719) 738-1130 Westminister King Soopers Pham:a 462 10351 N. Federal Westminister. CC (303) 465-1749 Walgreen Drug #4= 15 5190 W. 1201h A% Westminister. CC ? _; (303) 410-1105 Westminster Albertson% 00820 5150 W. 1200 t A'. - Westminster. CO (303) 404 3639 Albertson 00872 5036 W. 92nd Avs Westminster, CO (303) 650-6527 Albertson 00875 5005 W. 72nd St. Westminster, CO (303) 4282165 Medicine Man Pha=iacy 3291 W. 74 th Ave Westminster, CO (303) 4283559 Phar-Mor 0182 6795 W. 88th Ave Westminster, CO (303) 431-1627 Price Club Pharmacy #440 6400 W. 92nd Ave Westminster. CO 8:� )30 (303) 412-1327 Safeway Pharrrac} *0241 8430 N. Federal B':. d. Westminster, COS :030 (303) 428 7681 Wal-Mart. Pharmac% #2223 9499 Sheridan Blv_ Westminster, CO S:030 (303) 427 7276 Walgreen Drug #2538 8735 Wadsworth r:: e. Westminter. CO 8.=-D03 (303) 4205619 Wheat Ridge American Pharmaceutical Sery 4485 Wadsworht E:'. d. Ste. I I I Wheat Ridge. CO ' -033 (303) 4210230 llt Pharmacy is open 24 hours Wheat Ridge Yuma Foothills Pharmacy W. 38 Th Ave.. # 100 A Ridge, CO 80033 (719) 784 3523 King Soopers Pharmacy 020 3400 Youngfield Wheat Ridge. CO 80033 (303) 238-7301 Lutheran Hospital Pharmacy 8300 W. 38th Ave. Wheat Ridge. CO 80033 (303) 4033544 Paylea-s Drug Store #5350 4260 Wadsworth Blvd. Wheat Ridge. CO 80033 (303) 420-1664 Safeway Pharmacy #1479 2900 Wadsworth Bivdf Wheat Ridge, CO 8t1033 (303) 465441.'. Walgreen Drug #0976 3494 Youngfield St, Wheat Ridge, CO 80033 (303) 4236321 Wheatridge Pharmacy 6650 W. 38th Ave. Wheat Ridge, CO 80033 (303) 4216111 Wheatridge American Pharmaceutical Sery 4485 Wadsworth Blvd., #104 Wheatridge. CO 80033 (303) 421 0230 Windsor S' 's Pharmacy #4 Aain St. CO 80550 (970) 6865050 Woodland Park Drake's Prescriptions 779 Gold Hill PI. Woodland Park, CO 80866 (719) 6876007 Sam's Woodland Park Pharmacy 723 Browning Woodland Park. CO 80866 (719) 687 9249 Wray Foltmer Drug Inc 317 Main St. Wray, CO 80758 (970) 33211911 Yuma D&s Pharmacy 208 S. Main St. Yuma. CO 80759 (970) 8485487 Shop -All Pharmacy 315 E. Sth Ave. Yuma, CO 80759 (970) 848-2877 t# Pharmacy is open 24 hours Alamosa Colorado Springs Alamosa Alamosa Pharmacy 21 1 1 Swart St. Sari Luis Valley Medical Alamosa. CO 81 lol (719) 589-1766 City Market Pharmacy #22 131 Market St, Alamosa, CO 81 101 (719) 589-6656 KMart Pharmacy #7533 157 Craft Dr. Alamosa, CO 81 101 (719) 589IJ444 Valley Wide Pharmacy 1847 2nd St. Alamosa, CO 81 101 (719) 589 3633 Wal Mart Pharmacy #0869 148 Craft Dr. Alamosa, CO 8 110 1 (719) 589A021 Arvada K Mart Pharmacy #4129 9881 W_ 53th Ave. Arvada, CO 80002 (203) 4228008 King Soopers Pharmacy 003 6350 Sheridan Blvd. Arvada, GO 80003 (303) 7154048 K+-- Soopers Pharmacy 022 N. 58 th Ave. .a, CO 80002 (303) 421 -1200 King Sooperss Pharmacy #36 8031 Wadwonh Blvd. Arvada, GO 90005 (303) 420-1377 King Soopers Pharmacy #45 12350 W. 64th Ave. Arvada, CO .80004 (303) 422-1476 Safeway Pharmacy #0328 7561 W. 80th Ave. Arvada, GO 80003 (303) 425-0371 Safeway Pharmacy #0330 9517 Ralston Rd. Arvada, CO 80002 (303) 425-7361 Safeway Pharmacy 01107 12680 W. 64th Ave. Arvada, CO 80004 (303) 423-6886 Aspen Carls Pharmacy 306 E. Main St. Aspen, CO 81612 (970) 9253273 Aurora Albertson #0859 15220 E. 6th St, Aurom, CO 60011 (303) 3404399 N �n #0888 1, S. Smoke Hill Rd. Aurora. CO 8o015 (303) 693-2707 • Family Pharmacy 1724 S. Chambers • Aurora. CO 80017 (303) 6954702 K-Mart Pharmacy #3043 15200 E. Colfax Ave. Aurora, GO 80011 (303) 3417420 King Soopers Pharmacy # 10 15250 E. Mississippi Aurora, CO 80012 (303).6718701 King Soopers Pharmacy If 14 655 Peoria St. Aurora, CO Boo 10 (303) 364 A 196 King Soopers Pharmacy # 16 19711 E. Smokey Hill Rd, Aurora, CO B0016 (303) 7152525 King Soopers Pharmacy 030 1155 S. Havana Aurora. CO 80012 (303) 755-1246 King Soopers Pharmacy #39 3190 S. Parker Rd. Aurora, CO 80014 (303) 7502452 King Soopers Pharmacy #49 17000 E. Iliff Ave. Aurora, CO 80013 (303) 7524777 King Soopers Pharmacy 052 15109 E. Colfax Ave. Aurora, CO 80011 (303) 3433170 King Soopers Pharmacy #66 10400 E. Colfax Ave. Aurora. CO 80010 (303) 361-9064 King Soopers Pharmacy #69 4257 S. Buckley Rd. Aurora, CO 80014 (303) 6808690 Price Club Pharmacy #439 1471 S. Havana St. Aurora, CO 80012 (303) 7508405 Safeway Pharmacy #0136 10777 E. Colfax Ave. Aurora, CO SOmO (303) 3402620 Safeway Pharmacy #0137 12200 E. Mississippi Aurora, CO 8W 10 (303) 6964923 Safeway Pharmacy 00138 1730 S. Buckley Rd. Aurora. CO 80012 (303) 6854694 Safeway Pharmacy #0139 16921 E. Quincy Aurora, CO 80010 (303) 693-9700 Senior Med Pharmacy 14707 E. Second Ave. Ste. 15 Aurora, CO 8001 1 (303) 343-6383 Wal-Mart Pharmacy #1492 14000 E. Exposition Aurora. CO 80012 (303) 3684116 Wal-Mart Pharmacy #1689 4401 S. Buckley Rd, Aurora, CO 80015 (303) 690-6272 Avon City Market Pharmacy #26 260 Beaver Creek Pl. Avon, CO 81620 (970) 949-6437 Wal-Mart Pharmacy # 1199 220 Beaver Creek Pl. Avon, CO 81620 (970) 9498544 Baylleld Mill St Drug Store 498 S. Church Bayfield, CO 81122 (970) 884-9133 Bergen Park King Soopers Pharmacy #64 1173 Colorado Hwy. 74 Bergen Park, CO 80439 (303) 6748246 Berthoud Berthoud Pharmacy 330 Mountain Berthoud. CO 80513 (970) 5322034 Boulder Alpine Pharmacy 1000 Alpine Boulder, CO 80304 (303) 4444448 Broadway Drug & General 2700 Broadway Boulder, CO 80304 (303) 442,0589 Goose Creek Pharmacy 2880 Folsom Boulder. CO 80304 (303) 4404200 Kart Pharmacy #4181 3325 28th St, Boulder, CO 80301 (303) 4444890 King Soopers Pharmacy $28 6550 Lookout Rd. Boulder, CO 80301 (303) 530�0400 King Soopers Pharmacy #33 3600 Table Mesa Dr. Boulder. CO 8=2 (303) 4994244 King Soopers Pharmacy #61 1650 30th St. Boulder. CO 80302 (303) 444,0164 Leevers Pharmacy 1850 Thirtieth St. Boulder, CO 90301 (303) 7867236 Safeway Pharmacy 00911 2798 Arapahoe Boulder, CO 80302 (303) 443-6142 Safeway Pharmacy #o9 t 9 4800 F. Baseline Rd, Boulder, CO 80302 (303) 4948851 Breckenridge City Market Pharmacy #3o 400 N Pky Breckenridge, CO 80424 (970) 453-0818 Brighton Beattie's Community Pharmacy 1295 Bridge St, Ste. 103 Brighton, CO 80601 (303) 655-1500 KMart Pharmacy #3890 825 S E. Kuner Rd. Brighton, CO 80601 (303) 654-0996 Safeway Pharmacy #0917 1605 Bridge St. Brighton. CO 80601 (303) 659-9660 Wal-Mart Pharmacy # 1659 60 W. Bromley Ln. Brighton. GO 80601 (303) 6592510 Broomfield K-Mart Pharmacy #7099 5005 W. 120th Ave. Broomfield. CO 80020 (303) 469-1927 King Soopers Pharmacy #08 5105 W. 120th Ave. Broomfield. CO SW20 (303) 466-1917 King Soopers Pharmacy #55 9983 Wadsworth Blvd. Broomfield. CO 80020 (303) 4247346 Pharmacy Corp Of America 557 Burbank St., Ste. t Broomfield. CO 80020 (303) 460-9474 Safeway Pharmacy # 1146 6775 W. 120th Ave. Broomfield, CO 80020 (303) 4668449 Brush B & B Pharmacy 210 Clayton St. Brush, CO 80723 (970) 842-2416 Buena Vista City Market Pharmacy #37 438 S Hwy. 24 Buena Vista, CO 81211 (719) 3953149 Byers Chase Pharmacy 568 N Hwy. 36 Byers, CO 80103 (303) 822-9371 Canon City Canon United #1714 3163 Eastridge Ln, Canon City. CO 8 12 12 (719) 275-0350 City Market Pharmacy # 17 1703 Fremont Canon City, CO 81212 (719) 2753319 Horizon Pharmacy 020 1337 Phay Caron City, CO 81212 (719) 275.9666 Safeway Pharmacy 00728 1414 Main St. Caron City, CO 81212 (7t9) 275 7511 Wal-Mart Pharmacy x1019 3105 Hwy. 50 Canon City. CO 8121_-- (719) 275-1641 Carbondale City Market Pharmacy #33 250 E. Valley Rd. Carbondale. CO 816:2 (970) 9633730 City Market Pharmac.- -35 1051 Hwy, #133 Carbondale. CO 81623 (970) 963-6727 Castle Rock King Soopers Pharmac; s71 100 Founders Pky. Castle Rock. CO 801 C= (303) 715-2535 Safeway Pharmacy 00033 100 S. Wilcox St. Castle Rock, CO So I (303) 688-6060 Wal-Mart Pharmacy #0984 880 S. Briscoe St. Castle Rock, CO So I (303) 6888335 Cedaredge Cedar Edge Pharmac} 215 Main St. Cedaredge, GO 81413 (970) 8563161 Colorado City Jeff's Valley Phamnac_t' 4491 Bent Bros Blvd. Colorado City, CO 8 i : 9 (719) 6763333 Colorado Springs A Village Pharmacy 3277 W. Carefree Cir. Colorado Springs. CO 8C917 (719) 5962141 Albertson #0858 455 E. Cheyenne Mt. B1. Colorado Springs, CO 90906 (719) 576AO77 College Pharmacy 833 N. Tejon Colorado Springs, CO 80903 (719) 634 4861 K4v1art Pharmacy #4088 701 N. Academy Blvd. Colorado Springs, CO 80909 (719) 4734631 Kart Pharmacy #4332 3020 N. Nevada Colorado Springs, CO 80907 (719) 4733822 K-Mart Pharmacy 07572 5885 Palmer Park Blvd. Colorado Springs, CO 80915 (719) 5975044 A4Express Scripts" r Pharmacy is open 24 hours . Proprassive tMaahearo Manapemenl r.ne 1199 Colorado Springs Dillon King Soopers Pharmacy #06 i W. Unitah ,rado Springs, CO 80904 (719) 636 6046 King Soopers Pharmacy 015 3175 S. Academy Blvd, Colorado Springs, CO 80910 (719) 3409211 King Soopers Pharmacy 037 3650 Austin Bulls Pky. Colorado Springs, CO 80918 (719) 5983578 King Soopers Pharmacy #51 665 Murray Blvd. Colorado Springs, GO 80915 (719) 574-2075 King Soopers Pharmacy 053 6930 N. Academy Blvd. I I Colorado Springs, CO 80918 (719) 5985191 King Soopers Pharmacy #58 815 Cl ieyerare Meadows Rd, Colorado Springs, CO 80906 (719) 527-1694 Medicine Shoppe #0014 3159 W. Colorado Ave. Colorado Springs, CO 80904 (719) 475 9030 Medicine Shoppe #0437 2439 N. Union Blvd. Colorado Springs, CO 80909 (719) 6303154 Medicine Shoppe 01146 2306 N. Waluatch Ave. Colorado Springs, CO 80907 (719) 4713600 -ire Shoppe #1404 Medical Center Pt. Ste, 140 Colorado Springs, CO 80907 (719) 5779800 Musick Drugs 309 E. Fontanero St. Colorado Springs, CO 80933 (719) 632-2634 Safeway Pharmacy #0811 3335 N. Academy Blvd. Colorado Springs, CO 80907 (719) 574 -1560 Safeway Pharmacy #0816 1920 Nevada Colorado Springs, CO 80907 (719) 636-6257 Safeway Pharmacy #0832 3175 W. Colorado Ave. Colorado Springs, CO 80904 (719) 473-7221 Safeway Pharmacy #0835 5060 N. Academy Blvd. Colorado Springs, CO 80918 (719) 593 -14 74 Safeway Pharmacy #0839 840 Village Center Dr. Colorado Springs, CO 80919 (719) 548-1477 Safeway Pharmacy #1064 7655 N. Union Blvd. Colorado Springs, CO 80918 (719) 531 9537 Safeway Pharmacy #1466 1121 N. Circle Dr. C do Springs, CO 80909 73 $O61 Safeway Pharmacy If1499 2895 N. Powers Rd. Colorado Springs, CO 80922 (719) 573.4759 Wal-Mart Pharmacy 01200 701 N. Academy Blvd. Colorado Springs, CO "m (719) 380,0808 Wal-Mart Pharmacy 01434 525 S. 8th St. Colorado Springs, CO 80935 (719).633-7511 Wal-Mart Pharmacy # 1896 8250 Razorback Rd. Colorado Springs, CO 80920 (719) 5932305 Commerce City King Soopers Pharmacy 002 6040 E. 64th Ave. Commerce City. CO 80022 (303) 288-6629 Conifer Aspen Park Drug 25797 Conifer Rd. Conifer, CO 80433 (303) 674-7745 Safeway Pharmacy 00011 10853 Us Rt 285 Conifer, CO 80433 (303) 8389870 Cortez City Market Pharmacy 008 508 E. Main Cortez, CO 81321 (970) 5658466 Wal-Mart Pharmacy #0966 2220 E. Main St. Cortez, GO 31321 (970) 5657038 Craig City Market Pharmacy #15 505 W. Victory Way Craig, CO 81625 (970) 824A449 K-Mart. Pharmacy #7560 1198 W. Victory Craig. CO 81625 (970) 824A376 Safeway Pharmacy #0635 1295 W. Victory Way Craig. CO 81625 (970) 8248118 Dacono Dacono Drug 901 Carbondale Dr. Dacono, CO 80514 (303) 833AO16 Delta City Market Pharmacy #04 122 Gunnison River Dr. Delta. CO 81416 (970) 874-6771 Medicine Shoppe #0735 260 E Hwy. 92 Delta, CO 81416 (970) 8744465 Denver Albertson #0817 3125 S. Sheridan Blvd. Denver, CO 80227 (303) 985A269 Albertson 00880 7475 B Iliff Ave. Denver, CO 80231 (303) 3693243 Albertson #0885 323 S. Broadway Denver, CO 80223 (303) 7448660 Albertson 90887 3909 E. Evan Ave. Denver, CO 80210 (303) 7584474 American Pharmaceutical Sery 1385 S. Colorado Blvd. Ste. #306 Denver, CO 80222 (.303) 759-6335 Apothecare -Portercare 2535 S. Downing C-10 Denver, CO 80210 (303) 7782427 Centura Senior Life Center Outpatient Pharmacy 1601 Lowell Blvd. Denver. CO 80204 (303) 8995263 Colorado Pharmacy 701 E. Colforx, #102 Denver, CO 80203 (303) 863 7644 Harkness Heights Pharmacy 4271 Lowell Blvd. Denver, CO 80211 (303) 455-2171 Huan Pharmacy 633 S. Federal Blvd#203 Denver, CO 80219 (303) 9363230 K-Mart Pharmacy #4121 5051 Federal Blvd. Denver, CO 80221 (303) 4338991 K-Mart Pharmacy $4187 2770 W. Evan Ave. Denver, CO 80219 (303) 9345819 K-Mart Pharmacy 94224 2150 S. Monaco Pky. Denver, CO 80222 (303) 7583520 K-Mart Pharmacy 07303 363 S. Broadway Denver. CO 80203 (303) 7338668 King Soopers Pharmacy #01 1331 N. Speer Blvd. Denver, CO 80204 (303) 571-1943 King Soopers Pharmacy #05 1370 Kearney St. Denver, CO 80220 (303) 388-1689 King Soopers Pharmacy #07 5125 W. Florida Denver. CO 80219 (303) 936-7403 King Soopers Pharmacy 017 2223 S. Monaco Pky. Denver. CO 80222 (303) 7589101 *King Soopers Pharmacy 919 3100 S. Sheridan Blvd. Unit 2 Denver, CO 80227 (303) 937A404 King Soopers Pharmacy #21 825 S. Colorado Blvd. Denver. CO 80222 (303) 7225793 *King Soopers Pharmacy 024 750 E. 104th Ave. Denver, CO 80233 (303) 4528661 King Soopers Pharmacy #26 6470 E. Hampden Ave. Denver, CO 80222 (303) 758-0011 King Soopers Pharmacy 029 1 I55 E. 9th Ave. Denver, CO 80218 (303) 8325298 King Soopers Pharmacy #31 1927 S. Wadsworth Deriver, GO 80227 (303) 9858797 King Soopers Pharmacy #35 890 S. Monaco Pky. Denver, CO 80222 (303) 333-1545 King Soopers Pharmacy 040 12043 W. Alameda Pky. Denier, CO 80228 (303) 9888058 King Soopers Pharmacy #54 7200 W. Alameda Pky. Denver, CO 80226 (303) 934-2284 King Soopers Pharmacy 056 2727 W. Evan Ave. Denver, CO 80219 (303) 936-2377 King Soopem Pharmacy #57 5301 W. 38th Ave. Denver, CO 80212 (303) 4257455 King Soopers Pharmacy 068 3801 E. 120th Ave. Denver, GO 80241 (303) 4519470 King Soopers Pharmacy #72 2700 S. Colorado Blvd. Denver, CO 80222 (303) 71SA057 Lo-Do Pharmacy 1730 Blake St. Ste. #100 Denver, CO 80202 (303) 2948443 Medicine Shoppe #0147 4391 Federal Blvd. Denver, CO 80211 (303) 4338907 Midtown Pharmacy 2005 Franklin Denver, CO 80205 (303) 861 7600 Pencol-Medisave Pharmacy 3535 Cherry Creek N Dr. Denver, CO 80209 (303) 3883613 Safeway Pharmacy #0018 1955 S. Sheridan Blvd, Denver. CO 80227 (303) 9899894 Safeway Pharmacy #0029 4950 E. Hampden Ave. Denver, GO 80222 (303) 691-0317 Safeway Pharmacy #0135 6220 E. 14th Ave. Denver, CO 80220 (303) 322A772 Safeway Pharmacy #0141 4884 Chambers Rd. Denver, CO 80239 (303) 371-6645 Safeway Pharmacy #0201 4860 Pecos St. Denver, CO 80221 (303) 433-6083 Safeway Pharmacy #0244 3800 W. 44th Ave. Denver, CO 80221 (303) 4588438 Safeway Pharmacy #0246 757 E. 20th Ave. Deriver, CO 80205 (303) 861 -1212 Safeway Pharmacy #0342 11088 W. Jewell Ave. Deriver, CO 80226 (303) 9898812 Safeway Pharmacy #0344 9160 W. Colfax Ave. Denver. CO 80214 (303) 232-1259 Safeway Pharmacy #103S 1653 S. Colorado Blvd. Denver, GO 80222 (303) 691 -2962 Safeway Pharmacy # 11 15 7150 Leetsdale Denver, CO 80224 (303) 377 -71I6 Safeway Pharmacy #1248 2660 N. Federal Blvd. Denver, CO 80211 (303) 4 77 -14 70 Safeway Pharmacy #1267 6460 E. Yale Ave. Denver. CO 80222 (303) 6918874 Safeway Pharmacy 03723 315 W. 2nd St. Denver. CO 81050 (719) 384 5616 Saigan Pharmacy 1005 S. Federal Blvd. Denver. CO 80219 (303) 742-0760 Unicare Rx 103543 S. Federal Blvd. Denver, CO 80219 (303) 9343306 University Park Pharmacy 1919 S. University Denver. CO 80210 (303) 7442701 Wal-Mart Pharmacy #2125 440 Wadsworth Blvd. Denver, CO 80226 (970) 2745214 Dillon City Market Pharmacy #20 300 Us Hwy. 6 Dillon, CO 80435 (540) 4685369 ♦ Pharmacy is open 24 hours Durango Highlands Ranch Durango rtsons 00801 . W. College Dr. Durango, CO 81301 (970) 3822228 City Market Pharmacy #06 Town Piz. S/c, #6 Durango, CO 81301 (970) 247-2921 City Market Pharmacy 921 3130 Main Ave. Durango, CO 81301 (970) 247A435 K-Mart Pharmacy #9759 800 S. Camino Del Rio Durango, CO 41301 (.970) 259-2214 Eagle City Market Pharmacy 034 103 Market St. Eagle. CO 81631 (970) 328-1311 Eaton Eaton Drug Store 122 Oak St. Eaton, CO 80615 (970) 454 -A 10 Edgewater King Scopers pharmacy 046 5505 W. 20th Ave. Edgewater, CO 80214 (303) 238J3381 Fawards ads Med Cu Pharmacy --j Beard Creek Rd. Edwards, CO 81632 (970) 926 7476 Elizabeth Country Pharmacy 34061 Forest Park Dr. Elizabeth, CO 80107 (303) 646 -14 45 Safeway Pharmacy 01532 220 S. Elizabeth St. Elizabeth. CO 80107 (303) 6460656 Englewood Albertson #0884 8557 E. Arapahoe Rd. Englewood, CO 80112 (303) 773-9543 Captains Centrum Pharmacy 8200 E. Belleview Ave. Ste. 100C Englewood, CO 80111 (303) 6943784 Health One Prof Pharmacy 14200 E. Arapahoe Rd. Englewood, CO 80112 (303) 6993070 Health Script Pharmcy Services 9 Inverness Dr. E. Englewood, CO 80112 (303) 7993771 Heritage Drug 7475 E. Arapahoe Rd. wood, CO 80112 77040 11 K-Mart Pharmacy #4131 200 W. Belleview Englewood, CO 80110 (303) 7940801 K-Mart Pharmacy 04918 9401 E. Arapahoe Rd. Englewood, CO 80112 (303) 3974949 King Soopers Pharmacy 904 5050 S. Federal Blvd. Englewood, CO 90110 (303).794 4397 King Soopers Pharmacy #48 4910 S. Yosemite Englewood, CO 80110 (303) 7733430 King Soopers Pharmacy 065 101 Englewood Pky. Englewood. CO 80110 (303) 7617817 Phar-Mor # 178 401 W. Girard Ave. Englewood, CO 801 10 (303) 7620622 Safeway Pharmacy #0008 7375 E. Arapahoe Rd. Englewood. CO 80112 (303) 779-5520 Safeway Pharmacy 00017 201 E. Jefferson Ave. Englewood. CO 80110 (303) 7817187 Safeway Pharmacy #1040 8200 S. Quebec Englewood, CO 80111 (303) 7734649 Swedish Professional Pharmacy 4990E Hampden. # 150 Englewood, CO SoI10 (303) 7888776 The Professional Phcy At 799 799 E. Hampden Ave. #120 Englewood, CO 80110 (303) 7887997 Evergreen Albertson #0815 30931 Stagecoach Blvd. Evergreen CO 80439 (303) 6790403 Federal Heights King Soopers Pharmacy #34 1575 W. 84th Ave. Federal Heights. CO 80221 (303) 427-9295 Fort Collins Albertsons 00814 1636 N. College Ave. Fort Collins, CO 80524 (970) 4165832 Albertson #0862 3660 S. Mason St. Fort Collins, CO 80525 (970) 223-IM Albertsons #876 731 S. Lemay Fort Collins. CO 80524 (303) 221-6845 K-Mart Pharmacy 04471 2535 S. College Ave. Fort Collins, CO 80525 (970) 4842975 King Soopers Pharmacy 009 1015 S. Taft Hill Rd. Fort Collins. CO 80521 (970) 2214940 King Soopers Pharmacy 018 2325 S. College Ave. Fort Collins, CO 80521 (970) 484-1410 Safeway Pharmacy #0913 2160 W. Drake Fort Collins, CO 80521 (970) 4842843 Safeway Pharmacy # 1071 460 S. College Ave. Unit a Fort Collins, CO 80524 (970) 484-9534 Safeway Pharmacy 01552 1426 E. Harmony Rd. Fort Collins, CO 80525 (970) 223-2556 Shopko #2124 135 Bockrnan Dr. Fort Collins, CO 80525 (970) 2230802 Wal-Mart Pharmacy 11008 4625 S. Mason St. Fort Collins, CO 80526 (970) 2230162 Fort Lupton Associated Pharmacists Of Fort Lupton 1115 2nd St. Fort Lupton, CO 80621 (303) 8927114 Fort Morgan Gibson Pharmacy 1000 Platte Fort Morgan, CO 80701 (970) 8678576 Safeway Pharmacy 00341 620 Platte Ave. Fort Morgan, CO 80701 (970) 8673027 Fountain K-Mart Pharmacy 07082 6460 Hwy. 8587 S. Fountain, CO 80817 (719) 3907880 Wal-Mart Pharmacy # 1273 6510 Hwy. 8587 Fountain. CO 80817 (719) 391-1505 Fraser Fraser Drug 535 Xerex, #A 101 Pob 1990 Fraser, GO 80442 (970) 7264000 Frisco Wal-Mart Pharmacy #0986 840 Summit Blvd. Frisco, CO 80443 (970) 6685961 Fruita City Market Pharmacy # 13 135 S. Plum Fruita. CO 81521 (970) 8580508 Glenwood Springs K Mart Pharmacy #9261 51027 Hwy. 6 Glenwood Springs, CO 81601 (970) 9455222 Safeway Pharmacy 01132 2001 Grind Glenwood Springs, CO 81601 (970) 945-1100 Wal-Mart Pharmacy 91095 3010 Blake Ave. Glenwood Springs, CO 81601 (970) 9455114 Golden Foss Drugs 1224 Wasiangton Ave. Golden. CD 80401 (303) 2788555 Safeway Pharmacy 00322 1701 Jackson St. Golden. CO 80401 (303) 278= 284 Wal-Mart Pharmacy #2293 952 Swede Gulch Rd. Golden. CO 80401 (303) 526 _334 Granby Granby Drug Store Inc 337 Agate Ave. Granby, CO 80446 (970) 887 C745 Grand Junction City Market Pharmacy #01 2770 Hwc. 50 S. Grand Junction, CO 81505 (970) 245 215 City Market Pharmacy #09 1909 N. F¢st St. Grand Junction, CO 81505 (970) 241-9007 City Market Pharmacy # 18 2830 North Ave. Eastgate Center Grand Junction, CO 81501 (970) 245-6381 City Market Pharmacy 025 569 32nd Rd. Coronado Plaza Grand Junction. CO 81504 (970) 434-9651 City Market Pharmacy #32 200 Rood Ave. Grand Junction CO 81501 (970) 241-2779 City Market Pharmacy #80 137 W. Main St. Grand Junction, CO 81501 (970) 2410035 City Market Pharmacy 082 425 Patterson Grand Junction. CO 81501 (970) 241-9171 K-Mart Pharmacy $7000 2809 North Ave. Grand Junction, CO 81501 (970) 2434338 Safeway Pharmacy # 1533 2901 r Rd. Grand )unction. CO 81050 (970) 248-9871 Wal-Mart Pharmacy # 1280 2881 North Ave. Grand Junction, CO 81501 (970) 241-6652 Walker Drug 2241 N. 7th Grand Junction. CO 81501 (970) 243-9303 Greeley Albertsons #0883 2325 23rd Ave. Greeley. CO 80631 (970) 330-6737 Alliance Pharmaceutical Group 822 7th St. Ste. 605 Greeley, CO 80631 (970) 3533316 K-Mart Pharmacy 04934 2400 W. 29th St, Greeley, CO 80631 (970) 330-1015 King Soopers Pharmacy #11 2100 35th Ave. Westland Lake Village Greeley. CO 80632 (970) 339-1717 King Scope" Pharmacy 032 2712 11 th Ave. Greeley, CO 80631 (970) 353-9780 King Soopers Pharmacy #95 1028 Sth Ave. Greeley, CO 80631 (970) 395-9011 Rocky Mountain Ltc Pharmacy 3005 W. 29th St.. Ste. C Greeley. CO 80631 (970) 3308993 Safeway Pharmacy 00320 1122 11 th Ave. Greeley, CO 80631 (970) 3530816 Safeway Pharmacy 009I S 3526 W. 10th St. Greeley, CO 80631 (970) 3518650 Wal-Mart Pharmacy #0980 3103 23rd Ave. Greeley. CO 80633 (970) 3304557 Gunnison City Market Pharmacy 019 880 N. Main Gunnison, CO 81230 (000) 0000000 Wal-Mart Pharmacy 01550 900 N. Main St. Building *a' Gunnison. CO 81230 (970) 64 t 4145 Highland Ranch Wal-Mart Pharmacy # 1252 6675 Buisness Center Dr. Highland Ranch, CO 80126 (303) 8507818 Highlands Ranch Arbertsons 00806 9449 S. University Highlands Ranch, CO 80126 (303) 791-9285 llt Pharmacy is open 24 hours Highlands Ranch Pueblo Horizon Pharmacy #26 'N. County Line Rd. ,at ids Ranch. CO 80126 (303) 791 6318 King Soopers Pharmacy #27 9551 S. Universtty Blvd. Highlands Ranch, CO 80126 (303) 715AO71 Safeway Pharmacy #1480 9255 S Broadway Highlands Ranch. CO 80126 (303) 6834)511 Hotchkiss Service United #1709 142 Bridge St. Hotchkiss, CO 81419 (970) R723250 Hugo Hugo Pharmacy 116 6th St Hugo. CO 80821 (719) 7432488 Idaho Springs Clear Creek Pharmacy 2325 Miner Idaho Spru igs, CO 80452 (303) 567-2496 Keystone Mountain View Drug 22869 Us Hwy, 6 Keystone. CO 80435 (970) 262-7678 v ruling s United #1708 103 Park Ave. Kremmling, CO 80459 (970) 7243205 La Junta Opera House Pharmacy 223 Colorado Ave. La Junta, CO 81050 (719) 384 2521 Wal -Mai t Pharmacy # 1384 27332 Hwy. 50 Frontage La Junta, CO 81050 (719) 384-6954 Lafayette Albertson #0892 200 Waneka Pky. Lafayette, CO 80026 (303) 6667962 Wal-Mart Pharmacy #1045 300 Waneka Pky, Lafayette. CO 80026 (303) 666,0434 Lakewood K Mart Pharmacy #7378 10555 W. Colfax Ave. Lakewood, CO 80215 (303) 2332880 King Soopers Pharmacy 059 1545 S. Kipling Lakewood, CO 80226 (303) 9898490 Ki, "oopers Pharmacy #60 1 'Jail La.. ood. CO 80215 (303) 233-1001 Peoples Pharmacy 255 Union Blvd. Ste. 100 Lakewood, CO 80228 (303) 9870707 Safeway Pharmacy #0041 13111 W. Alameda Pky. Lakewood, CO 80228 (303) 98040283 Las Animas Vale -Med Health Mart 159 Bent Ave. Las Animas, CO 81054 (719) 456-1691 Littleton Albertson #0866 9052 W. Ken Caryl Ave. Littleton. CO 90123 (303) 9736473 Albertson 00871 161 W. County Line Rd. Littleton, CO 80126 (303) 7954811 Albertson #0874 3615 W. Bowles Littleton, CO 80123 (303) 7948535 Apothecare Pharmacy 7780 S. Broadway, # 190 Littleton, CO 80122 (303) 738-2662 Costco 9468 8686 Park Meadow Ctr. Dr Littleton, CO 80124 (303) 7088571 Horizon Ltc Pharmacy 8089 S. Lincoln St. Littleton. CO 80122 (303) 7947507 K-Mart Pharmacy #3627 8500 W.Cresdine Ave. Littleton, CO 80123 (303) 9710917 Ken Caryl Pharmacy 8340 Sangre De Cristo Littleton, CO 80127 (303) 9797774 King Soopers Pharmacy #25 11747 W. Ken Caryl Ave. Littleton, CO 80127 (303) 933-6119 King Soopers Pharmacy 938 5050 E. Arapahoe Rd. Littleton, CO 80122 (303) 7703402 King Soopers Pharmacy #41 6760 S. Pierce St. Littleton, CO 80123 (303) 9792180 King Soopers Pharmacy #47 7575 S. University Blv Littleton, CO 80122 (303) 7982491 King Soopers Pharmacy 050 9820 W. Bellview Littleton, CO 80123 (303) 978-9950 King Soopers Pharmacy 063 8200 S. Holly St. Littleton, CO 80122 (303) 7794242 Price Club Pharmacy 0443 7900 W. Quincy Ave. Littleton, CO 80123 (303) 932-1505 Safeway Pharmacy #0009 7500 S. Pierce St Littleton. CO 80123 (303) 9728600 Safeway Pharmacy #0027 5025 S. Kipling St. Littleton, CO 80127 (303) 9736795 Wal-Mart Pharmacy 01308 7900 W. Quincey Ave. Littleton. CO 80123 (303) 971 D624 Wise Pharmacy 6169 S. Balsam Way Littleton, CO 80123 (303) 9338181 Longmont Albertson 00890 1750 N. Main Longmont. CO 80501 (303) 7762168 K-Mart Pharmacy 03310 2151 N. Main St. Longmont, CO 80501 (303) 7722052 King Soopem Pharmacy #42 2255 N. Main St. Longmont. CO 80501 (303) 7727552 Longmont Clinic Pharmacy 1925 Mountain View Ave. Longmont, CO 80501 (303) 776-0709 Medicine Shoppe #1230 510 Coffman Longmont. CO 80501 (303) 772-1551 Safeway Pharmacy 009I0 1632 Hover Rd. Longmont. CO 80501 (303) 776-0508 Safeway Pharmacy # 1116 1050 Florida Ave. Longmont, CO 80501 (303) 682-0698 Shopko #2118 955 S. Hover Longmont, CO 80501 (303) 6516771 Wal-Mart Pharmacy #0905 800 S. Hover Rd. Longmont, CO 80501 (303) 6780931 Louisville Albertson #0812 910 W. Cherry St. Louisville. CO 80027 (303) 6730697 King Soopers Pharmacy # 13 1375 S. Boulder Rd. Louisville. CO BW27 (303) 673-1818 Safeway Pharmacy #0909 707 S. Boulder Rd. Louisville. CO 00027 (303) 6652025 Loveland Albertson 00904 1451 Eisenhower Blvd. Loveland. CO 80537 (970) 6675642 Columbine Drug 2295 W. Eisenhower Loveland. CO 80538 (970) 6634600 County Market Pharmacy 1325 E. Eisenhower Loveland, CO 80538 (970) 6636365 K4Nart Pharmacy #7329 2665 W. Eisenhower Loveland, CO 80537 (970) 6634044 King Soopers Phamracy 044 253 E. 29th St. Loveland, CO 80537 (970) 6696275 Medicine Shoppe 00139 1524 W. Eisenhower Loveland, CO 80537 (970) 669-5308 Safeway Pharmacy #0914 2321 W. Eisenhower Loveland, CO 80537 (970) 669-1548 Safeway Pharmacy #0915 860 Cleveland Loveland, CO 80537 (970) 6634092 Shopko 02117 950 E. Eisenhower Blvd. Loveland. CO 80537 (970) 962-9388 Wal-Mart Pharmacy #0953 3133 N. Garfield Loveland, CO 80537 (970) 6693991 Lyons St Wain Pharmacy Inc 440 Main St. Lyon, CO 80504 (303) 823-9134 Mancos Old Frontier Phamracy 136 N. Main Mancos, CO 81328 (970) 533-1302 Montrose City Market Pharmacy #03 128 S. Townsend Montrose, CO 81401 (970) 2492665 City Market Pharmacy #40 16400 S. Townsend Montrose, CO 81401 (970) 2403236 Safeway Pharmacy 01131 1329 S. Townsend Ave. Montrose, CO 81401 (970) 2494160 Wal-Mart Pharmacy 01058 2201 S. Townsend Ave. Montrose. CO 81401 (970) 249 7742 Monument Safeway Pharmacy # 1440 624 Hwy. 105 Monument. CO 80132 (719) 488-1189 New Castle City Market Phi macy 041 850 Castle Valley Blvd. New Castle, CO 81647 (970) 984 -2067 Northglenn Albertson 00981 500 E. 120th Ave. Northglenn, CO 80233 (303) 4504145 Apothecary Services 11678 Huron St. Northglenn. CO 80234 (303) 4522988 Safeway Pharmacy #0935 650 Malley Dr. Northglenn, CO 80233 (303) 451 -9221 Pagosa Springs City Market Pharmacy 045 63 N. Pagosa Blvd, Pagosa Springs, CO 8 114 7 (970) 731 6006 Palisade Palisade Pharmacy 707 Elberta Ave. Suite b Palisade. CO 81526 (970) 4645668 Parachute City Market Pharmacy 928 0071 Siperelle Dr. Parachute. CO 81635 (970) 285-1651 Parker Albertsons #0813 9571 S. Parker Rd. Parker. CO 80134 (303) 84 I -7120 K4.4art Pharmacy 07538 10901 S. Parker Rd. Parker. CO 80134 (303) 8408168 King Soopers Pharmacy #67 17761 Cottonwood Dr. Parker. CO 80134 (303) 6934804 Safeway Pharmacy 00034 11000 S. Parker Rd. Parker, CO 80134 (303) 841 -1866 Pueblo Albertson #0816 1601 Hwy. 50 W. Pueblo, CO 81008 (719) 543-6921 American Pharmaceutical Sery 2329 N. Grand Ave. Pueblo. CO 81003 (719) 5442146 Blende Drug Inc 1910 Santa Fe Dr. Pueblo, CO 81006 (719) 542 -24 77 K-Mart Pharmacy #3171 3960 Northern Ave. Pueblo, CO 81005 (719) 5644332 4 ! Pharmacy is open 24 hours Pueblo Wray K-Mart Pharmacy #4453 5 N. Elizabeth St. ,lo, CO 81003 V 19) 5450707 King Soopers Pharmacy #12 3050 W. Northern Ave. Pueblo, CO 81004 (719) 564-0491 King Sooprrs Pharmacy 043 102 W. 29th St, Pueblo. CO 81003 (719) 544,0870 Midtown Grove Drug Store 1000 W. 6th St. Pueblo, CO 81003 (719) 5453412 Safeway Pharmacy #0714 617 W. 29th St, Pueblo, CO 81008 (719) 54540634 Safeway Pharmacy #0715 1322 E. 8d, St, Pueblo, CO 81001 (719) 5424801 Safeway Pharmacy 00729 1231 S. Prairie Ave. Pueblo. CO 81005 (719) 5614407 Wal-Mart Pharmacy #0842 755 Desert Flower Blvd. Pueblo. CO 81001 (719) S43a3348 Wal-Mart Pharmacy #1001 4080 W. Northern Ave. Pueblo, CO 81005 (719) 561 0951 ely kangely Komer Drug 101 Main St. Rangely, CO 81648 (970) 675-9830 Rifle City Market Pharmacy #07 1320 Railroad Ave. Rifle, CO 81650 (970) 625-9420 Salida Safeway Pharmacy 90817 232 G St. Salida, CO 81201 (719) 539.6933 Wal-Mart Pharmacy #0921 7865 West Hwy. 50 Salida, CO 81201 (719) 53M614 Steamboat Springs City Market Pharmacy #14 1825 Central Park Dr. Steamboat Springs, CO 80477 (970) 879-7317 Safeway Pharmacy #0637 37500 Hwy. 40 E. Steamboat Springs, CO 80477 (970) 897-2503 Wal-Mart Pharmacy #1808 1805 Central Park Dr. Steamboat .Springs, CO 80477 (970) 8793688 Sterling Wal-Mart Pharmacy 00924 102 N. 12th Ave. Sterling, CO 80751 (970) 522-8340 Telluride Sunshine Pharmacy 236 W. Colorado Telluride, CO 81435 (970) 7283601 Thornton Albertson #0851 8978 Washington St. Thornton. CO 80229 (303) 289A355 K-Mart Pharmacy $4411 1400 E. 104th Ave. Thornton, CO 80229 (303) 252-9150 Safeway Pharmacy #0237 9131 N. Washington St. Thornton, CO 80229 (303) 451,0873 Safeway Pharmacy #0242 3904 E. 120th Ave. Thornton, CO 80233 (303) 4572562 Wal-Mart Pharmacy # 1231 550 E. 102rd St. Thornton, CO 80229 (303) 451 Z404 Trinidad Horizon Pharmacy #19 100 E. Main St. Trinidad, CO 81082 (719) 8462201 Safeway Pharmacy 90722 457 W. Main St. Trinidad, CO 81082 (719) 8463086 Wal-Mart Pharmacy #0962 2202 Freedom St. Trinidad, CO 81082 (719) 8463358 Vail City Market Pharmacy #42 Vail Apothecary 2099 N. Frontage Rd. Vail, CO 81657 (970) 4763762 Eagle Valley Pharmacy 181 W. Meadow Dr. Vail, CO 81657 (970) 4797253 Westminister King Soopers Pharmacy 062 10351 N. Federal Blvd. Wesunintster, CO 80030 (303) 4654749 Westminster Albertson #0820 5150 W. 120111 Ave. Westminster, CO 60030 (303) 4043639 Albertson #0872 5036 W. 92rd Ave. Westminster, CO 80030 (303) 650E527 Albertson #0875 5005 W. 72n1d St. Westminster, CO 80030 (303) 4282165 Phar-Mor #182 6795 W. 88th Ave. Westminster. CO BW30 (303) 431-1627 Price Club Pharmacy $440 6400 W. 92nd Ave. Westminster, CO BW30 (303) 4124327 Safeway Pharmacy #0241 8430 N. Federal Blvd, Westminster, CO 80030 (303) 4287681 Wal-Mart Pharmacy 02223 9499 Sheridan Blvd. Westminster, CO 80030 (303) 4277276 Wheat Ridge American Pharmaceutical Sery 4485 Wadsworht Blvd. Ste. I I 1 Wheat Ridge, CO BW33 (303) 421-0230 King Soopers Pharnacy #20 3400 Youngfield Wheat Ridge, CO 8W33 (303) 2387301 Lutheran Hospital Pharmacy 8300 W. 38th Ave. Wheat Ridge. CO 80033 (303) 4033544 Safeway Pharmacy #1479 3900 Wadsworth Blvdf Wheat Ridge, CO 80033 (303) 465A413 Wheatridge American Pharmaceutical Sery 4485 Wadsworth Blvd., 0104 Wheatridge. CO 80033 (303) 4210230 Windsor Steele's Pharmacy #4 1159 Main St. Windsor, CO 80550 (970) 686-6050 Woodland Park Drake's Prescriptions 779 Cold Hill Pl. Woodland Park, CO 80866 (719) 687-6007 Wray Foltmer Drug Inc 317 Main St. Wray. CO 80758 (970) 3324911 * Pharmacy is open 24 hours Express Scripts* Progressive Healthcare Management GeoNetwork Analysis Summary The City of Fort Collins The Express Scripts' Provider Networks provide a minimum of one provider within 5 miles accessibility at the following levels: ::..Y..:::::.:..::.:::::::::.:::::: r, ::.......... .. .: .)'.)v.:.. .. .......:.�:::::: ...... .............. ............. }) 4n. it..v v: 3. y,:;.}}.:�4�:}}}::::�i:: ;.YY:.}:4::.Yi•: :::.:::::}:<.:::::::. .,. ...::......,�:: �.Y}:.. ::..: �::::.�:.:: ::...... �7.�'�lFiA7I .::::::::::: :.:::: c4:::ii" I 95.5 95.5 100.0 93.5 97.9 * Some members do not have a licensed pharmacy within 5 miles of their residence. Only 95.5% have a licensed available pharmacy within 5 miles, therefore ESI's PERxSelect network has 100.0% of the total available providers within 5 miles. The City of Fort Collins Network Pharmacy Accessibility Analysis July 27, 1998 A report on the accessibility of the Express Scripts, Inc. (PERxSelect Network) for the employees of The City of Fort Collins Express Scripts, Inc. 14000 Riverport Drive Maryland Heights, MO 63043 Phone: 1-800-332-5455 Fax: 1-314-770-0164 http-//www.express-scripts.com THIS FORM MUST BE COMPLETED BY ALL PROPOSERS CITY OF FORT COLLINS, COLORADO PROPOSAL FORM COVERAGES QUOTING (Please check all that apply) CARVE -OUT MEDICAL PPO PPO POS EPO Stop- PRESCRIPTION Network Network Network TPA UR Loss DRUGS Our proposal is valid for 90 days 2. Fee/Rate Guarantee PPO Network months POS Network months EPO Network months TPA months UR months Stop -Loss months Carve -out PPO Prescription Drugs 36 months 3. Standard & Poor's Rating (if applicable): N/A 4. Commissions: Yes No No If Yes: To Whom: $ /year 5. Contact Name (in case of questions regarding proposal): Gary Hattendorf Telephone Number: 1-800-955-1171. extension 2003 Fax Number: 602-225-2861 6. Carrier Name: Express Scripts/ValueRx 7. Complete the following: Express Scripts/ValueRx COMPANY NAME JulL27. 1998 DATE Ika tA SIGNATURE Kurt Blumenthal PRINTED SIGNATURE Vice President of Finance TITLE 14000 Riverport Drive ADDRESS Maryland Heights Missouri. 64043 CITY, STATE, ZIP CODE St. Louis County COUNTY 314-770-1666. extension 7487 TELEPHONE NUMBER ANSWERS MUST BE PROVIDED FOR ALL ABOVE QUESTIONS ON THIS FORM. DO NOT REFERENCE ANOTHER SECTION OF THE PROPOSAL FOR YOUR RESPONSE. Express Scripts, Inc. (PERxSelect Network) - The City of Fort Collins i Table of Contents Access standard comparison................................................................................................................. 1 All Employees All Providers Accessibilitysummary ......................................................................................................................... 2 All Employees All Providers 1 provider within 5 miles of covered member All Accessibilitysummary......................................................................................................................... 3 All Employees All Providers 1 provider within 5 miles of covered member Without ZIP Codes not meeting the access standard........................................................................................... 4 All Employees All Providers 1 provider within 5 miles of covered member Without Express Scripts, Inc. (PERxSelect Network) - The City of Fort Collins Access standard comparison Access standard comparison All Employees . All Providers P e 80 r c e t 60 0 f e m 40 p I 0 Y e e 20 s 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Miles to a choice of providers 1 provider 2 providers 3 providers 4 providers 5 providers Express Scripts, Inc. (PERxSelect Network) - The City of Fort Collins 2 Accessibility summary I Arovtder group, ) All Providers ' 46,217 providers at 49,771 locations (based on 50,523 records) EmpCoyee.raup All Employees 1,203 employees XC t ss. Stdlnd. 1 provider within 5 miles of covered member ill t?rnp.j 1,203(100.0%) Key geogr�pEtie areas AH employees:: �.> rwmfser_af Percent Averagelutance G�ty employe a► w wu to r. }�rewd. FORT COLLINS, CO 947 100 0 . 1.3 LOVELAND, CO 71 94 6 2.1 LAPORTE, CO 44 100 0 2.4 WELLINGTON, CO 29 45 55 4.4 WINDSOR, CO 28 100 0 2.5 BELLVUE, CO 16 56 44 4.8 LIVERMORE, CO 9 0 100 18.5 GREELEY, CO 8 100 0 1.5 EATON, CO 5 100 0 4.0 GILL, CO 5 0 100 8.4 10 Express Scripts, Inc. (PERxSelect Network) - The City of fort Collins 3 Accessibility summary ACi!>ility apalysispcii"iattidas Provicler, group' All Providers 46,217 providers at 49,771 locations (based on 50,523 records) Ef#iployee group All Employees 1,203 employees fi CeSS standard 1 provider within 5 miles of covered member Etrtp byees itl: Out 54 (4.5%) desired access Express Scripts, Inc. (PERxSelect Network) - The City of Fort Collins 4 ZIP Codes not meeting the access standard 80610 2 0 2 100 7.8 80512 1b p 7 . d 49 bbl 80515 1 0 1 too 7.1 80624 5 0 5 _. 100 _ 8.4 80536 9 0 9._ too 18.5 8Q538 39 = 3 2 5 Sib 80539 2 0 2 100 6.0 $f154o t 0 1 _ i' too. 5.7 80541 2 0 2 too 6.0 So650 3 b 2 _ G 100 1 }0 80651 1 0 1 100 10.1 Si)545 3 :: 0 3 }00 356 80549 29 0 16 55 5.5 8083 1 Q 1 100 351 113 3 54 48 10.7 %ccess standard: 1 provider within 5 miles of covered member Provider group: All Providers The City of Fort Collins Network Pharmacy Accessibility Analysis July 27, 1998 A report on the accessibility of the Express Scripts, Inc. (PERxCare Network) for the employees of The City of Fort Collins Express Scripts, Inc. 14000 Riverport Drive Maryland Heights, MO 63043 Phone: 1-800-332-5455 Fax: 1-314-770-0164 httpV/www.express-scripts.com Express Scripts, Inc. (PERxCare Network) - The City of Fort Collins i Table of Contents Accessstandard comparison................................................................................................................. 1 All Employees All Providers Accessibilitysummary......................................................................................................................... 2 All Employees All Providers 1 provider within 5 miles of covered member All Accessibilitysummary......................................................................................................................... 3 All Employees All Providers 1 provider within 5 miles of covered member Without ZIP Codes not meeting the access standard........................................................................................... 4 All Employees All Providers 1 provider within 5 miles of covered member Without Express Scripts, Inc. (PERxCare Network) - The City of Fort Collins Access standard comparison Access standard comparison All Ernfo- pes All ProyWers 100% P e 80 r c e n t 60 0 f e m 40 P 1 0 Y c e 20 s 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Miles to a choice of providers 1 provider 2 providers 3 providers 4 providers 5 providers 1 Express Scripts, Inc. (PERxCare Network) - The City of Fort Collins Z Accessibility summary ACc-essibl lity drtlysis 511~ieaiiohs _ .. .... PfOvidr group All Providers 3 7,5 85 providers at 39,649 locations (based on 40,210 records) Employee group All Employees 1,203 employees Access s#anrlard 1 provider within S miles of covered member All employees 1,203 (loo.o^i^) Express Scripts, Inc. (PERxCare Network) - The City of Fort Collins Accessibility summary 3 Executive Summary Questionnaire Cost Quotation) Performance Guarantees Exhibits: Network Provider Contract 1 ClientAgreement 2 Member Communication Packet 3 Annual Report & 1st Quarter Financial Report 4 Statement of Confirmation 5 Implementation Timeline 6 Standard Report Packet 7 State of Colorado Network Listing 8 Geo Access Analysis Summary 9 Mail Service Communications 10 Formulary Listing 11 Certificate of Insurance 4 Express Scripts* Progressive Healthcare Management Express Scripts, Inc. (PERxCare Network) - The City of Fort Collins ZIP Codes not meeting the access standard AWE 7ota1 7ota1, 'Ztft itmher of aumfxY<irf Cork ampMyeec provides f*lemtrer 80512 16 0 7 s�51 s i 0 1 80615 5 1 1 80524 177 4 6 80624 5 0 5 80535 44 0 14 80536 9 0 9 8f1538 39 3 1 80540 1 0 1 80650 2 0 2 80651 1 0 1 80545 3 <I 0 3 80549 29 0 26 8Z083 1 U t 333 A 78 ,ccess standard: 1 provider within 5 miles of covered member Provider group: All Providers ryegs >�diout 44 .................................................... 6.4 1 oa e� 20 6.4 3 75 100 8.7 32 73 100 22.4 3 Si 100 5.4 1(10 era ................... 100 11.0 100 36s6 90 6.8 1 nn . yin 23 1 10.4 4 V♦ � Express Scri pt5 Progressive Healthcare Management v Date Dear Dr 14000 Riverport Drive Maryland Heights, M0 63043 314-770-1666 800-332-5455 http://www.express-scripts.com Thank you for assisting us in controlling the prescription medication costs for your patient through the use of a less expensive alternative to . We have changed the prescription you wrote for this medication as we discussed to the preferred product . By prescribing the preferred product in the future, you will assist us in lowering the cost of the prescription benefit for our members health plan. To avoid any confusion and summarize our conversation, here is documentation to attach to your patients chart. Patients name: Original medication: New medication: Approved by: date / / ❑ Your patient was consulted and approved this change. ❑ No change in medication was made at your patients request. Sincerely, confinnl.doc Pharmacy Benefit Management • Informed Decision Counseling . Disease Management Healthcare Information Management . Infusion Therapy Management . Eyecare Management �♦ Express Scri ptV Progressive Healthcare Management v Date: Dear ID# The medication originally prescribed for you is not covered by your insurance. to change the prescription to This is a similar medication used to treat the same condition. 14000 Riverport Drive Maryland Heights, MO 63043 314-770-1666 800-332-5455 http://www.express-scripts.com which was Your physician has agreed Your Express Scripts pharmacist works with your physician to provide you with the safest and most effective therapy available. Our goal is to maximize your health care benefit by controlling costs. This is accomplished through the use of generic medications and therapeutic alternatives that your physician agrees are appropriate for the proper treatment of your condition. If you have any questions regarding this change, please call me at 1-800-451-6245. Extension axxcl.doc Ph. Pharmacy Benefit Management • Informed Decision Counseling • Disease Management Healthcare Information Management . Infusion Therapy Management . Eyecare Management �♦ Express Scri ptV Progressive Healthcare Management v Date: Dear ID# 14000 Riverport Drive Maryland Heights, MO 63043 314-770-1666 800-332-5455 http://www.express-scripts.com Your physician has agreed to change your prescription written for to This is a similar medication used to treat the same condition. is not covered by your insurance. Your express Scripts pharmacist works with your physician to provide you with the safest and most effective therapy available. Our goal is to maximize your health care benefit by controlling costs. This is accomplished through the use of generic medications and therapeutic alternatives that your physician agrees are appropriate for the proper treatment of your condition. If you have any questions regarding this change, please call me at 1-800-451-6245. Extension Pharmacy Benefit Management • Informed Decision Counseling + Disease Management Healthcare Information Management . Infusion Therapy Management . Eyecare Management �AW Express Scripts® IVProgressive Healthcare Management 000045-A-002-001-0D0045 JOHN DOE 14000 RIVERPORT MARYLAND HEIGHTS MO 63043-4805 Dear Member: 14000 Riverport Drive St. Louis, MO 63043 (314)770-1666 COPAYS QUOTED ON THIS LETTER ARE BASED UPON YOUR BENEFIT IN EFFECT AT THE TIME OF PRINTING. IF YOUR BENEFIT HAS CHANGED AFTER THE DATE ON THIS LETTER, YOUR ACTUAL COPAY MAY BE DIFFERENT. 04/01/97 Your prescription drug plan offers a Mail service Pharmacy option through Express scripts. This plan will save you money and allow you the convenience of having your medicine delivered to your home or office. In addition to the convenience of home delivery, mail service prescriptions can be filled for up to a ninety day supply for one copay. Mail service is particularly convenient for maintenance medications... those prescriptions taken over a long period of time. According to our records, you or a member of your family has received prescriptions for certain maintenance medications during the last three months. Express scripts also administers your Prescription Drug Card program and if you had sent the prescriptions listed below to the Express Scripts Mail service Pharmacy, you could have saved time and money: --- Local Pharmacy ---- ---- Express scripts --- Medication 1-30 Day 3-30 Day 1-90 Day savings -------- -------- ---------------- -------- ;TAC 150MG $5.00 $15.00 $5.00 $10.00 LOTENSIN 10MG $3.00 $9.00 $3.00 $6.00 Your Total savings: $16.00 Please look at the Total savings column and see how much money you could have saved by mailing your maintenance medication prescriptions to Express scripts. We have enclosed an Express scripts mailer envelope and a copay coupon to reduce your cost for each of the above prescriptions so you can decide for yourself if the Express scripts Mail Service Pharmacy serves your needs for convenience and cost savings. If you would like to have your prescriptions filled by Express scripts, contact your physician for new prescriptions. If you would like a 90 day supply, please have your physician indicate the appropriate quantity on your prescriptions. Thank you for considering Express scripts. If you have any questions concerning this letter please call Express scripts at 1-800-206-4005. Sincerely, Dan Cordes R.Ph. Vice President of Pharmacy 45616889100 Pricing quoted on this letter assumes that, if applicable, your mail service deductible has been met, your benefit cap has not been exceeded, and your out of pocket maximum has not been met. No Text CD N 1 MEMBER LOC PROD QTY RPH DEO 00 6305338 6 P A049 0712 VASOTEC TAB 5MG 90 ea SZB age 07/15/98 ITEM TOTAL: ****** END PICK LIST FOR ORDER NUM 86166925 ****** {� CUSTOMER SERVICE qg Express Scripts' P.O. BOX 66773 QUESTIONS w Progressive Healthcare Management ST_LOUIS_MO GJ n W Z 07/15/98 Order No: 86166925 w 0 w MEMBER Rx 6305338 VASOTEC TAB 5MG 90 ea $89.41 0 " PAYMENT $0.00 00 Cr a. w x m r z Z O Cc a W 2 H AMOUNT DUE: $89.41 Z r w Q O Z c; U All incge1rie8 must: be gg8e i Rwriting. Please complete and return 1On a ow I wish to w R, "0 po you I o FOR REFILLS" PLEASE OBTAIN NEW PRESCRIPTION FORM FROM YOUR PHYSICIAN Express Scripts' Progressive Healthcare Management P.O. BOX 66773 ST.LOUIS,MO 63166-6773 MEEM t® IS SS 10 AMOUNT DUE' s 00001 DO YOU AVr PAY BY CREDITOCARD? YES NO IF SO, PLEASE SEE THE REVERSE SIDE. A ILL PAID IN LINE DAYS REFILLS VALID REORDER PATIENT ITEM 'X' X# SUPPLY MEDICATION REMAINING THRU DATE ******* 6305338 VASOTEC TAB 5MG 00 CALL PHYSICIAN EXPRESS SCRIPTS, INCORPORATED MEMBER TEST 00 0164 170-4 MC £ 0) 0 rt a C000(D0P-rtOHO H0Oa00rtwemvl m�19mrrtm�a:zrtH O 04 trDC1•C P0 rWr ON -mNmZrgaoth H 0 aH rt" Ham• N•rt m N•r- w N- N ro Fhm m aO N H 0•0 Fhty 0010 H Fp•t0 Pctp-01100 OON OOm mrtrhmO 0)HFmO'mHrtfn0M 0 rt£ m 0'• P. W4 r-m1•cmw0 UpOmN m Fh FrtH C] H A rt"W Fr rt x m p H M:CF'KOON• FWrA OPOP)mn N-G•• rt "0 N•m x H.0 w w F- OM FhO•m v3 00• E rtaH O £ I-h O H rt ON t7 OP- ()FhHt:rm txJ N•O a�:1m On ap•14 CA " W 00) (Z!O Oct t1J rt N Hrr7dpmF C] m Cr 0• rt m O H I O rho H H m a FhK � P.O. BOX 66773 5 Phone refill service 2-1 ST.LOUIS,MO 63166 1-B00-945-5979 a� 6305338 Dr.T.DOCTOR 7/14/98 MEMBER TEST m� Take 1 tablet daily m m� x_ og VASOTEC TAR 5MG ffs MSD 712 MERCK .s NO. OF REFILLS 0 o TIME OUAN. 90 M IIMR�II��IEII9I�iNIIIN ag CEIi m R. Ph. 86166925 :MRER TEST 14000 RIVERPORT DRIVE ST LOVIS, NO 63043 ;E1b£z£1•c0E-0)M m�d P-t'J F •O H N•H awcJ zrtG LOON r-OO• � 0,0' N n z 0"0 rto OH N•zm �fmtj MqOD)O0 r"OO H n fl crC A:A �C •• a H17 rtm 0 aazm &O`a&0w H P-0 NO O P-O O' W Fr -WO- PV OOP-PON 0 0 rt N•rtLq m m Vj O `gQP—M% N 1roED rt WF mo H Otr£ woapu1c (D !4 1`1 M '•5 N H W O IQ P_ H rtm n EnC1 0 rttO O•artl-hP< 0 0) 1-"OaN•mO�rj 01•C m O N•rtO . tl7C 6409WOO rt �dm aa0Hm0N-H1C HnH oOw . P.P.1 Grq H o rooOil U'm 0 • N•rt M� rt OOztro FtLj O HO"Om t7 t7 "N • H O HrtH rl r`01 WC;Of rtHm > mOO 1 iq at4ar CO mH OO H rom qU:VJH P•�n PU P-0 ti7 o C rt OMC,HG0�D0H Oz I 010C:11� rh n Gdc�nyrtm cn C' Wo t4clP_H wa O V90 0wFw m H 0, n1.7 Hrn rtao N-ortzH•C m N•rt aim HO NFN•�:o WHHHHG5NO: 0' 0HNOO'mrtz W ma :40moccD g� o r_ 1•4 rtF-3rt. a 0 x aO'::rn 43 to H m OC+1ro HPb C5H5 ax 004X Z O HOHmm N•xmOmO OmNo bIDH 10H Ort O ? CO Fh aP•O trx H C+J c: xx m O t40f rtO Q•F A y0 Hx H rr_; H01"C m w W P.0 U0i 7.' Ogq.. 0) 0 Hm ro NO3 w •' OrorA HOz- OOH r)po "N 5Cx mH •• c o 0 0 is o aw W W I w w OhH In(Drrw0`0 O w H•X 00.4 a as rn H oto ra`t0111h012 05 0•INn ow O�•%n H-0 £ A oa 7 Om�wn+'cto 0 t_1 .. Npvu) rrto all O1 m (I m r•O 000 a P. zz rooaa0F P-ate Wav3":4 000 00 0 0 mInFH• 0 1 O woka pll-3:x N n ro M W rr &t P. roo PO&OO rtmm- HrDa WP- M m N• x N• am O1 tao KatrHH5 H m a: Ra 0 m F1-4Ca0 m rt P. xx NN cD OC aw "o P t am HOtywo r•rto xc m m arrrnz5 Fh q rrtm �°e N:00 rt o n DD1 P) o 164 0 a o C0 rtt7G "C Z rt x r*0r EfU330rto H0)rt o m Wri) tid 0 a N N w 0 Im 0 � m rt OD Ow 14000 RIVERPORT DRIVE,ST LOUIS, MO 63043 0 7/14/98 63-053-38 90 MEMBER TEST VASOTEC TAB 5MG 7/14/98 $0.00 5328193 00006-0712-94 *NSC AL2 CHOCOLATE $89.41 Dr.T.DOCTOR /DEA N 14000 RIVERPORT DR,MARYLAND HGTS MO - $70.58 13W - 15W -16W -601 MERCK 46 IIIi11N1IIII1IIB111IIpI11lII MSD 712 6305338 6305338 Bin: A 13.11 MSD 712 MEMBER TEST VASOTEC TAB 5MG III III $$$ dindamycin HCl - generic Azifhromycin $$$ azithromycin - ZITHROMAX Clarithromycin $$$$$ dadthromycin - BIAXIN TETRACYCLINES Tetracyclines $ doxycydine hydate - generic $ doxycydine hydate (coated) - generic $$ minocydine HCI - generic $ tetracycline HCl - generic FLUOROQUINOLONES $$$$ ciprofloxacin - CIPRO $$$$ ofloxacin - FLOXIN AMINOGLYCOSIDES neomycin sulfate - generic SULFONAMIDES Sulfonamides $$$ sulfadiazine - generic $ sulfamethoxazole - generic $ sulfisoxazole - generic $ sulfisoxazole - GANTRISIN (susp only) ANTIMYCOBACTERIAL AGENTS Antimycobacterial Agents $ ethambutol HCI - MYAMBUTOL $ isoniazid - generic $$ pyrazinamide - generic $$$$$ dfabutin - MYCOBUTIN $$$$$ rifampin - RIMACTANE ANTIFUNGALS Antifungals $$$$$ flucytosine - ANCOBON $ gdseofulvin micronize - generic 4/15/98 9:22 AM — indicates that the generic product is not A -rated by the FDA. $$ gdseofulvin mic rosize - GRIFULVIN V $$ griseofulvin ultrambosize - FULVICIN P/G $ nystatin - generic $$$$$ terbinafine HCI - LAMISIL Imidazole-Related Antifungals lmidazoles $$$ ketoconazole - NIZORAL Tiiazoles $$$$$ fluconazole - DIFLUCAN $$$$$ itraconazole - SPORANOX ANTIVIRALS Antiretrovirals Andretrovirals - Protease Inhibitors $$$$$ indinavir sulfate - CRIXIVAN $$$$$ nelfinavir - VIRACEPT $$$$$ ritonavir- NORVIR $$$$$ saquinavir mesylate - INVIRASE $$$$$ saquinavir - FORTOVASE Andretrovirals - Purine Analogues $$$$ didanosine - VIDEX Antiretrovirals - Pyrimidine Analogues $$$$$ lamivudine - EPIVIR $$$$$ zalcitabine - HIVID Anfiretrovirals - Thymidine Analogues $$$$$ stavudine - ZERIT $$$$$ zidovudine - RETROVIR Antiretrovirals - RTI - Non -Nucleoside Analogues $$$$$ delavirdine - RESCRIPTOR $$$$$ nevirapine - VIRAMUNE Antiretroviral Combinations $$$$$ lamivudine-zidovudine - COMBIVIR Influenza -A Agents $$ rimantadine HCI - FLUMADINE Herpes Agents Herpes Agents - Purine Analogues $$$$ acyclovir - generic $$$$ valacydovir HCI - VALTREX Herpes Agents - Thymidine Analogues $$$$ famciclovir - FAMVIR 4/15/98 9:22 AM -- indicates that the generic product is not A -rated by the FDA. Our goal at Express ScriptsNalueRx is to form a partnership with City of Fort Collins by employing proven and innovative managed care principles and leading edge technology to provide high -quality, cost-effective healthcare services. This proposal has been prepared for City of Fort Collins with the goal of outlining a long-term relationship between City of Fort Collins and Express ScriptsNalueRx. Express ScriptsNalueRx provides progressive healthcare management by leveraging our expertise in pharmacy benefit management (PBM) to make a positive impact on City of Fort Collins's total healthcare benefit. Express ScriptsNalueRx is integrating pharmacy and medical claims data to develop new strategies to decrease total healthcare spending and improve health outcomes. We are applying the principles of managed care to a diverse group of healthcare businesses. Progressive healthcare management is relevant to everything we do. Our Clients Will Benefit from the Merger of Express Scripts and ValueRx City of Fort Collins will benefit directly from the recent merger of Express Scripts and ValueRx. We have joined forces to form the nation's largest independent pharmacy benefit manager. Specifically, these are the benefits our new company will bring City of Fort Collins. Express ScriptsNalueRx is the largest pharmacy benefit manager independent of pharmaceutical manufacturer ownership. This enables us to manage the pharmacy benefit objectively for the best clinical result for members and cost outcomes for clients, without bias for a parent company's products and its profits. Unlike other PBMs, Express ScriptsNalueRx manages the pharmacy benefit in the context of the entire medical benefit, using information technology to monitor and improve practice patterns, predict disease risk, and intervene to measurably improve the management of disease processes and outcomes. Express ScriptsNalueRx clients will all benefit from the broader service skill set created by the integration of the two organizations. These skills were developed in service to distinctly different clients. Historically, ValueRx primarily worked with large employers, unions, and indemnity carriers. Express Scripts primarily worked with managed care organizations and smaller employers through relationships with third party administrators. Now, Express Scripts/ValueRx has solutions for any client need. By doubling our size, we will also have the ability to invest more heavily in new product development and advanced technology. By broadening our pool of leading clinical talent, we will have the ability to develop the most innovative, industry -shaping products and services. By Express Scripts° Progressive Healthcare Management Executive Summary for City of Fort Collins page 1 AVORD. DATE AON Risk Services of MO 8182 Maryland Avenue St. Louis, MO 63105 .4-721-5100 Express Scripts, Inc, 14000 Riverport Drive Maryland Heights MO 63043 THIS 18 TO CERTIFY THAT THE POLICIES OF140'"TED NOTWITHSTANDING ANY 1RAPlCE LIST TERM CERTFICA ATE MAY BE SUED OR MAY C EXCLUswNs AND CONp1 . _ OF SUCH e POLLS. LMYYTS.>< ME OF aLSURANCE POLICYNUMaq A Cmama CIAL cauAL UABIUTY I RCM37690893 CLAIMS MADE E] PEP. —CLAIMS & CONTRACTOR'S PROi. AUrOMOBE.EUABEJrY B ANY UO 84UUNPQ3977 ALL OWNED Auros SCHEDULED AUTOS NIREO AUTOS NON -OWNED AUTOS GARAGE UAelutt EXCEaa LIAEurY A UMBRELLA FORM HCM37690893 OCCURR OTIEA THAN UMBRBLA FORM WOR omos COMPENSATION B AND 84W8BA6966 04PLOTER PL1ABEITY COMPANIES 8,C81D Al -Professional Limb. HCM37690893 A -Managed Care Limb. HCM37690893 DESCRIPrNIN OP OPi11ATNINfR.OQATTONfYYENMXWWECmL REMa For Sample Purposes Only * Claims Made Retro Date 12/1/96 mu, bAYEND OR ALTER THE CO L CNL LNIS C MITIFIC IV. VERAGE AFFORDEET BY COMPANIES AFFORDING COVERAGE COMPANY LETTER A LETTER B COMPANY Hertford Fire G_ A MDD.Nj pA LETTM C Twin City Fire Ins Co AZ LETTERCOMPANY D Hartford Casualty MO & MA MANY E LETTER Is POLICY EFFECTryE I POLICY EIa m� D. ATE (MM/Op/yY) DATE 12/01/971 12/01/98 3OVEFOR Th RESPEC �UB.IECCT ro s LWAITS ATE is t f ffe) f S COMBINED SINGLE 12/01/97 12/01/98 us11r f BODILY INJURY . (Per person) BODILY INJURY (Per wddetd PROPERTY DAMAGE * 12/01/971 12/01/98 12/01/971 12/01/98 * 12/01/97 12101/98 1,000,000 Per claim * 12/01/07 12/01/98 1,000,000 ann. agg. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPWATION GATE THE7iEOF. THE ISSUING COMPANY WILL ENDEAVOR TO For Sample Purposes Only MAIL 30 DAYS WRITTENNOTICETOTHE J.CLEFT.BUTFALURE TOMAILSUCHNO CATEI'IO�ERNAMEDTOTHE U TICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OFANYKINDUPONTHEC .ITS AGENTS ORREPRESENTATIVES. THOROMOREP t (} 0 _ 1l• _ 000686000 ANTIMALARIALS Antimalarial $ chloroquine phosphate - generic $ hydroxychloroquine sulfate - generic $$$$$ pyrimethamine - DARAPRIM $ quinine sufate - generic AMEBICIDES Amebicides $ iodoquinol - generic ANTHELMINTICS Anthelmintic $$$ mebendazole - generic $ piperazine citrate - generic $ pyrantel pamoate - generic $$$ thiabendazole - MINTEZOL MISC. ANTIINFECTIVES Misc. Antiinfectives $ metronidazole - generic $$$$$ pentamidine isethionate - NEBUPENT $ trimethoprim - generic $$$$$ vancomycin HCI - VANCOCIN $$$$$ loracarbef - LORABID Chloramphenicols $ chloramphenicol - generic Antiprotozoal Agents $$$$$ atovaquone - MEPRON Misc. Antiinfective Combinations $ erythromycin & sulfisoxazole - generic $$$ erythromycin & suifisoxazole - PEDIAZOLE $ trimethoprirnlsulfamethoxazole - generic ANTINEOPLASTIC AGENTS Note: All oral antineoplastic agents are formulary. 4/15/98 9:22 AM -- indicates that the generic product is not A -rated by the FDA. ANTINEOPLASTICS Alkylating Agents Alkylating Agents $$$$ altretamine - HEXALEN $$ busulfan - MYLERAN Nitrogen Mustards $$ chlorambucil - LEUKERAN $$ cyciophosphamide - CYTOXAN $$ melphalan - ALKERAN Nitrosureas $$ lomustine - CEENU Antimetabofrfes $ mercaptopurine - PURINETHOL $$ methotrexate - generic Antineoplastic Hormones Androgens-Antineoplastic $$$$$ testolactone - TESLAC Estrogens-Antineoplastic $$$$$ diethylstilbestrol diphosphate - STILPHOSTROL $$$$$ estramustine phosphate sodium - EMCYT Aromatase Inhibitors $$$$$ Anastrozole- ARIMIDEX Progestins Antineoplastic $$ megestrol acetate - generic Antineoplastic Hormones Misc. $$$ tamoxffen citrate - NOLVADEX (Zeneca brand only) Mitotic Inhibitors $$$$$ etoposide - VEPESID Antineoplastics Misc. $$$$ bicalutamide - CASODEX $$$$ flutamide - EULEXIN $$$ hydroxyurea - generic $$$$ leucovorin calcium - generic $$$ levamisole HCI - ERGAMISOL $$$$ mitotane - LYSODREN $ procarbazine HCl - MATULANE $$$$$ goserelin acetate - ZOLADEX (INJ) ENDOCRINE AND METABOLIC AGENTS CORTICOSTEROIDS Glucocorticosteroids 4/15/98 9:22 AM — indicates that the generic product is not A -rated by the FDA. $ dexamethasone - generic $ hydrocortisone - generic- $ prednisone - generic $$$ prednisolone - PRELONE ANDROGEN-ANABOLICS Androgens $$$$$ danazol - DANOCRINE $$$ fluoxymesterone - generic - $ methyltestosterone - generic $$$$ testosterone - ANDRODERM ESTROGENS Estrogens $ estertfied estrogens - generic $ estradiol - generic- $$ estradiol - ALORA $$ estradiol - CLIMARA $ estradiol - ESTRACE $ estrogens, conjugated - PREMARIN $ estropipate - ORTHO-EST Estrogen Combinations Estrogen & Androgen $$ est estrogens & methyltest - ESTRATEST HS $$ est estrogens & methyltest - ESTRATEST $$ conjugated estrogens-medroxyprogesterone acetate - PREMPHASE $$ conjugated estrogens-medroxyprogesterone acetate - PREMPRO CONTRACEPTIVES Progestin OC's $$$ norethindrone - MICRONOR Monophasic OC's $$ desogestrel & ethinyl estrad - ORTHO-CEPT $$ desogestrel & ethinyl estrad - DESOGEN $ ethynodiol diaoet & eth estrad - generic $$$ levonorgestrel & eth estradiol - ALESSE $ levonorgestrel & eth estradiol - generic $$$ levonorgestrel & eth estradiol - NORDETTE $ norethindrone & eth estradiol - generic $$$ norethindrone & eth estradiol - MODICON .5/35 $ norethindrone & eth estradiol - generic $$ norethindrone & eth estradiol - ORTHO-NOVUM 1/35 $$$ norethindrone & eth estradiol - OVCON-35 $$$ norethindrone & eth estradiol - OVCON 50 $$$ norethindrone acet & eth estra - LOESTRIN 1.5/30 $$$ norethindrone acet & eth estra - LOESTRIN 1/20 $ norethindrone & mestranol - generic 4/15/98 9:22 AM -- indicates that the generic product is not A -rated by the FDA. $$ norethindrone & mestranol - ORTHO-NOVUM 1150 $$$ norgestrel & ethinyl esfradiol - LOIOVRAL $$ norgestimate & ethinyl esbWiol - ORTHO-CYCLEN $$$ norethin acet & estrad-fe - LOESTRIN FE 1/20 $$$ norethin acet & estrad-fe - LOESTRIN FE 1.5/30 Biphasic OC's $ norethindrone-eth estradiol - generic $$$ norethindrone-eth estradiol - ORTHO-NOVUM 10/11 Triphasic OC's $$$ levonorgestrel & eth esbadiol - TRIPHASIL $$ norethindrone-ethinyl estrad - ORTHO-NOVUM TAB 71717 $$ norgestimate-ethinyl estradiol - ORTHO TRI-CYCLEN PROGESTINS $ medroxyprogesterone acetate - generic - $ medroxyprogesterone acetate - AMEN $ medroxyprogesterone acetate - PROVERA ANTIDIABETICS Insulin Human Insulin $$$ human insulin - HUMULIN $$$$ insulin lispro - HUMALOG Sulfonylureas $ acetohexamide - generic $$ glimepidde - AMARYL $ glipiade - generic $$ glipizide - GLUCOTROL XL $ glyburide - generic $$ glyburide - GLYNASE PRESTAB $ tolazamide - generic $ tolbutamide - generic Biguanides $$$$$ metformin HCI - GLUCOPHAGE Alpha-Glucosidase Inhibitors $$$$$ acarbose - PRECOSE Insulin Sensitizing Agents Thiazolidinediones $$$$$ troglitazone - REZULIN Diabetic Other $$ glucagon - GLUCAGON (INJ) THYROIDS 4/15/98 9:22 AM — indicates that the generic product is not A -rated by the FDA. Thyroid Hormones $ levothyroxine sodium - SYNTHROID $$$ liotrix - THYROLAR Antithyroid Agents $ propylthiouracil - generic OXYTOCICS Oxytocics $ methylergonovine maleate - METHERGINE $$$ oxytocin - SYNTOCINON MISC. ENDOCRINE AGENTS Adrenal Steroid Inhibitors $$$$$ aminoglutethimide - CYTADREN Calcium Regulators Biphosphonates $$$$ alendronate sodium - FOSAMAX $$$ eiidronate disodium - DIDRONEL Calcitonins $$$ calcitonin (salmon) - MIACALCIN (INJ) $$$ calcitonin (salmon) - MIACALCIN NASAL SPRAY Fertility Regulators Ovulation Stimulants -Synthetic $$ domiphene citrate - generic $$ domiphene citrate - SEROPHENE Ovarian Stimulants-Gonadotropins $$$$$ urofollitropin - METRODIN (INJ) $$$$$ urofollitropin - FERTINEX (INJ) $$$$ dwonic gonadotropin - PROFASI (INJ) $$$$$ menotropins - PERGONAL (INJ) Gonadotropin Releasing Hormones $$$$ nafarelin acetate - SYNAREL Posterior Pituitary Vasopressin $$$$ desmopressin acetate - generic- $$$$$ desmopressin acetate - DDAVP CARDIOVASCULAR AGENTS CARDIOTONICS 4/15/98 9:22 AM - indicates that the generic product is not A -rated by the FDA. Digitalis $ digoxin - LANOXICAPS $ digoxin - LANOXIN ANTIANGINAL AGENTS Nitrates $ isosorbide dinitrate - generic $$ isosorbide dinitrate - DILATRATE SR $ isosorbide mononitrate - generic $$ isosorbide mononitrate - IMDUR $$ isosorbide mononitrate - MONOKET $ nitroglycerin - generic (SL tabs, ointment, capsules, patches) $ nitroglycerin - NITROSTAT $$$ nitroglycerin - NITRO•DUR $$$ nitroglycerin - TRANSDERM NITRO (excluded in closed formulary) $$$ nitroglycerin - NITRODISC (excluded in dosed formulary) BETA BLOCKERS Beta Blockers Non -Selective $$$$ carvedilol - COREG $$ nadolol - generic $$$ penbutolol sulfate- LEVATOL $$ pindolol - generic $ propranolol HCI - generic $$$$$ sotalol HCI - BETAPACE Beta Blockers Cardio-Selective $$$ acebutolol HCI - generic $ atenolol - generic $$ metoprolol tartrate - generic $$ metoprolol succinate - TOPROL XL Alpha -Beta Blockers $$$ labetalol HCI - TRANDATE CALCIUM BLOCKERS $$$ amlodipine - NORVASC $$$ diltiazem - generic $$$ diltiazem - DILTIA XT $$$ diltiazem - CARDIZEM CD $$$ diltiazem - TIAZAC $$ nifedipine - generic $$ nifedipine - ADALAT CC (excluded in dosed formulary) $$$ nifedipine - PROCARDIA XL $ verapamil HCl - generic $$$ verapamil HCI - VERELAN Calcium Blockers - Misc. $$$$$ nimodipine - NIMOTOP 4/15/98 9:22 AM — indicates that the generic product is not A -rated by the FDA. ANTIARRHYTHMICS Antiarrhythmic Type f — Nonspecif $$$$$ modcizine HCI -ETHMOZINE Antiarrhythmics Type I -A $$ disopyramide phosphate - generic $$$ disopyramide phosphate - NORPACE CR $$ procainamide HCI - generic $$ quinidine gluconate - generic $ quinidine sulfate - generic $$$$$ quinidine pdygalacturonate - CARDIOQUIN Andanhythmics Type I-B $$$ mexiletine HCI - generic $$$$ mexiletine HCI - MEXITIL $$$$ tocainide HCI - TONOCARD Antiarrhythmics Type I-C $$ tiecainide acetate - TAMBOCOR $$$$$ propafenone HCI - RYTHMOL Andanhythmics Type 111 $$$$$ amiodarone - CORDARONE Antiarrhythmics - Misc. $$$$$ sotalol HCI - BETAPACE ANTIHYPERTENSIVES ACE Inhibitors $$ benazepol HCI - LOTENSIN $ captopril - generic $$ fosinopril sodium - MONOPRIL $$$ lisinopril - ZESTRIL $ moexipril - UNIVASC (excluded in dosed formulary) $$$ quinapril HCI - ACCUPRIL $ trandolapril - MAVIK (excluded in dosed formulary) Antiotensin 11 Receptor Antagonists $$$$ losartan - COZAAR $$$$ valsartan - DIOVAN Adrenolytic Antihypertensives Adrenolytics - Central $ clonidine HCI - generic $$$$ donidine HCI - CATAPRES-TTS $ guanfacine HCI - generic Methyldopa Adrenolytic Antihypertensives Adrenolytics 4/15/98 9:22 AM — indicates that the generic product is not A -rated by the FDA. 10 methyldopa - generic Adrenolytics - Peripheral $ prazosin HCI - generic $$$ doxazosin mesylate - CARDURA $$$ terazosin HCI - HYTRIN Antihypertensive Combinations ACE Inhibitors and Calcium Blockers $$$ benazepril & amlodipine - LOTREL $$$ trandolapril & verapamil - TARKA ACE Inhibitors & Thiezfdes $$$ benazepril & HCTZ - LOTENSIN HCT $$$ lisinopril & HCTZ - ZESTORETIC Beta Blocker Combinations $$ atenolol & chlorthalidone - generic $$ bisoprolol & HCTZ - ZIAC $ propranolol & HCTZ - generic Vasodilators & Thiazides $ hydralazine & HCTZ - generic Angiotensin Il Receptor Antagonists & Thiazides $$$$ losartan & HCTZ - HYZAAR DIURETICS Loop Diuretics $$$ bumetanide - generic $ furosemide - generic Potassium Sparing Diuretics $ spironolactone - generic Thiazides $ chlorthalidone- generic $ hydrochlorothiazide - generic $$ indapamide - LOZOL $$ metolazone - ZAROXOLYN $$ metolazone - MYKROX Combination Diuretics $ spironolactone & HCTZ - generic $ triamterene & HCTZ - generic PRESSORS Pressors 4/15/98 9:22 AM -- indicates that the generic product is not A -rated by the FDA. 11 $$$$$ midodrine HCI - PROAMATINE ANTIHYPERLIPIDEMICS Bile Sequestrants $$$$ colestipol HCI - COLESTID $$$ cholestyramine - generic Fibric Acid Derivatives $$$$ gemfibrozil - generic HMG CoA Reductase Inhibitors $$$$ atorvastatin - LIPITOR $$$$ pravastatin - PRAVACHOL $$$$$ simvastatin - ZOCOR Nicotinic Acid Derivatives 3 $$$$ niacin - NIASPAN MISC. CARDIOVASCULAR AGENTS Peripheral Vasodilators $ isoxsuprine - generic RESPIRATORY AGENTS Note: The use of OTC products is recommended when possible. All legend generic products are formulary and covered. ANTIHISTAMINES Antihistamines - Ethylenediamines $ hipelennamine - generic Antihistamines - Phenothiazines $ promethazine - generic Antihistamines - Piperidines $ cyproheptadine HCI - generic Antihistamines - Non -Sedating $$$$$ astemizole - HISMANAL $$$$$ cetirizine - ZYRTEC (tab, syrup) $$$$$ loratadine - CLARITIN (tab, syrup) $$$$$ fexofenadine - ALLEGRA Antihistamine Mixtures $$ pheniramine-phenyltoloxamine-pydlamine - POLY-HISTINE DECONGESTANTS Note: The use of OTC products is recommended when possible. 4/15/98 9:22 AM 12 indicates that the generic product is not A -rated by the FDA. maintaining, empowering, and expanding our outstanding sales, account, and customer service teams, we will deliver cutting -edge consultative services and expertise. The combination of Express Scripts and ValueRx will also offer clients greater mail service capacity, greater choice of retail pharmacy networks, coordination of formularies and pharmaceutical manufacturer relations over a broader base of business, access to new products and services, including industry -leading clinical services, formulary management and provider profiling capabilities. Express ScriptsNalueRx Offers A Range of Managed Care Services Express ScriptsNalueRx's pharmacy benefit management business currently provides managed prescription drug services, including formulary administration and drug utilization review to over 22 million members in the United States and Canada. Express ScriptsNalueRx's Health Management Services, provides comprehensive informed decision counseling (the Express Health LinesM program) and disease management support services through a 24-hour call center staffed by registered nurses and pharmacists. In addition, Health Management Services provides enhanced concurrent and retrospective drug utilization review services, and complete formulary management and drug product preference programs. Practice Patterns Sciences offers healthcare information management services, linking healthcare data from all points of care. IVTx applies managed care techniques to infusion therapy and injectable drug therapies. Our Strengths Assure Your Results Our strengths in the following fields will assure City of Fort Collins a cost effective, well managed pharmacy and medical benefit: ♦ Commitment and Customer Focus ♦ Distinctive PBM Services ♦ Information System Management ♦ Advanced Clinical Strategies ♦ Reduced Medical Costs Through Effective Formulary Management Customer Focused Services To better serve City of Fort Collins, the Express ScriptsNalueRx account management team is led by a member of the Express ScriptsNalueRx's Senior Management. The account management team includes a dedicated account manager, an MIS liaison, and a clinical pharmacist. Our flexible system will allow Express ScriptsNalueRx to easily conform to the account structure of City of Fort Collins. We are experienced in working with various medical carriers and third party administrators (TPAs) throughout Texas because of the numerous clients, including municipalities, we have in this area of the United States. This allows us to provide a smooth transition and continuity of data and reporting, A thorough and smooth transition for your members is assured. Express ScriptsNalueRx maintains the high service levels our clients have come to expect. Express Scripts® Progressive Healthcare Management Executive Summary for City of Fort Collins page 2 Nasal Steroids $$$ beclomethasone diprop monohyd - BECONASE AQ $$ budesonide - RHINOCORT $$$ fluticasone propionate (nasal)- FLONASE $$$ mometasone - NASONEX $$$ trimacinolone acetonide - NASACORT Nasal Antibiotics $$$ mupirocin calcium - BACTROBAN Nasal Anticholine►gics $$ ipratropium bromide (nasal) - ATROVENT COUGH/COLD/ALLERGY Note: The use of OTC products is recommended when possible. All legend generic products are formulary and covered. Antdussive - NonNarcotiic $$ benzonatate - generic Expectorants $$ guaifenesin - LIQUIBID Mucolytics $$ acetylcysteine - generic Cough/Cold/Allergy Combination Products Decongestant & Antihistamine $$$ brompheniramine & psuedoeph - BROMFED, -PD $$$$$ chlorphen-phenyltolox-PE-PPA - NALDECON $$$ chlorphen-phenind & phanylprop - NOLAMINE $$$$$ fexofenadine & pseudoephedrine - ALLEGRA D $$$$$ loratadine & pseudoephedrine - CLARITIN-D $$$$$ loratadine & pseudoepheddne - CLARITIN D 24 $$ phenir-pyril-phenyltolox & PPA - POLY-HISTINE D $$ phenir-pydl-phenyltolox & PPA - POLY-HISTINE D -PED Decongestant w/Expectorant $$ phenylephrine-GG - LIQUIBID-D $$$ pseudoephedrine-GG - GUAIFED, -PD Antitussive-Expectorant $$$ hydromorphone-GG - DILAUDID COUGH SYRUP Narcotic Antitussive-Decongestant $ pseudoephedrine w/hydr000done- HISTUSSIN D Narcotic Aniitussive-Decongestant-Antihistamine $$ phenylprop-bromphen w/ cod - POLY-HISTINE CS $$ phenyleph-CPM w/ hydrocod - HISTUSSIN HC Non -Narcotic Antitussive-Decongestant-Antihistamine $$ phenylprop-bromphen-DM - POLY-HISTINE DM $$$ phenylpropanolamine-GG - ENTEX LA $$ phenylpropanolamine-GG - EXGEST LA 4/15/98 9:22 AM — indicates that the generic product is not A -rated by the FDA. 13 $$$ pseudoephedrine-GG - ENTEX PSE $$ pseudoepheddne-GG - ZEPHREX LA ANTIASTHMATICS Anticholinergics $$ ipratropium bromide - ATROVENT Anti -Inflammatory Agents $$$ cromolyn sodium - INTAL Sympathomimetics Beta Adrenergics $ albuterol - generic $$ albuterol - PROVENTIL HFA $ albuterol sulfate - generic $$$ albuterol sulfate - VOLMAX $ metaproterenol sulfate - generic $$$ metaproterenol sulfate - ALUPENT INHALER $$ pirbuterol - MAUR AUTOHALER $$$ salmeterol xinafoate - SEREVENT Mixed Adrenergics $$$ epinephrine HCI - EPIPEN, EPIPEN JR (INJ) Xanthines $ theophylline - generic (liquid, immediate release) $$$ theophylline - SLO-BID $$ theophylline - THEO-DUR (sprinkle, tablet) $$$ theophylline - T-PHYL $$$$ theophylline - UNI-DUR $$$$ theophylline - UNIPHYL Steroid Inhalants $$ beclomethasone dipropionate - BECLOVENT $$ budesonide - PULMICORT $$$ flunisolide - AEROBID, M $$$ hiamcinolone acetonide - AZMACORT $$$ fluticasone propionate - FLOVENT Leukobiene Modulators 5-Lipoxygenase Inhibitors $$$$ zileuton - ZYFLO Leukotriene Receptor Antagonists $$$$ zafiriukast - ACCOLATE Asthma Combinations Anticholinergic-Beta Agonists $$ ipratropium-albuterol - COMBIVENT MISC. RESPIRATORY AGENTS 4/15/98 9:22 AM 14 indicates that the generic product is not A -rated by the FDA. Cystic Fibrosis Agents Hydrolytic Enzymes $$$$$ domase alfa - PULMOZYME GASTROINTESTINAL AGENTS LAXATIVES Misc. Laxatives $$ PEG -electrolyte - COLYTE ULCER DRUGS GI Antispasmodics-Anticholinergics Belladona Alkaloids $ phenobarbital & belladonna elk - generic $$ hyoscyamine sulfate - LEVSIN $$ hyoscyamine sulfate - LEVSINEX $$ hyoscyamine sulfate - LEVBID Antispasmodics $ dicyclomine HCI - generic H-2 Antagonists $$ clmetidine - generic $$$$ nizatadine - AXID $$$ ranitidine HCI - generic Prostaglandins $$$ misoprostol - CYTOTEC Proton Pump Inhibitors $$$$$ omeprazole - PRILOSEC Ulcer Therapy Combinations $$$ metronidazole-tetracycline wl bismuth subsalicylate - HELIDAC $$$$ ranitadine-bismuth citrate - TRITEC Misc. Anti -Ulcer $$ sucralfate - generic $$$ sucralfate - CARAFATE (suspension only) ANTIEMETICS Note: The use of OTC products is recommended when possible (i.e., dimenhydrate, meclizine) Antiemetics - Anticholinergic $$$ promethazine HCI - PHENERGAN (supp) $$ trimethobenzamide HCI - generic Antiemefics - Misc. $$$ prochlorperazine - generic 4/15/98 9:22 AM indicates that the generic product is not A -rated by the FDA. 15 5-HT3 Receptor Antagonists $$$$$ granisetron - KYTRIL $$$$$ ondansetron - ZOFRAN DIGESTIVE AIDS Digestive Enzymes $$$$$ pancrelipase - PANCREASE MT Digestive Aids - Mixtures $$$ amylase -lipase -protease - PANCREASE MISC. GI AGENTS Gallstone So/ubilizing Agents $$$$$ ursodiol - ACTIGALL GI Stimulants $$$$ cisapdde - PROPULSID $$ metodopramide HCI - generic Inflammatory Bowel Agents $$$$ mesalamine-ASACOL $$$$$ mesalamine - ROWASA $$$$ olsalazine sodium - DIPENTUM $ sulfasalazine - generic $$$ sulfasalazine - AZULFIDINE EN TABS GENITOURINARY PRODUCTS URINARY ANTIINFECTIVES Urinary AnNinfectives $$ nitrofurantoin - FURADANTIN SUSP $$ nitrofurantoin macrocrystal - generic $$$ nitrofurantoin macrocrystal - MACRODANTIN $$ nitrofurantoin monohyd macro - MACROBID URINARY ANTISPASMODICS Urinary Antispasmodics $ bethanechol chloride - generic $ oxybutynin chloride - generic $$ hyoscyamine - generic $$$ hyoscyamine sulfate - LEVSIN VAGINAL PRODUCTS 4/15/98 9:22 AM 16 indicates that the generic product is not A -rated by the FDA. Vaginal Antiinfectives $$$ clindamycin phosphate vaginal - CLEOCIN VAG $$$ metronidazole vaginal - METROGEL VAG GEL $ nystafin vaginal - generic $$ sulfanilamide vaginal - generic lmidazole-Related AnWngais $$ terconazole vaginal cream - TERAZOL 7 $$ terconazole vaginal cream - TERAZOL 3 $$ terconazole vaginal supp - TERAZOL 3 Vaginal Estrogens $$$ estradiol vaginal - ESTRACE VAG $$$ conjugated estrogens - PREMARIN VAG MISC. GENITOURINARY AGENTS Prostatic Hypertrophy Agents $$$$ finastedde - PROSCAR Urinary Analgesics $ phenazopyddine HCI - generic CENTRAL NERVOUS SYSTEM AGENTS ANTIANXIETY AGENTS Benzodiezepines $$ alprazolam - generic $$ chlordiazepopde - generic $$ diazepam - generic $$ lorazepam - generic $$ oxazepam -generic Misc. Andanxiety Agents $$$$ buspirone HCI - BUSPAR $ hydroxyzine HCI - generic ANTIDEPRESSANTS MAO Inhibitors $$$ phenelzine sulfate - NARDIL $$$ tranylcypromine sulfate - PARNATE Modified Cyclics $$$ nefazodone HCI - SERZONE $ trazodone HCI - generic Selective Serotonin Reuptake Inhibitors (SSRIs) 4/15/98 9:22 AM — indicates that the generic product is not A -rated by the FDA. 17 $$$$ fluoxetine - PROZAC $$$ paroxetine - PAXIL $$$$ sertraline HCI - ZOLOFT Tricyclic Agents $ amitriptyline HCI - generic $$ desipramine HCI - generic $ doxepin HCI - generic $ imipramine HCI - generic $$ nortriptyline HCI - generic Alpha-2 Receptor Antagonists (Tetracyclics) $$$ mirtazapine - REMERON Misc. Antidepressants $$$ bupropion HCI - WELLBUTRIN, SR $$ maprotiline HCI - generic $$$$ venlafabne Hd - EFFEXOR, XR ANTIPSYCHOTICS Benzisoxazoles $$$$$ risperidone - RISPERDAL Butyrophenones $ haloperidol - generic Dibenzodiazpeines $$$$$ olanzapine - ZYPREXA Dibenzodiazepines $$$$$ clozapine - CLOZARIL Phenothiazines $ chlorpromazine HCI - generic $ fluphenazine HCI - generic $$ perphenazine - generic $ thioddazine HCI - generic $$$ thioridazine HCI - MELLARIL-S Thioxanthines $ thiothixene - generic Misc. Antipsychotics $$$ loxapine succinate - generic Lithium $ lithium carbonate - generic $ lithium carbonate - ESKALITH CR $ lithium citrate - generic HYPNOTICS 4/15/98 9:22 AM 18 — indicates that the generic product is not A -rated by the FDA. Senzodiazepine Hypnotics $ temazepam - generic $$ triazolam - generic Non-Benzodiazepine - GABA-Receptor Modulators $$$ zolpidem tartrate - AMBIEN STIMULANTS Misc. Stimulants $$ dextroamphetamine sulfate - DEXEDRINE $$ methylphenidate HCI - generic $$$$ pemoline - CYLERT MISC. PSYCHOTHERAPEUTIC AGENTS Anfidementia Chohnomimetics- ACHE Inhibitors $$$$$ donepezil HCI - ARICEPT Misc Psychotherapeutic $ disulfiram - generic ANALGESICS AND ANESTHETICS NON -NARCOTIC ANALGESICS Analgesics -Sedatives $ acetaminophen-butalbital - generic $$$ acetaminophen-butalbital - AXOCET $$ acetaminophen-butalbital - PHRENILIN, FORTE $ phenyltoloxamine w/ APAP - generic $ acetaminophen-call-butalbital - generic $$$ acetaminophen-call-butalbital - ESGIC PLUS $ aspirin-caffeine-butalbital - generic NARCOTIC ANALGESICS Narcotic Agonists $$ codeine sulfate - generic $$$$$ fentanyl - DURAGESIC $ hydromorphone HCI - generic— $$$ hydromorphone HCI - DILAUDID $ morphine sulfate - generic- $$$$ morphine sulfate - MS CONTIN $$ morphine sulfate - MSIR $$$$$ oxycodone HCI - OXYCONTIN $$$$ oxycodone HCI - OXY IR $$ propoxyphene napsylate - generic $$$ tramadol HCI - ULTRAM 4/15/98 9:22 AM indicates that the generic product is not A -rated by the FDA. 19 Narcotic Partial Agonists $$$ pentazocine w/ naloxone - TALWIN NX Narcotic Antagonists $$$$$ naltrexone HCI - REVIA Narcotic Combinations Codeine Combinations $ acetaminophen w/ codeine - generic $$$ acetaminophen w/ codeine - CAPITAUCOD (susp) $ aspirin w/ codeine - generic $$ acetaminophen w/ hydrocodone - LORCET, PLUS $$ butalbital/aspirin/caffeine w/ codeine - generic $$$$ ibuprofen w/hydrocodone - VICOPROFEN $ oxycodone w/ aspirin - generic Dihydrocodeine Combinations $$ APAP-call-dihydrocodeine - DHC PLUS Hydrocodone Combinations $$$$ acetaminophen w/ hydrocodone - LORTAB LIQUID Pentazocine Combinations $$$ pentazodne w/ APAP- TALACEN ANTIRHEUMATIC AGENTS Salicylates Salicylates $$$ diflunisal - generic $$ salsalate - generic Salicylate Combinations $$ choline & mag salicylate - generic- $$$$ choline & mag salicylate - TRILISATE NSAIDs $$$ diclofenac sodium - generic $$$$ etodolac - generic $$$$ etodolac-LODINE $$$$ etodolac - LODINE XL $$$ fenoprofen calcium - generic $$$$ flurbiprofen - generic $ ibuprofen - generic $ indomethacin - generic $$$ ketoprofen - generic $$$$ ketoprofen - ORUVAIL $$$$ nabumetone - RELAFEN $$ naproxen - generic $$$ naproxen sodium - generic $$$$ naproxen sodium - NAPRELAN $$$$ oxaprosin - DAYPRO $$$ sulindac - generic $$$$ tolmetin sodium - generic 4/15/98 9:22 AM -- indicates that the generic product is not A -rated by the FDA. 20 Gold Compounds $$$$$ auranofin - RIDAURA Anti -Rheumatic Antimetabolite $$ methotrexate - generic Misc. Anti -Rheumatics $ hydroxychloroquine- generic MIGRAINE AGENTS Migraine Products $$ ergotamine tartrate - ERGOMAR $$$$$ sumatriptan succinate - IMITREX Migraine Combinations $ APAP-isometheptene-dichloral - generic- $$ APAP - isometheptene-dichloral - MORIN Ergot Combinations $$$$ ergotamine w/ PB & belladonna - BELLERGAL-S GOUT AGENTS Gout $ allopurinol - generic $ colchicine - generic Uricosurics $ indomethacin - generic $ probenecid - generic $ sulfinpyrazone - generic Combination Gout Drugs $ colchicine w/ probenecid - generic NEUROMUSCULAR AGENTS ANTICONVULSANTS Barbiturates $ butabarbital - generic $ phenobarbital - generic Benzodiazepines $$$ clonazepam - KLONOPIN Hydantoins $ phenytoin sodium prompt - generic- $$ phenytoin - DILANTIN 4/15/98 9:22 AM -- indicates that the generic product is not A -rated by the FDA. 21 $$ phenytoin sodium extended - DILANTIN Succinimides $$$$ ethosuximide - ZARONTIN Valproic Acid $$$$ divalproex sodium - DEPAKOTE $$$$ valproate sodium - generic $$$$ valproate sodium - DEPAKENE SYRUP $$$$ valproic acid - generic $$$$ valproic add - DEPAKENE Misc. Anticonvulsants $$ carbamazepine - generic $$$ carbamazepine - TEGRETOL $$$ carbamazepine - TEGRETOL XR $$$$$ gabapentin - NEURONTIN $$$$$ lamobigine - LAMICTAL $$ primidone - generic $$$$$ topiramate - TOPAMAX ANTIPARKINSONIANS Antiparkinsonian Anticcholinargicc $ benztropine mesylate - generic $ tdhexyphenidyl HCI - generic Antiparkinsonfan Dopaminergic $ amantadine HCI - generic $$$$$ bromocriptine mesylate - PARLODEL $$ levodopa - DOPAR $$$$$ pergolide mesylate - PERMAX $$$$$ pramipexote - MIRAPEX $$$$$ ropinirole - REQUIP Levodopa Combinations $$$$ carbidopa-levodopa - generic $$$$ carbidopa-levodopa - SINEMET CR Antiparkinsontan Monoamine Oxidase Inhibitor $$$$$ selegiline HCI - ELDEPRYL SKELETAL MUSCLE RELAXANTS Central Muscle Relaxants $$ badofen - generic $$ cyciobenzapdne HCI - generic $$ diazepam - generic $$$ metaxalone - SKELAXIN $$$ orphenadrine citrate - NORFLEX Direct Muscle Relaxants $$$$$ dantrolene sodium - DANTRIUM 4/15/98 9:22 AM 22 indicates that the generic product is not A -rated by the FDA. We have developed a unique service approach that delivers relevant consultative tools designed to support you in attaining your goals for your prescription and medical benefits programs. As your partner in progressive health care management, we will provide you with meaningful analysis of your claims data, enabling you to make informed decisions relative to plan design and its impact on your drug spend and overall medical cost and utilization. Distinctive PBM Services Our dedicated team will respond to all your needs. We use an integrated implementation approach to assure that you and your members receive the excellent Member's Client's service we are known to provide. Whether it's Needs Goals customized materials or a special toll -free number for your members, we will work with City of Fort Collins to develop the approach that best fits their needs. Our dedicated Client Service team members monitor transition and implementation. They act as the liaison between you and Express ScriptsNalueRx to ensure that critical decisions are made and communicated in Express Scripts/ValueRx Team conjunction with the mutually agreed upon implementation timetable. Your Express ScriptsNalueRx team leader will provide a single point of contact for all inquiries and requests. Client Services: Express ScriptsNalueRx's Client Services team is responsible for making sure that our Client's needs and questions are satisfied in a timely manner. Customer Service: The Express ScriptsNalueRx's Customer Service department responds to calls from members for general information and specific questions concerning network, mail service and member submitted claims. Customer Service monitors representatives' calls to ensure the service provided not only meets, but exceeds, member expectations. Operations: Our operations department, including group implementation and claims administration, prides itself on its eligibility accuracy, claims processing time, extensive Concurrent Drug Utilization Review edits, and response time. Management Information Systems: Our in-house dedicated MIS liaison and information systems specialists are available to solve all system -related challenges. Provider Relations: Our Provider Relations department provides support for the pharmacy network that includes independent and chain pharmacies. Survey responses indicate Express ScriptsNalueRx is preferred by network pharmacists for quick and accurate system response, communication of client implementations, and assistance through our Pharmacy Help Desk. Mail Service Pharmacy: Express ScriptsNalueRx owns and operates five Mail Service Pharmacies that are fully integrated with our national retail pharmacy network. Express 4 Express Scripts® IV Progressive Healthcare Management Executive Summary for City of Fort Collins page 3 Muscle Relaxant Combinations $$$ carisoprodol w/ ASA - generic $$$ orphenaddne w/ ASA & caff - NORGESIC, FORTE ANTIMYASTHENIC AGENTS Antimyasthenic Agents $$$$ neostigmine bromide - PROSTIGMIN $$$$ pyridostigmine bromide - MESTINON NUTRITIONAL PRODUCTS VITAMINS Oil Soluble Vitamins Vitamin D $$$ calcitriol - ROCALTROL $ ergocaldferol -CALCIFEROL Vitamin K $$$ phytonadione - MEPHYTON MULTIVITAMINS Ped MV w/ Fluoride Ped Vitamins ACD w/ Fluoride $$ pediatric vitamins ACD w/ fluoride - generic Ped MV w/Fluoride $$ pediatric multivitamins w/FI - generic- Ped Multi Vitamins w/Fl & FE $$ Ped multi vitamins w/FI & FE - generic Ped Vitamins ACD Fluoride & iron $$ pediatric vitamins ACD fluoride & iron - generic Prenatal Vitamins Prenatal Vitamins $ prenatal vitamin - generic Prenatal MV & Min w/FE-FA $ prenatal multivit-min wlFe-FA - generic- $$ prenatal multivit-min w/Fe-FA - NATALINS RX $$ prenatal multivit-min w/Fe-FA - NIFEREX-150 FORTE, -PN, PN-FORTE $$ prenatal multivit-min w/Fe-FA - PRENATE 90 $$ prenatal multivit-min w/ Fe -FA - PRENATE ULTRA Iron w/Vitamins $$ iron w/ vitamins - CHROMAGEN FA $$$ iron w/ vitamins - CHROMAGEN FORTE MINERALS & ELECTROLYTES 4/15/98 9:22 AM 23 indicates that the generic product is not A -rated by the FDA. Potassium $ potassium bicarbonate - generic $ potassium bicarbonate & chloride - generic $ potassium chloride - generic $$$ potassium gluconate - generic HEMATOLOGICAL AGENTS HEMATOPOIETIC AGENTS Colony Stimulating Factor Erythropoietins $$$$$ epoetin alfa - PROCRIT (INJ) ANTICOAGULANTS Coumarin Anticoagulants $$$ warfarin sodium - COUMADIN HEMOSTATICS Hemostatics - Systemic $$$$$ aminocaproic Acid - AMICAR MISC. HEMATOLOGICAL AGENTS Platelet Aggregation inhibitors $$$$$ anagrelide HCI - AGRYLIN $$$$ ticlopidine HCI - TICLID Hematorrheological $$ pentobfylline - generic $$$ pentoxifylline - TRENTAL Antiplatelet Agents $ dipyridamole - generic Hematopoietic Mixtures $$ iron combinations - CHROMAGEN TOPICAL AGENTS OPHTHALMICS Note: All generic products are formulary and covered. Ophthalmic Antiinfectives Ophthalmic Antibiotics $$$ ciprofloxacin HCI - CILOXAN 4/15/98 9:22 AM 24 — indicates that the generic product is not A -rated by the FDA. $ erythromycin - generic $ gentamicin sulfate - generic $ gentamicin sulfate - GENTACIDIN $$$ ofloxacin - OCUFLEX $ tobramycin sulfate - generic Ophthalmic Sulfonamides $ sodium sulfacetamide - generic $ sodium sulfacetamide - SULF-10 Ophthalmic Antivirals $$ idoxuridine - HERPLEX $$$$$ trifluridine - generic $$$ vidarabine ophthalmic - VIRA-A Ophthalmic AntSungal $$$$$ natamycin - NATACYN Ophthalmic Ari infective Combinations $ sulfacetamide sodium & phenylephrine- VASOSULF $$ trimethoprim-polymyxin b - POLYTRIM Beta-blockers - Ophthalmic $$$$ betaxold HCI-BETOPTIC $$$$ betaxolol HCI - BETOPTIC-S $$$$ carteolol - OCUPRESS $$$ levobunolol HCI - generic $ timolol maleate - generic $$$$ timolol - BETIMOL Ophthalmic Steroids Ophthalmic Steroids $ dexamethasone - generic $ dexamethasone sodium phosphate - generic $$ fluorometholone- generic $$ fluoromethalone - EFLONE $$ fluoromethalone - FLUOR -OP $$$ fluoromethalone - FML $$$ fluoromethalone - FML FORTE $$ medrysone - HMS $$ prednisolone sodium phosphate - INFLAMASE FORTE $$ prednisolone sodium phosphate - INFLAMASE MILD $$ rimexolone - VEXOL Ophthalmic Steroid Combinations $ neomycin-polymy-dexameth - generic $$$ neomycin-polymy-dexameth - DEXACIDIN $$$ neomycin-polymy-dexameth - MAXITROL $$ sulfacetamide sod-fluorometh - FML-S $ sulfacetamide sod-pred - generic $$ sulfacetamide sod-pred - VASOCIDIN $$$ tobramycin-dexamethasone - TOBRADEX Prostaglandins - Ophthalmic $$$$$ latanoprost - XALATAN 4/15/98 9:22 AM 25 indicates that the generic product is not A -rated by the FDA. Cydoplegics Cycloplegics $ atropine sulfate - generk - $ atropine sulfate - ATROPISOL Ophthalmic Decongestants Ophthalmic Decongestants $ naphazoline HCI - generic $$ naphazoline HCI - VASOCON Miotics Miotics - Direct Acting $$$$ acetylcholine chloride - MIOCHOL-E $ carbachol - generic $$$$$ carbachol - CARBASTAT (INJ) $ pilocarpine HCI - generic $$ pilocarpine HCI - PILOCAR Miotic Combinations $$$ pilocarpine & epinephrine - E-PILO $$$ pilocarpine & epinephrine - P1E1, P2E1, P3E1 RE1, P6E1 Adrenergic Mydriatics $$$$$ apradonidine HCI - IOPIDINE $ dipivetrin - generic $$ dipivefrin - PROPINE $$ epinephrine HCI -EPIFRIN Ophthalmic Local Anesthetics $$ proparacaine HCI - OPHTHAINE Misc. Ophthalmics Ophthalmic Antiallergic $$$$ levocabastine HCI - LIVOSTIN $$$ lodoxamide tromethamine - ALOMIDE $$$$$ olopatadine HCI - PATANOL Ophthalmic NSAIDs $$$$ didofenac sodium - VOLTAREN $$$ flurbiprofen sodium - generic $$$$$ ketorolac tromethamine - ACULAR Ophthalmic Carbonic Anhydrase Inhibitors $ acetazolamide - generic $$$$ acetazolamide - DIAMOX SEQUELS $$$ dorzolamide HCI - TRUSOPT $$ methazolamide - generic $$$ methazolamide - MZM OTICS 4/15/98 9:22 AM 26 -- indicates that the generic product is not A -rated by the FDA. Otic Combinations Otic Steroid -Antibiotic Combinations $ neomycin-polymyxin-HC - generic Otic Analgesic Combinations $ pramoxine-HC - generic $ benzocaine & antipyrine - generic- $$ benzocaine-phenyleptuine-antipyrine - TYMPAGESIC Otic Miscellaneous $$$ triethanolamine oleate - CERUMENEX MOUTH & THROAT (Local) AGENTS Antiinfectives - Throat $ nystatin - generic $$$ clotrimazole - MYCELEX TROCHE Steroids - Mouth $ triamcinolone acetonide - generic Dental Products Fluoride Dental Rinse $ sodium fluoride - generic Fluoride Dental Gel sodium fluoride - generic stannous fluoride - generic ANORECTAL AGENTS Rectal Steroids $ hydrocortisone - generic $ hydrocortisone acetate - generic lntrarectal Steroids $$ hydrocortisone - generic- $$$$$ hydrocortisone - CORTENEMA $$$ hydrocortisone acetate - CORTIFOAM Rectal Local Anesthetics $ pramoxine HCI - generic Rectal Combinations Rectal Anesthetic/Steroids $ hydrocortisone w/ pramoxine - generic $$$ hydrocortisone w/ pramoxine - PROCTOCREAM-HC $$$ hydrocortisone w/ pramoxine - PROCTOFOAM-HC DERMATOLOGICAL AGENTS Acne Products 4/15/98 9:22 AM 27 .., indicates that the generic product is not A -rated by the FDA. $$$$$ adapalene - DIFFERIN $$$$ azelaic acid - AZELEX $ benzoyl peroxide - PERSA-GEL $$$$ metronidazole - METROGEL $$$$$ tretinoin - RETIN-A $$$$$ isotretinoin - ACCUTANE Acne Antibiotics $ clindamycin phosphate - generic $$$ clindamycin phosphate - CLEOCIN T $ erythromycin - generic $$$$ erythromycin - EMGEL Acne Combinations $$$$ sulfacetamide sodium w/ sulfur - generic $$$$ benzoyl peroxide-erythomycin - BENZAMYCIN Antibiotics - Topical $ bacitracin - generic $$ gentamicin sulfate - generic $$$ mupirocin - BACTROBAN $ neomycin sulfate - generic Antibiotic Mixtures Topical $ neomycin-polymyxin w/ lidocaine - generic $ neomycin-bacitracin-polymyxin w/ lidocaine - generic Antibiotic Steroid Combinations $ neomycin-HC acetate - generic $ neomycin-gramicidin-nystatin-biamcinolone - generic Antifungals - Topical $ nystatin - generic $$$$ terbinafine - LAMISIL lmidazole-Related Antifungals (Topical) $ clotrimazole (topical) - generic $$$$ econazole nitrate - SPECTAZOLE $$$ ketoconazole (topical) - NIZORAL $ miconazole nitrate (topical) $$$ oxiconazole nitrate - OXISTAT Antifungals - Topical Combinations $$$$ clotrimazole w/ betamethasone - LOTRISONE $ nystatin-triamcinolone - generic Antipsoriatics $$$$ anthralin - DRITHOCREME $$$$ anthralin - DRITHOSCALP $$$$$ etretinate - TEGISON Antiseborrheic Products $ selenium sulfide - generic 4/15/98 9:22 AM 28 — indicates that the generic product is not A -rated by the FDA. Antiviral - Topical $$$$$ acydovir topical - ZOVIRAX Bum Products $ nitrofurazone - generic $ silver sulfadiazine - generic Corticosteroids - Topical $$$ adometasone dipropionate - ACLOVATE $ betamethasone dipropionate - generic $$$$ aug betamethasone dipropionate - generic $$ betamethasone valerate - generic $$$$ dobetasol propionate - generic $$$$$ dobetasol propionate - TEMOVATE $$ desonide - generic $$ desoximeWme - generic $$$$$ diflorasone diacetate - PSORCON $$ fluocinolone aoetonide - generic $$ fluocinolone aoetonide - FS SHAMPOO $$$$ fluocinonide - generic $$$ fluticasone propionate - CUTIVATE $$ hydrocortisone - generic $$$ hydrocortisone valerate - WESTCORT $ triamcinolone acetonide - generic Steroid -Local Anesthetics $$ pramoxine-HC - EPIFOAM Kerstolytics $$$$$ podofilox - CONDYLOX Keratolytic Combinations $$ salicylic add & lactic add - generic Local Anesthetics - Topical $ lidocaine HCl - generic $$$ lidocaine-prilocaine - EMLA Depigmenting Agents $$$$$ trioxsalen - TRISORALEN Scabiccides & Pediculocides $ lindane - generic Misc. Topical $$$$$ fluorouracil - EFUDEX $$$$$ fluorouracil - FLUOROPLEX $$$$$ masopr000l - ACTINEX MISC. AGENTS Chelating Agents $$$$$ penicillamine - CUPRIMINE 4/15/98 9:22 AM 29 — indicates that the generic product is not A -rated by the FDA. Cydosponne Analogs $$$$$ cyclosporine - NEORAL $$$$$ cyclosporine - SANDIMMUNE Inosine Monophosphate Dehyrogenase Inhibitors $$$$$ mycophenolate mofetil - CELLCEPT Macrolide Immunosuppressants $$$$$ tacrolimus - PROGRAF Punne Analogs $$$ azathioprine - generic K Removing Resin $ sodium polystyrene sulfonate - generic Interferon $$$$$ interferon alpha-2b - INTRON-A $$$$$ interferon beta-1 a - AVONEX DIAGNOSTIC PRODUCTS Diagnostic Reagents Chemstrip K Test Strips Glucose Blood Diagnostic Reagents Accu-Chek Advantage Test Strips Accu-Chek Easy Test Strips Accu-Chek Instant Test Strips Chemstrip bG Test Strips One Touch Test Strips Sure Step Test Strips Tracer bG Test Strips Glucose Urine Test Chemstrip uG Test Strips Chemstrip uGK Test Strips Chemstrip K Test Strips MEDICAL DEVICES Blood Glucose Monitoring Tests Accu-Chek Advantage Kit Accu-Chek Advantage Conversion Kit Accu-Chek Easy Kit Accu-Chek Instant Kit Accu-Chek III Kit Advantage Glucose Control Kit Easy Glucose Control Kit Instant Glucose Control Kit One Touch Basic Kit One Touch Profile Kit 4/15/98 9:22 AM 30 -- indicates that the generic product is not A -rated by the FDA. Sure Step IGt Lancets SoftClix Lancets Soft Touch Lancets Lancet Devices SoftClix Lancet Device Soft Touch lancet Device Respiratory Therapy Supplies AEROCHAMBER 4/15/98 9:22 AM 31 indicates that the generic product is not A -rated by the FDA. amoxicillin & pot clavulanate, 1 -A- ampicillin, 1 ampicillin w/ probenecid, 1 acarbose, 7 anagrelide, 24 ACCOLATE, 14 Anastrozole, 5 Accu-Chek Advantage Conversion Kit, 30 ANCOBON, 2 Accu-Chek Advantage Kit, 30 ANDRODERM, 6 Accu-Chek Advantage Test Strips, 30 anthralin, 28 Accu-Chek Easy Kit, 30 APAP--aft-dihydrocodeine, 20 Accu-Chek Easy Test Strips, 30 APAP-isometheptene-dichloral, 21 Accu-Chek III Kit, 30 apraclonidine, 26 Accu-Chek Instant Kit, 30 ARICEPT, 19 Accu-Chek Instant Test Strips, 30 ARIMIDEX, 5 ACCUPRIL, 10 ASACOL, 16 ACCUTANE, 28 aspirin w/ codeine, 20 acebutolol, 9 aspirin-caffeine-butalbital, 19 acetaminophen w/ codeine, 20 astemizole, 12 acetaminophen w/ hydrocodone, 20 atenolol, 9 acetaminophen-butalbital, 19 atenolol & chlorthalidone, 11 acetaminophen-call-butalbital, 19 atorvastatin, 12 acetazolamide, 26 atovaquone, 4 acetohexamide, 7 atropine, 26 acetylcholine, 26 ATROPISOL, 26 acetylcysteine, 13 ATROVENT, 13,14 aclometasone, 29 AUGMENTIN, I ACLOVATE, 29 auranofin, 21 ACTIGALL, 16 AVONEX, 30 ACTINEX, 29 AXID, 15 ACULAR, 26 AXOCET, 19 acyclovir, 3, 29 azelaic acid, 28 ADALAT CC, 9 AZELEX, 28 adapalene, 28 azithromycin, 2 Advantage Glucose Control Kit, 30 AZMACORT, 14 AEROBID, M, 14 AZULFIDINE, 16 AEROCHAMBER, 31 AGRYLIN, 24 alendronate, 8 ALESSE, 6 bacitracin, 28 ALKERAN, 5 baclofen, 22 ALLEGRA, 12 BACTROBAN, 13,28 ALLEGRA D, 13 beclomethasone, 13, 14 allopurinol, 21 BECLOVENT, 14 ALOMIDE, 26 BECONASE AQ, 13 ALORA, 6 BELLERGAL-S, 21 alprazolam, 17 benazepril, 10 altretamine, 5 benazepril & amlodipine, 11 ALUPENT INHALER, 14 benazepril & HCTZ, 11 amantadine, 22 BENZAMYCIN, 28 AMARYL, 7 benzocaine & antipyrine, 27 AMBIEN, 19 benzonatate, 13 AMEN, 7 benzoyl peroxide, 28 AMICAR, 24 benzoyl peroxide-erythomycin, 28 aminocaproic Acid, 24 benztropine, 22 aminoglutethimide, 8 betamethasone, 29 amiodarone, 10 BETAPACE, 9, 10 amitriptyline, 18 betaxolol, 25 Amlodipine, 9 bethanechol, 16 amoxicillin, I BETIMOL, 25 4/15/98 9:22 AM 32 indicates that the generic product is not A -rated by the FDA, ScriptsNalueRx's mail service pharmacies are committed to rapid and accurate prescription processing time, enhanced generic fill rate, intervention rate, and change rate to more cost effective medications. Retail Pharmacy Network: Providers in Express Scripts'NalueRx's retail pharmacy network, that includes more than 98 percent of pharmacies nationwide are contractually bound to, and audited for, consistent quality standards. Express Scripts/ValueRx has several nationwide networks offering options for access and cost containment. An example of Express Scripts'NalueRx's flexibility is the 321 networks we have customized to meet the needs of specific clients. Information System Management: Developed and Operated In-house Express ScriptsNalueRx has been developing and operating its own systems since our inception in 1986. We have found that we have a better understanding of our needs and those of City of Fort Collins than does an outside Computerworld listed vendor. As such we are adept at customizing reports, eligibility Express Scripts / formats and feeds, claims processing, and specialized programs ValueRx among the designed for our business. Our clients have noted that frequently, Premier 100 Companies when they request an individualized report, we can produce it in- house in a matter of days thus eliminating the time needed to for most effective outsource the request and await production. Express management of ScriptsNalue Rx also has options for on-line and ad hoc user information. defined reporting giving you the greatest possible flexibility in managing your prescription benefit. Express ScriptsNalueRx believes that having total control over our own MIS operations will afford City of Fort Collins ease of administration of their prescription drug program. Advanced Clinical Strategies Express ScriptsNalueRx offers many cost containment programs and a variety of preferred drug lists from which City of Fort Collins may choose. We provide advanced pharmacy services to City of Fort Collins merging pharmacy and medical data. We have redefined formulary management to allow for improved formulary decisions. Product selection is not be based merely upon the lowest net cost product or product with the highest rebate, but is centered on each drugs' relative overall impact on medical costs and quality of life as they relate to a specific disease state. This new capability can provide City of Fort Collins with a new set of skills in controlling overall medical costs. Advanced clinical services provide additional quality enhancements and cost control now and into the future. These are some of the advanced clinical services City of Fort Collins may choose: Proprietary drug product preference programs control bottom -line cost while maintaining clinical quality by shifting utilization to preferred products through plan design and intervention strategies. Plan sponsors may choose from a range of formularies —from open to closed —which may vary in coverage and savings potential. Express Scripts% Progressive Healthcare Management Executive Summary for City of Fort Collins page 4 BETOPTIC, -S, 25 chloroquine, 4 BIAXIN,2 chlorphen-phenind & phenylprop,13 bicalutamide, 5 chlorpromazine, 18 bisoprolol & HCTZ, 11 chlorthalidone, I BROMFED, -PD, 13 choline & mag salicylate, 20 bromocriptine, 22 chorionic gonadotropin, 8 brompheniramine & psuedoeph, 13 CHROMAGEN, 24 budesonide, 13, 14 CHROMAGEN FA, 23 bumetanide, I I CHROMAGEN FORTE, 23 bupropion, 18 CILOXAN, 24 BUSPAR, 17 cimetidine, 15 buspirone, 17 CIPRO, 2 busulfan, 5 ciprofloxacin, 2, 24 butabarbital, 21 cisapride, 16 butalbital/aspirin/caffeine w/ codeine, 20 clarithromycin, 2 CLARITIN, 12 CLARITIN-D, -D 24,13 CLEOCIN, 17 CALCIFEROL, 23 CLEOCIN T, 28 calcitonin, 8 CLIMARA, 6 calcitriol, 23 clindamycin, 2, 17, 28 CAPITAL/COD, 20 clobetasol, 29 captopril, 10 clomiphene, 8 CARAFATE, 15 clonazepam, 21 carbachol, 26 clonidine, 10 carbamazepine, 22 clotrimazole, 27 CARBASTAT, 26 clotrimazole w/ betamethasone, 28 carbidopa-levodopa CR, 22 cloxacillin, 1 CARDIOQUIN, 10 clozapine, 18 CARDIZEM CD, 9 CLOZARIL, 18 CARDURA, l 1 codeine sulfate, 19 carisoprodol w/ ASA, 23 colchicine, 21 carteolol, 25 colchicine w/ probenecid, 21 carvedilol, 9 COLESTID, 12 CASODEX, 5 colestipol, 12 CATAPRES-TTS, 10 COLYTE, 15 CECLOR CD, I COMBIVIR, 3 CEDAX, I CONDYLOX, 29 CEENU, 5 conjugated estrogens, 6, 17 cefaclor, 1 conjugated estrogens-medroxyprogesterone acetate, 6 cefaclor monohydmte, 1 CORDARONE, 10 cefixime, 1 COREG, 9 cefpodoxime, 1 CORTENEMA, 27 cefprozil, 1 CORTIFOAM, 27 ceftibuten, 1 COUMADIN, 24 CEFTIN, I COZAAR, 10 cefuroxime, 1 CRIXIVAN, 3 CEFZIL, I cromolyn, 14 CELLCEPT, 30 CUPRIMINE, 29 cephalexin, I CUTIVATE, 29 CERUMENEX, 27 cyclobenzaprine, 22 cetirizine, 12 cyclophosphamide, 5 Chemstrip bG Test Strips, 30 cyclosporine, 30 Chemstrip K Test Strips, 30 CYLERT, 19 Chemstrip uG Test Strips, 30 cyproheptadine, 12 Chemstrip uGK Test Strips, 30 CYTADREN, 8 chlorambucil, 5 CYTOTEC, 15 chloramphenicol, 4 CYTOXAN, 5 chlordiazepoxide, 17 4/15/98 9:22 AM 33 -- indicates that the generic product is not A -rated by the FDA. danazol, 6 Easy Glucose Control Kit, 30 DANOCRINE, 6 econazole, 28 DANTRIUM, 22 EFFEXOR, 18 dantrolene, 22 EFLONE, 25 DARAPRIM, 4 EFUDEX, 29 DAYPRO, 20 ELDEPRYL, 22 DDAVP, 8 EMCYT, 5 delavirdine, 3 EMGEL, 28 DEPAKENE, 22 EMLA, 29 DEPAKOTE, 22 ENTEX LA, 13 desipramine, 18 ENTEX PSE, 14 desmopressin, 8 EPIFOAM, 29 DESOGEN, 6 EPIFRIN, 26 desogestrel & ethinyl estrad, 6 E-PILO, 26 desonide, 29 epinephrine, 14, 26 desoximetasone, 29 EPIPEN, IR, 14 DEXACIDIN, 25 EPIVIR, 3 dexamethasone, 6,25 epoetin alfa, 24 DEXEDRINE, 19 ERGAMISOL, 5 dextroamphetamine, 19 ergocalciferol, 23 DHC PLUS, 20 ERGOMAR, 21 DIAMOX SEQUELS, 26 ergotamine, 21 diazepam, 17, 22 ergotamine w/ PB & belladonna, 21 diclofenac, 20, 26 erythromycin, 1, 25,28 dicyclomine, 15 erythromycin & sulfisoxazole, 4 didanosine, 3 ESGIC PLUS, 19 DIDRONEL, 8 ESKALITH CR, 18 diethylstilbestrol, 5 est estrogens & methyltest, 6 DIFFERIN, 28 esterified estrogens, 6 diflorasone, 29 ESTRACE, 6,17 DIFLUCAN, 3 estradiol, 6, 17 diflunisal, 20 estramustine, 5 digoxin, 9 ESTRATEST, HS, 6 DILANTIN, 21 estropipate, 6 DILATRATE SR, 9 ethambutol, 2 DILAUDID, 19 ETHMOZINE, 10 DILAUDID COUGH SYRUP, 13 ethosuximide, 22 DILTIA XT, 9 ethynodiol diacet & eth estrad, 6 diltiazem, 9 etidronate, 8 DIOVAN, 10 etodolac, 20 DIPENTUM, 16 etoposide, 5 dipivefrin, 26 EULEXIN, 5 dipyridamole, 24 EXGEST LA, 13 disopyramide CR, 10 disulfiram, 19 divalproex, 22 -Ti- donepezil, 19 famciclovir, 3 DOPAR, 22 FAMVIR, 3 domase alfa, 15 fenoprofen, 20 dorzolamide, 26 fentanyl, 19 doxazosin, 11 FERTINEX, 8 doxepin, 18 fexofenadine, 12 doxycycline, 2 fexofenadine & pseudoephedrine, 13 DRITHOCREME, 28 finasteride, 17 DRITHOSCALP, 28 flecainide, 10 DURAGESIC, 19 FLONASE, 13 FLOVENT, 14 4/15/98 9:22 AM 34 -- indicates that the generic product is not A -rated by the FDA. FLOXIN, 2 fluconazole, 3 flucytosine, 2 FLUMADINE, 3 flunisolide, 14 fluocinolone, 29 fluocinonide, 29 fluoromethalone, 25 FLUOR -OP, 25 FLUOROPLEX, 29 fluorouracil, 29 fluoxetine, 18 fluoxymesterone, 6 fluphenazine, 18 flurbiprofen, 20, 26 flutamide, 5 fluticasone, 13, 14, 29 FML, 25 FORTOVASE,3 FOSAMAX, 8 fosinopril, 10 FS SHAMPOO, 29 FULVICIN P/G, 3 FURADANTIN, 16 furosemide, 11 gabapentin, 22 GANTRISIN, 2 gemfibrozil, 12 GENTACIDIN, 25 gentamicin, 25, 28 glimepiride, 7 glipizide, 7 glucagon, 7 GLUCOPHAGE,7 GLUCOTROL XL, 7 glyburide, 7 GLYNASE PRESTAB, goserelin, 5 granisetron, 16 GRIFULVIN V, 3 griseofulvin, 2, 3 GUAIFED, -PD, 13 guaifenesin, 13 guanfacine, 10 -H- haloperidol, 18 HELIDAC, 15 HERPLEX, 25 HEXALEN,5 HISMANAL, 12 HISTUSSIN D, 13 HISTUSSIN HC, 13 HIVID,3 HMS, 25 HUMALOG, 7 human insulin, 7 HUMULIN, 7 hydralazine & HCTZ, 11 hydrochlorothiazide, I I hydrocortisone, 6, 27, 29 hydrocortisone acetate, 27 hydrocortisone w/ pramoxine, 27 hydromorphone HCI, 19 hydromorphone-GG, 13 hydroxychloroquine,4, 21 hydroxyzine, 17 hyoscyamine, 15, 16 HYTRIN, 11 HYZAAR, i l ibuprofen, 20 ibuprofen w/hydrocodone, 20 idoxuridine, 25 IMDUR, 9 imipramine, 18 IMITREX,21 indapamide, I I indinavir, 3 indomethacin, 20, 21 INFLAMASE FORTE, 25 INFLAMASE MILD, 25 INSPIREASE, 31 Instant Glucose Control Kit, 30 insulin lispro, 7 INTAL, 14 interferon alpha-2b, 30 interferon beta -la, 30 INTRON-A, 30 INVIRASE, 3 iodoquinol, 4 IOPIDINE, 26 ipratropium, 13, 14 ipratropium-albuterol, 14 iron w/ vitamins, 23 isoniazid, 2 isosorbide, 9 isotretinoin, 28 isoxsuprine, 12 itraconazole, 3 ketoconazole, 3, 28 ketoprofen, 20 ketorolac, 26 KLONOPIN, 21 KYTRIL, 16 labetalol, 9 09M -L- 4/15/98 9:22 AM 35 -- indicates that the generic product is not A -rated by the FDA. LAMICTAL, 22 masoprocol, 29 LAMISIL, 3,28 MATULANE, 5 lamivudine, 3 MAVIK, 10 lamivudine-zidovudine, 3 MAXAIR AUTOHALER, 14 lamotrigine, 22 MAXITROL, 25 LANOXICAPS, 9 medroxyprogesterone, 7 LANOXIN, 9 medrysone, 25 latanoprost, 25 megestrol, 5 leucwvorin, 5 MELLARIL, -S, 18 LEUKERAN, 5 melphalan, 5 levamisole, 5 menotropins, 8 LEVATOL, 9 MEPHYTON, 23 LEVBID, 15 MEPRON, 4 levobunolol, 25 mercaptopurine, 5 levocabastine, 26 mesalamine, 16 Ievodopa, 22 MESTINON, 23 levonorgestrel & eth estradiol, 6, 7 metaproterenol, 14 levothyroxine, 8 metaxalone 22 LEVSIN, 15,16 metformin, 7 LEVSINEX, 15 methazolamide, 26 lidocaine, 29 METHERGINE, 8 lidocaine-prilocaine, 29 methotrexate, 5, 21 lindane, 29 methyldopa, 1 I liotrix, 8 methylergonovine, 8 LIPITOR 12 methyltestosterone, 6 LIQUIBID, 13 metoclopramide, 16 LIQUIBID-D, 13 metolazone, 11 lisinopril, 10 metoprolol, 9 lisinopril & HCTZ, 11 METROGEL, 28 lithium, 18 METROGEL VAG GEL, 17 LIVOSTIN, 26 metronidazole, 4, 17, 28 LO/OVRAL, 7 metronidazole-tetracycline w/ bismuth subsalicylate, 15 LODINE, XL, 20 mexiletine, 10 lodoxamide, 26 MEXITIL, 10 LOESTRIN, 6 MIACALCIN, 8 LOESTRIN FE, 7 MIACALCIN NASAL SPRAY, 8 lomustine, 5 miconazole, 28 LORABID, 4 MICRONOR, 6 loracarbef, 4 midodrine, 12 loratadine, 12 MIDRIN, 21 loratadine & pseudoephedrine, 13 minocycline, 2 Iorazepam, 17 MINTEZOL, 4 LORCET, PLUS, 20 MIOCHOL-E, 26 LORTAB LIQUID, 20 MIRAPEX, 22 losartan, 10 mirtazapine, 18 losartan & HCTZ, I 1 misoprostol, 15 LOTENSIN, 10 mitotane, 5 LOTENSIN HCT, 11 MODICON, 6 LOTREL, 11 moexipril, 10 LOTRISONE, 28 mometasone, 13 loxapine, 18 MONOKET, 9 LOZOL, 11 MONOPRIL, 10 LYSODREN, 5 moricizine, 10 morphine, 19 MS CONTIN,'19 MSIR, 19 MACROBID, 16 mupirocin, 13, 28 MACRODANTIN, 16 MYAMBUTOL, 2 maprotiline, 18 MYCELEX TROCHE, 27 MYCOBUTIN, 2 4/15/98 9:22 AM 36 -- indicates that the generic product is not A -rated by the FDA. mycophenolate, 30 MYKROX, 11 MYLERAN, 5 MZM, 26 nabumetone, 20 nadolol, 9 nafarelin, 8 NALDECON, I? naltrexone, 20 naphazoline, 26 NAPRELAN, 20 naproxen, 20 NARDIL, 17 NASACORT, 13 NASONEX, 13 NATACYN, 25 natamycin, 25 NEBUPENT, 4 nefazodone, 17 nelfinavir, 3 NORGESIC, FORTE, 23 norgestimate & ethinyl estradiol, 7 norgestimate-ethinyl estradiol - ORTHO TRI-CYCLEN, 7 norgestrel & ethinyl estradiol -, 7 -rj- NORPACE CR, 10 nortriptyline, 18 NORVASC,9 NORVIR, 3 nystatin-triamcinolone, 28 neomycin, 2,28 neomycin-bacitracin-polymyxin w/ lidocaine, 28 neomycin-gramicidin-nystatin-triamcinolone, 28 neomycin-HC acetate, 28 neomycin-polymy-dexameth, 25 neomycin-polymyxin w/ lidocaine, 28 neomycin-polymyxin-HC, 27 NEORAL,30 neostigmine, 23 NEURONTIN, 22 nevirapine, 3 niacin, 12 NIASPAN, 12 nifedipine, 9 NIFEREX-150 FORTE, -PN, PN-FORTE, 23 nimodipine, 9 NIMOTOP, 9 NITRODISC, 9 NITRO-DUR, 9 nitrofurantoin, 16 nitrofurazone, 29 nitroglycerin, 9 NITROSTAT, 9 Nizatadine, 15 NIZORAL, 3,28 NOLAMINE, 13 NOLVADEX, 5 NORDETTE, 6 norethin acet & estrad-fe, 7 norethindrone, 6 norethindrone & eth estradiol, 6 norethindrone & mestranol, 6 norethindrone acet & eth estra, 6 norethindrone-ethinyl estrad - ORTHO-NOVUM TAB 7/7/7, 7 NORFLEX, 22 OCUFLEX, 25 OCUPRESS,25 ofloxacin, 2, 25 olanzapine, 18 olopatadine, 26 olsalazine, 16 omeprazole, 15 ondansetron, 16 One Touch Basic Kit, 30 One Touch Profile Kit, 30 One Touch Test Strips, 30 OPHTHAINE, 26 orphenadrine, 22 orphenadrine w/ ASA & caff, 23 ORTHO TRI-CYCLEN, 7 ORTHO-CEPT,6 ORTHO-CYCLEN, 7 ORTHO-EST, 6 ORTHO-NOVUM, 7 ORUVAIL, 20 OVCON,6 oxacillin, 1 oxaprosin, 20 oxazepam, 17 oxiconazole, 28 OXISTAT, 28 oxybutynin, 16 oxycodone, 19 oxycodone w/ aspirin, 20 OXYCONTIN, 19 oxytocin, 8 -P- P1El, P2EI, P3El NEI, NE1, 26 PANCREASE, 16 PANCREASE MT, 16 pancrelipase, 16 PARLODEL, 22 PARNATE, 17 paroxetine, 18 PATANOL, 26 PAXIL, 18 PCE, 1 ped multi vitamins w/FI & FE, 23 Pediatric multivitamins w/Fl, 23 4/15/98 9:22 AM 37 — indicates that the generic product is not A -rated by the FDA. pediatric vitamins ACD fluoride & iron, 23 pediatric vitamins ACD w/ fluoride, 23 PEDIAZOLE,4 pemoline, 19 penbutolol, 9 penicillamine, 29 penicillin, I pentamidine, 4 pentazocine w/ APAP, 20 pentazocine w/ naloxone, 20 pentoxifylline, 24 pergolide, 22 PERGONAL, 8 PERMAX, 22 perphenazine, 18 PERSA-GEL,28 phenazopyridine, 17 phenelzine, 17 PHENERGAN, 15 pheniramine-phenyltoloxamine-pyrilamine, 12 phenobarbital, 21 phenobarbital & belladonna alk, 15 phenylephrine-GG, 13 phenyltoloxamine w/ APAP, 19 phenytoin, 21, 22 PHRENILIN, FORTE, 19 phytonadione, 23 PILOCAR, 26 pilocarpine, 26 pilocarpine & epinephrine, 26 pindolol, 9 piperazine, 4 pirbuterol, 14 podofrlox, 29 POLY-HISTINE, 12,13 POLY-HISTINE D, -PED, 13 POLY-HISTINE DM, 13 POLYTRIM,25 potassium bicarbonate, 24 potassium chloride, 24 potassium gluconate, 24 pramipexole, 22 pramoxine, 27 pramoxine-HC, 27, 29 PRAVACHOL, 12 pravastatin, 12 prazosin, I PRECOSE, 7 prednisolone, 6, 25 prednisolone sodium phosphate, 25 prednisone, 6 PRELONE,6 PREMARIN, 6, 17 PREMPHASE, 6 PREMPRO, 6 prenatal vitamin, 23 PRENATE 90, 23 PRENATE ULTRA, 23 PRILOSEC, 15 primidone, 22 PROAMATINE, 12 probenecid, 21 procainamide, 10 procarbazine, 5 PROCARDIA XL, 9 prochlorperazine, 15 PROCRIT, 24 PROCTOCREAM-HC, 27 PROCTOFOAM-HC, 27 PROFASI, 8 PROGRAF, 30 promethazine, 15 propafenone, 10 PROPINE, 26 propoxyphene napsylate, 19 propranolol, 9 propranolol & HCTZ, 1 I PROPULSID, 16 propylthiouracil, 8 PROSCAR, 17 PROSTIGMIN, 23 PROVENTIL HFA, 14 PROVERA,7 PROZAC, 18 pseudoephedrine-GG, 13 PSORCON, 29 PULMICORT, 14 PULMOZYME, 15 PURINETHOL, 5 pyrantel, 4 pyrazinamide, 2 pyridostigmine, 23 pyrimethamine, 4 quinidine, 10 quinine sulfate, 4 S'E ranitadine-bismuth citrate, 15 ranitidine, 15 RELAFEN,20 REMERON, 18 REQUIP, 22 RESCRIPTOR, 3 RETIN-A, 28 RETROVIR, 3 REVIA, 20 REZULIN, 7 RHINOCORT, 13 RIDAURA, 21 rifabutin, 2 rifampin, 2 RIMACTANE, 2 rimantadine, 3 rimexolone, 25 RISPERDAL, 18 4/15/98 9:22 AM 38 -- indicates that the generic product is not A -rated by the FDA. risperidone, 18 SYNTOCINON, 8 ritonavir, 3 ROCALTROL, 23 ropinirole, 22 ROWASA, 16 tacrolimus, 30 RYTHMOL, 10 TALACEN, 20 TALWIN NX, 20 —� TAMBOCOR, 10 salicylic acid & lactic acid, 29 salmeterol, 14 salsalate, 20 SANDIMMUNE, 30 saquinavir, 3 selegiline, 22 selenium sulfide, 28 SEREVENT, 14 SEROPHENE,8 sertraline, 18 SERZONE, 17 silver sulfadiazine, 29 simvastatin, 12 SINEMET CR, 22 SKELAXIN, 22 SLO-BID, 14 sodium fluoride, 27 sodium polystyrene sulfonate, 30 sodium sulfacetamide, 25 Soft Touch Lancet Device, 31 Soft Touch Lancets, 31 SoftClix Lancet Device, 31 SoftClix Lancets, 31 sotalol, 9, 10 SPECTAZOLE,28 spironolactone, I spironolactone & HCTZ, I 1 SPORANOX, 3 stannous fluoride, 27 stavudine, 3 STILPHOSTROL, 5 sucralfate, 15 SULF-10, 25 sulfacetamide sod-fluorometh, 25 sulfacetamide sodium & phenylephrine, 25 sulfacetamide sodium w/ sulfur, 28 sulfacetamide sod-pred, 25 sulfadiazine, 2 sulfamethoxazole, 2 sulfanilamide, 17 sulfasalazine, 16 sulfinpyrazone, 21 sulfisoxazole, 2 sulindac, 20 sumatriptan succinate, 21 SUPRAX,1 Sure Step Kit, 31 Sure Step Test Strips, 30 SYNAREL,8 SYNTHROID, 8 tamoxifen, 5 TARKA, 11 TEGRETOL, 22 TEGRETOL XR, 22 temazepam, 19 TEMOVATE, 29 TERAZOLE, 17 terazosin, 11 terbinafine, 3, 28 terconazole, 17 TESLAC, 5 testolactone, 5 testosterone, 6 tetracycline, 2 THEO-DUR, 14 theophylline, 14 thiabendazole, 4 thioridazine, 18 thiothixene, 18 THYROLAR, 8 -T- TIAZAC, 9 TICLID, 24 ticlopidine, 24 timolol, 25 TOBRADEX, 25 tobramycin, 25 tobramycin-dexamethasone, 25 tocainide, 10 tolazamide, 7 tolbutamide, 7 tolmetin, 20 TONOCARD, 10 TOPAMAX, 22 topiramate, 22 TOPROL XL, 9 T-PHYL, 14 Tracer bG Test Strips, 30 tramadol, 19 TRANDATE, 9 trandolapril, 10 trandolapril & verapamil, 1 I TRANSDERM NITRO, 9 tranylcypromine, 17 trazodone, 17 TRENTAL, 24 tretinoin, 28 triamcinolone, 14, 27, 29 triamterene & HCTZ, 11 triazolam, 19 triethanolamine, 27 trifluridine, 25 4/15/98 9:22 AM 39 indicates that the generic product is not A -rated by the FDA. trihexyphenidyl, 22 TRILISATE, 20 trimacinolone, 13 trimethobenzamide, 15 trimethoprim, 4 trimethoprim/sulfamethoxazole, 4 trimethoprim-polymyxin b, 25 trioxsalen, 29 tripelennamine, 12 TRIPHASIL, 7 TRISORALEN, 29 TRITEC, 15 troglitazone, 7 TRUSOPT,26 T-STAT, 28 TYMPAGESIC, 27 -U- ULTRAM,19 UNI-DUR, 14 UNIPHYL, 14 UNIVASC, 10 urofolliotropin, 8 ursodiol, 16 V valacyclovir HCI, 3 valproate, 22 valproic acid, 22 valsartan, 10 VALTREX,3 VANCOCIN, 4 vancomycin, 4 VANTIN, 1 VASOCIDIN, 25 VASOCON, 26 VASOSULF, 25 venlafaxine, 18 VEPESID,5 verapamil, 9 VERELAN,9 VEXOL, 25 VICOPROFEN,20 vidambine, 25 VIDEX, 3 VIRA-A, 25 VIRACEPT,3 VIRAMUNE, 3 VOLMAX, 14 VOLTAREN,26 -W- warfarin, 24 WELLBUTRIN, 18 WESTCORT, 29 -X- XALATAN, 25 -Z_ zafirlukast, 14 zalcitabine, 3 ZARONTIN, 22 ZAROXOLYN, 11 ZEPHREX LA, 14 ZERIT, 3 ZESTORETIC, I ZESTRIL,10 ZIAC, 11 Adovudine, 3 zileuton, 14 ZITHROMAX, 2 ZOCOR, 12 ZOFRAN,16 ZOLADEX,5 ZOLOFT, 18 zolpidem, 19 ZOVIRAX, 29 ZYFLO,14 ZYPREXA, 18 ZYRTEC,12 40 4/15/98 9:22 AM — indicates that the generic product is not A -rated by the FDA. PLACE STAMP HERE ❑ PLEASE CHECK HERE FOR CHANGE OF ADDRESS 4 Express Scripts' Progressive Healthcare Management MAIL PHARMACY SERVICE PO BOX 52123 PHOENIX, AZ 85072-2123 so 4iveHExpress Scripts ft pe HsScripts! Ill IMA� PMIFF Compleft aK 5 see"ns to order yew medications MQUIEK FOLD OYERIMDSM ----------- L any, /1 4: 10�f�Iil -0 /4 *Wats$hW#* • Name Last First M.I. Nickname • Sex: E] M E] F E] No known allergies E] Other ins. Coverage Smoker 0 Pregnant ntact Drink LeConses Alcohol Physician Birth Date Name Last First M.I. Nickname • Sex: E] M F-1 F E] No known allergies ❑ Other ins. Coverage - - Physician Birth Date [] Smoker E] Pregnant 11 Contact El Drink Lenses Alcohol Name Last First M.I. Nickname • Sex: E] M E] F E] No known allergies E] Other ins. Coverage Physician Birth Date El Smoker ❑ Pregnant 0 LenContact o Drink ses ❑ Alcohol Name Last First M.I. Nickname • Sex: E) M E] F E] No known allergies E] Other ins. Coverage Contact Ei Drink [I Smoker [I Pregnant ❑0 Lenses Alcohol Physician Birth Data Spacial Handling Roqulredi --------- ---- ---- Non -Child -Resistant Containers I certify that all information on this form IS correct. I permit Express Scripts to release all information to plan sponsor, administrator or Please sign below if you want prescriptions for you or your eligible dependents dispensed In non -child resistant containers. underwriter. .9-; "AAA Express Script Pmg M N!", M ressive Heafthcare Management Signature Required 4 Signature Required I request this and all future orders be shipped "signature required". If you wish to resume receiving child -resistant WMKML600 9/97 I understand there will be an extra charge for this service. containers, please check box. 0 Q O 4 Q 3 02 I SN am RL �3 wpmpLxf -� mmcro gi wm nc��n r. r m a 41 o Y m e w N m m e 3 < W m O VI Ym J j N Y N � � • y JN P.. NPJW NeYN ,ONYmVI J P A-ev_ " �:, w Y[f N N �(Ny@AY W O M A- :PV YG WC6. `t apt w td+m E m A wA a S N YNAY O.bA +u TJ YA V(N V1 �34; & H H O ID P N �•.� 4' M V J 1' 1c 3 N i 3 m W J N •O e i,, q. w ry c a Advanced proactive drug utilization strategies based on concurrent and retrospective analysis identify inappropriate drug usage, promote proper use of medications, and support a cost-effective pharmacy benefits. The Express Health Line sMprogram is a direct line to healthcare information that provides confidential, non -directive health and education counseling and disease management services through a 24-hour call center staffed by registered nurses and pharmacists. Disease management programs offer City of Fort Collins a broad array of services from turn -key programs to component support that can impact the financial performance of a health benefits program. The programs offer City of Fort Collins true disease management - a comprehensive, integrated, cost-effective approach to treatment encompassing clinical guidelines, patient education, provider partnering, behavior modification, prevention strategies, and outcomes measures. Data integration and analysis is a function of Practice Patterns Science, Inc. (PPS), a subsidiary of Express ScriptsNalueRx. This information service company processes and sorts medical encounter claims data, prescription drug claims data, clinical laboratory claims data, and patient outcomes data into meaningful diagnostic clusters. PPS analyzes the variations in disease -specific patterns of treatment at the provider and patient levels. Medical risk managers use PPS' analytical tools to manage healthcare resources to achieve better health outcomes at a lower cost. Reduced Costs and better Outcomes Through Effective Formulary Management PBMs owned by pharmaceutical manufacturers may offer higher discounts from Average Wholesale Price on their How parent company's products. But these products may be Express more expensive, or less effective, therapeutic alternatives. Scripts/ Nonetheless, these products obtain favored positions on ValueRx these PBM's formularies, resulting in greater market share Reduces for the parent's drugs, and higher health benefits costs for the PBM's clients. Express ScriptsNalueRx has the ability, Drug as the largest independent PBM, to achieve the most cost- Costs effective and clinically appropriate drug mix. 4l Express Scripts® Progressive Healthcare Management Executive Summary for City of Fort Collins pages EXPRESS SCRIPTS RANKS #1 IN OVERALL CUSTOMER SATISFACTION FOR THE SECOND CONSECUTIVE YEAR' 1 #1 Lowest Cost of Drugs Express Scripts ranks #1 with customers in an independent survey for the second consecutive year! Our commitment earned us honors in nine categories (nearly doubling our efforts from 1996) essential to superior pharmacy benefit management. Flexibility to Meet Each Client's Needs Today and Tomorrow #1 Management Reports #1 Eligibility Data Management #1 I.D. Card Production and Distribution #1 Retrosoective DUR Th—q Benefit Manapement In01Me lL Mer Satlal lon S—y. 1997 Just as every client is unique, so is every plan. For this reason, Express Scripts provides flexible benefit design options, working with each client to set or change plan parameters and examine specific needs on an ongoing basis. The broad areas addressed include type of pharmacy service and network, member cost sharing programs, plan sponsor cost savings programs and drug category inclusion/exclusion decisions. To enhance the process, Express Scripts uses proprietary plan modeling tools and programs. The result is benefit design consultation to serve each member population. Express Scripts also offers programs designed to meet the unique needs of various audiences including Medicare, Medicaid, seniors, and workers' compensation. Setting Quality Standards At Express Scripts, we believe quality must be at our very foundation. To that end, we've established a total quality management system for all areas of our business. This comprehensive program includes periodic measurement of customer service, mail service pharmacy, client services and information systems. Specific performance measures are evaluated including response time for customer calls, mail service prescription processing time, speed of installation and claims processing time. Our results are examined and evaluated to identify opportunities for continuous improvement. Express Scripts. Inc. is a leader in progressive healthcare management. delivering advanced capabilities in several complementary healthcare businesses. Express Scripts' pharmacy benefit management business currently provides managed prescription drug services to millions of members throughout the United States and Canada. Practice Patterns Science. Inc. offers healthcare information management services, linking healthcare data from all points of care. ESI Vision Care offers an innovative managed vision care program. the Universal Allowance Plan. IVTx applies managed care principles to infusion therapy management. Health Management Services provides comprehensive informed decision counseling (Express Health Line" ) and disease management services (HealthExpress ) through a 24-hour call center staffed by registered nurses and pharmacists Express Scripts' businesses serve HMOs. third -party administrators. insurance companies, unions and self -insured employers Express Scripts (http //www.express-scripts com) is headquartered in St Louis, Missouri Delivering Advanced Clinical Capabilities Express Scripts extensive consultative services help clients better manage diseases, drug costs and overall healthcare spending. By going beyond the basics of pharmacy benefit management, Express Scripts delivers advanced capabilities. ExpressPreferencelm Programs Proactive drug therapy management programs shift utilization to preferred products ExpressPreference`"' programs help control bottom -line costs while maintaining clinical quality through proprietary programs that successfully shift utilization to preferred products through plan design and intervention strategies. Plan sponsors may choose from a range of formularies —from open to closed —which may vary in coverage and savings potential. • The Physician Preference program is a voluntary formulary that proactively educates physicians and patients about the opportunity to choose less costly therapeutically and chemically equivalent drugs from the preferred product list. A three -tiered copay structure can be added to provide a financial incentive to the member. • The Select Preference program is a restricted formulary that provides coverage for products on a preferred list; the corresponding non -preferred products are not covered. This can be implemented on the initial prescription or on the first refill. • The Full Preference program is a closed formulary including 800 of the most frequently prescribed medications that offers the highest plan savings. Prescriptions for preferred products are covered by the plan; non -preferred products are not covered by the plan. The ExpressTherapeuticss' Program An advanced drug utilization stategy program combining clinical intervention modules and communication strategies The ExpressTherapeuticss" program is an advanced proactive drug utilization strategy based on concurrent and retrospective analysis that identifies inappropriate drug usage, promotes proper use of medications and supports a cost-effective pharmacy benefit. Disease Management - HealthExpresg'"Program A targeted, cost-effective approach to treatment Express Scripts provides a comprehensive, integrated approach to disease management. This consultative service, providing useful information to clients, members and physicians, can include the following components: • Targeted member identification • Member phone assessment, follow-up calls and counseling • Member educational materials and newsletters • Targeted outbound -call wellness programs • Member satisfaction and health status surveys via phone/mail • Physician intervention program via phone/fax • Medical and prescription drug clinical guidelines for physicians • Outcome surveys including clinical, economic, physician report card and member satisfaction Independence and Drug Mix for Bottom Line Savings Express Scripts' progressive management approach means striving to be cost-effective while maintaining quality healthcare. Because Of our independent status, Express Scripts is able to make decisions to reduce bottom line costs for our clients. Although PBMs are often compared on discounts offered, it's drug mix, not discounts that most dramatically impacts bottom line costs. PBMs offering higher discounts cannot compete with Express Scripts' ability to achieve the most cost-effective drug mix for our clients. Proactive Service Translates into Customer Satisfaction Express Scripts consistently delivers superior service through separate toll -free numbers and service organizations for clients/plan sponsors, members and pharmacists. To better manage the pharmacy benefit, Express Scripts assigns a dedicated client service team to each client as the single point of contact. Each team is responsible for benefit design consultation, implementation, reporting and ongoing support. The Express Scripts PBM Delivers Being a full service PBM means comprehensive, integrated products and services. At Express Scripts, every offering has been conceived with our customers' interests in mind. From proprietary software to plan design consultation, Express Scripts focuses on exceeding client expectations. Network Pharmacy Services On -Line Claims Processing Ensures accuracy and member safety instantly Within seconds, on-line claims processing provides eligibility verification, formulary information, copay information and appropriate concurrent drug utilization review (DUR) for members' prescriptions dispensed. National Pharmacy Network Management Convenient access to retail pharmacies Our network covers more than 98 percent of all U.S. retail pharmacies in operation, including independents and all chains. Express Scripts offers flexibility in size and type of network to meet individual client needs, including two primary networks and exclusive provider networks. Mail Service Pharmacy Completely integrated retail and mail pharmacy services Express Scripts owns and operates mail service pharmacy facilities in St. Louis, Missouri and Tempe, Arizona for effective national coverage and total system backup. Retail and mail pharmacy services are fully integrated to maximize quality of care and cost-effectiveness. Express Scripts' high level of intervention with physicians coupled with investment in both automation and registered pharmacists provide an optimum balance of quality of care, savings and customer satisfaction. Clinical Pharmacy Services Working to develop advanced PBM services By integrating information technology with investment in clinical pharmacy knowledge and services, Express Scripts is positioned as a leader in the pharmacy benefit industry. Drug Utilization Review Three types of DUR: prospective, concurrent and retrospective A sophisticated Drug Utilization Review system, composed of prospective, concurrent and retrospective elements, enhances quality patient care and cost containment. Every prescription is screened to detect potential problems through Express Scripts' DUR programs which track, analyze and address the behavior of prescribers, pharmacists and members. The DUR system also reinforces the use of drugs on the preferred product list. Formularies Reference list of safe, high -quality, cost-effective medications Express Scripts offers a choice of formularies which vary in design from open formularies which are merely guidelines to closed formularies which are restricted lists of covered drugs that more effectively control costs, while maintaining treatment integrity. Reporting Capabilities Multiple options for useful and accurate information Express Scripts provides traditional paper and ad hoc reports. Increasingly, our clients utilize executive overview and on-line reporting for expedited delivery of information. Executive Overview Report This management summary report presents information on drug spending activity in the form of tables, graphs and explanatory text describing cost and utilization trends on a quarterly basis. On -Line Reporting Express Scripts allows clients instant on-line access to information on cost and utilization patterns, specific therapy and drug use, and exception reporting on high cost claimants. With this decision support tool, clients can easily customize their data on-line for analysis, reporting, monitoring and management of the pharmacy benefit. Information covers plan reports, member reports, drug summary reports, physician ranking reports and physician utilization reports. Delivering results through independence, insight and integration. **A* Express Scripts® f Progressive Healthcare Management Deming Progressive Pharmacy Benefit Management At Express Scripts, we take a progressive approach to pharmacy benefit management (PBM). Our unique approach combines full service capabilities and consultative services, resulting in focused, tested and proven PBM programs. This management style —coupled With our independent status — has established Express Scripts as a clear leader in the PBM industry. With more than 5,000 clients and a decade of experience, Express Scripts offers its customers programs and plans that provide quality care and proven savings. Express Scripts has broadened its scope to include various healthcare entities, with pharmacy benefit management remaining our core business. Express Scripts is independent of pharmaceutical manufacturer and medical provider ownership, allowing us to make decisions in our clients' best interests. Taking a progressive approach also means proactive service, anticipating client needs and identifying client opportunities. Express Scripts offers a variety of pharmacy benefit programs and options, consulting with clients to create individualized plans to meet each client's unique goals. t� Express Scripts® Progressive Healthcare Management 14000 Riverport Drive Maryland Heights, MO 63043 800-332-5455 ext. 7777 http://www.express-scrfpts.com Ui L �i CI; W? The patient's guide to prescription drug choices �A, Express Scripts® Progressive Healthcare Management :ieii ieric drugs? Generic :u,q+ ' nave the same active chemical Compos':i.>r c=. their brand -name equivalent. Exp:ese, 'S: rip°'s, only uses generic drugs that have d4ari+( ,:.tatted I_rio-equivalency deemed by the ': ,: ci ; i, d Drug Administration (FDA) to product: crie s,cme effect in the body as their brandn�;r untecparts.Inactive ingredients such a,• a=e., dyes, and binders are allowed to be different; these ingre- dients should not affect the safety and effica- cy of a drug. In addition, only drugs that are not currently protected V by patents can 7 have a generic tF# version manufactured. Currently. 80 percent of all medicn.h. ns. ave r„ generic equivalent drug. Are generic drugs as safe as brand -name drugs? Closely regulated by the FDA, numerous laboratory tests are conducted to assure generic drugs maintain the some high standards for safety and effectiveness as their brand -name counterparts. In fact, generic drugs must abide by the same rules that brand -name drugs do for quality. How often are generic drugs used to fill prescriptions? According to the National Association of Pharmaceutical Manufacturers, retail and hospital pharmacists fill more than 450 million prescriptions with generic drugs each year. This represents greater than one out of three prescriptions dispensed to American consumers. Why should I choose generic drugs? To date, generic drugs have saved Americans more than $40 billion. How? Prices for generic drugs average 40 to 60 percent lower than those of brand - name drugs. in addition, tax dollars are saved due to lower federal and state spending on prescriptions for members of government programs. Generics maintain the same high standards for safety and effectiveness as their brand -name counterparts. National Recognition For the third year in a row, Express Scripts was recognized by Fortune as one of America's 100 fastest growing companies. Of the 9,000 companies reviewed, Express Scripts ranked 65th. Only 13 companies have been privileged to make this list for a third year. More importantly, Express Scripts was nationally recognized in the 1997 Pharmacy Benefit Management Institute (PBMI) Customer Satisfaction Survey. Express ScriptsNalueRx received the highest average ranking overall, for the second consecutive year, of all vendors when comparing the average ranking for all functions. In addition, Express Scripts received the highest ranking relative to the competition in nine specific areas: => Lowest Cost of Drugs =z> Benefit Management Consulting Services � Management Reports � Generic Substitution � Eligibility Data Management � Pharmacy Network and Quality Size "Managemenwt � ID Card Production and Distribution � Concurrent DUR Retrospective DUR *Pharmacy Benefit Institute (PBMI),1997 Summary We believe the Express ScriptsNalueRx merger creates the most superior PBM in the industry — offering City of Fort Collins the most advanced clinical, consultative, customer service and information system technology partner available. Express ScriptsNalueRx welcomes the opportunity to show City of Fort Collins our vision of the future, which is woven throughout this proposal. We hope you share this vision, and we look forward to building a successful partnership that will enhance the health of all of City of Fort Collins's members. Express Scripts* Progressive Healthcare Management Executive Summary for City of Fort Collins page 6 •��rn ••1 w w W Z W VIA d0 do d0 c7 Rom _ d0 Z w i `CZ wY W= ¢¢wo W ZW w¢ W Vl w0<O¢w ZQD �w aW zaa¢Oa yZ¢OQ <WX dZp oarCx • „�"�¢ ��¢ °e�m¢ c�sa �� z�¢�wacorii2¢5 cQ=100.>��xoQ2o L • J¢ dJJ O WddJOJJ ' 0 WO¢JJ . lAo QZCI>¢JJZ OOQm>w�yJJZ Q= Q Q W Q f= 0 0 0 0 W a F O 6 W Q S U O W¢ Q Q- W W S] W r Q- m daww33 �d¢m w333 �a¢w�3 �fzaaa¢r333E sdd¢¢33 L• • z /� FI a 5 N m x a O '[ w O z a¢ m ¢¢ y ¢ LIJTa 'Dy dd? 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Present your PERx Card at the Participating .Phnnmr_cj� and} •r ! co,�crf rent pc• p: ipt:or is: Brand Name Prescription: a 10.00 Generic Prescription: $ zoo The enclosed brochure is a reminder on how to use our exciting program, Should you have any dfficulties at the pharmacy, please have the pharmacist call our Help Desk at (800) 235-4357. Most of the time, the situation can be resolved while you are still in the store. Should you have any questions, please contact our Customer Service department at (800) 451-6245. LB L 102-t WE LOOK FORWARD TO SERVING YOU. IMPORTANTI Please check name and social security number (ID#) for accuracy before using card Note: ID# is your social security number THANK YOU11 Pharmacy Benefit Management • Practice Patterns Science Eyecare Management . Infusion Therapy Management 215 North Mason Street • 2nd Floor • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6775 • FAX (970) 221-6707 GENERAL QUESTIONSQ11JESTIONS TO BE ANSWERED BY ALL PROPOSERS All proposals submitted must include answers to the following questions: Administrative Agrreementc and GeneraHnformation 1. It is the intention of the City that the master contract reflect the elimination of the actively -at -work restriction or deferred effective date for all initially enrolled active or inactive employees and dependents. This will include only initial eligibles (those eligible on the effective date of the contract) including COBRA continuees. Please indicate your acceptance to this requirement. ,The Express ScriptsNalueRx contract makes no assumptions in regard to eligibility. The City will inform ESI of eligible members. 2. It is required that proposals assume that all participants (including COBRA) presently covered will be covered under a successor plan regardless of medical condition, disables status, or whether they are actively -at -work or on a no -loss no -gain basis for both the City and the participant. Is your proposal written in accordance with this requirement? The Express ScriptsNalueRx proposal is written in accordance with the eligibility requirement as set forth by the City of Fort Collins. 3. If your company is awarded this business, how soon after notification of the award would you be able to have a draft of the contract? As soon as Express ScriptsNalueRx is awarded the Prescription Drug Management contract, we will provide a draft of the contract after the initial meeting with the City. The meetings are held with the City will ensure that all requirements are identified and satisfied. 4. If the services furnished by your company differ in any respect from those described, please indicate where such differences exist. If you do not indicate any differences, it will be assumed that the services included in your proposal do, in fact, exactly match those described. Express Scripts® VProgressive Healthcare Management City of Fort Collins 7127198 1 The services and programs described herein reflect the prescription drug services furnished by Express ScriptsNalueRx . 5 Provide a sample contract similar to the one that would be used for the City. City Standard Services Agreement is enclosed as Exhibit "A", note specific exception or changes requested. A sample of the Prescription Drug Agreement that would be executed for the City is found in Exhibit 1 . 6. Commissions or fees of any type are nnQt to be paid to any entity as part of the cost of the services requested in this specifications letter. Is your proposal written in accordance with this provision? Yes, Express ScriptsNalueRx is submitting this proposal in accordance with the provision that commissions or fees are not being paid to any entity as part of the cost of services requested in the specification letter. 7. Please provide at least three Colorado (preferably municipality plans with at least 500 employees) references (not current Segal Company clients) for each service you are proposing. List the name of the organization, address, telephone number, and contact person's name and title. If your company is quoting all or a portion of the benefits included in this Request for Proposal, please provide references for each benefit you are proposing. Also, provide the name and telephone number of any clients you are not now serving that you were serving three years ago. Why are you not providing service to these clients? Archdiocese of Denver 1300 S. Steele Street Denver, CO 80210 Barbara Buchanan 303-388-4411 ConAgra/Monfort PO Box G Greeley, CO 80632 Kent McDaniel 970-395-8457 . Express Scripts° 1WProgressive Healthcare Management City of Fort Collins 7127.198 2 Vail Associates, Inc. PO Box 7 Vail, CO 81658 Jennifer Schofield 970-845-2450 8. Provide samples of any communication materials that would be provided by your company to the City at no additional cost. What customized materials are available? Please identify the retention costs associated with these communication materials. The member communication booklet, that will be provided to the City employees at no additional cost is found in Exhibit 2. Express Scripts/ValueRx will work with the City to customized additional pieces to include in the implementation packet. We will determine the cost of customized pieces, if applicable, during discussions with the City. 9. Would you agree to contractual performance guarantees regarding telephone calls, referrals, access standards, i.d. cards, NCQA accreditation? Please provide the specific standards and examples of similar arrangements with other clients. The performance guarantees offered to the City are found with the Cost Quotation. These guarantees will be part of the contract executed between Express Scripts/ValueRx and the City. 10. The City will require that contracts include language that any data associated with the City's plan is the property of the City and, as such, must be available to the City (e.g., when changing vendors). Please indicate your acceptance of this requirement. SECTION 5.1 of our standard agreement describes the Ownership and Use of Prescription Drug Records: (a) All records and other data provided to ESI by Sponsor, other than records that ESI is required to maintain by law (including, but not limited to, records required to be maintained by the Mail Service Pharmacy) shall remain the property of Sponsor; provided, that Sponsor irrevocably grants ESI permission to use both during and after the term of this Agreement and/or transfer to third parties the drug and related medical data collected by ESI or provided to ESI Express Scripts' VProgressive Healthcare Management City of Fort Collins 7127198 3 by Sponsor for research, cost analyses, cost comparison or other business purposes of ESI, all without charge to ESI. ESI shall retain full ownership rights over all compilations, analyses and reports prepared by ESI under this Agreement. In any case, ESI shall maintain Member confidentiality to the extent required by law, and shall not provide to any third party information identifiable as relating specifically to any Member without such Sponsor's consent. (b) Sponsor, at its own expense, may inspect ESI's records relating to Sponsor's Plan not more frequently than once each year. Such inspection shall be conducted at ESI's offices and shall be subject to such limitations to protect the confidentiality of information relating to other prescription drug programs and the members thereof as ESI may reasonably determine. 11. Record keeping: a. Discuss how participant and dependent records are maintained. Express Scripts maintains demographic information such as name, date of birth, sex, card date issued, and number of cards sent to each employee. Up to seven additional segments of coverage history can be maintained for each member record. Each line of history data includes the effective date, termination date and subgroup number of the member. b. Indicate your data needs from the City in order to administer this program. Express ScriptsNalueRx ' eligibility experts will assist the City in developing a timely and accurate transfer of members' information both for setup and ongoing updates. Throughout account set-up and implementation, Express ScriptsNalueRx will assist the City with record layouts, software specifications, and evaluation of the option best suited to your needs. Basic eligibility data required by Express Scripts includes: ♦ Names of all covered members ♦ Social Security number of primary member ♦ Address of primary member (street/city/state/zip) ♦ Type of patient identifying codes, e.g., cardholder, spouse or dependent ♦ Birth dates ♦ Effective date of coverage Express Scripts* VProgressive Healthcare Management City of Fort Collins 7127198 4 ♦ Termination date ♦ Group identifying codes ♦ Subgroup identifying codes, e.g., active, retired, salaried, location, etc. ♦ Gender Code c. How will your organization verify eligibility? The Express Scripts' eligibility verification process is as follows: A member either goes to a participating pharmacy and presents his/her identification card to the pharmacist along with the prescription, or the member sends in his/her prescription to the mail service pharmacy. The pharmacist keys in the group number and member identification number into the on-line system. The Express Scripts system checks the following eligibility elements on-line in real- time with an average response time of .89 seconds: ♦ Group Eligibility - Verification of the plan parameters of the group including copay requirements and maximum supply limitations. ♦ Patient Eligibility - Patient eligibility is identified by Social Security number, Claim number, name and date of birth and/or suffix number. Drug Eligibility - This verifies that the pharmaceutical product ordered is covered by the plan as pre -determined by the plan administrator. Mail order prescription requests for medication not covered will either be returned to the patient or, if the patient requests, the order will be filled and the patient will be invoiced. After eligibility is confirmed, the Express Scripts/ValueRx system conducts on- line Drug Utilization Review (DUR). If there are no serious interactions or allergies, the pharmacist will dispense the medication. The member is responsible for paying the appropriate copay as indicated on the pharmacist's on-line computer. If the above eligibility elements cannot be confirmed at the point -of -sale, the pharmacist receives a message to telephone the Express Scripts/ValueRx Help Desk to ensure the accuracy of the data entered by the pharmacy and to verify the Express Scripts/ValueRx ' eligibility file. If the information validates eligibility, Express ScriptsNalueRx 'Help Desk will provide the appropriate code to the pharmacist to allow the prescription to be filled. The pharmacist cannot override 40 Express Scripts° WProgressive He fthr m Management City of Fort Collins 7127198 5 the system without a code from the Help Desk. In the event eligibility cannot be validated, the pharmacist handles the situation in accordance with the City's plan parameters, as determined during account implementation. 12. Confirm that you will be Year 2000 compliant, and describe your procedures to become compliant. By January 1, 1999, Express ScriptsNalueRx systems will be Year 2000 compliant. We are approximately 90% complete with program modifications, and are scheduled to complete all system and integration testing by the 4th quarter 1998. Express ScriptsNalueRx has been working on modifying its systems for the year 2000 since 1995. Our current eligibility format accommodates century changes on all data fields. We have projects to rewrite specific modules of our systems; these projects will incorporate Year-2000 changes. As we perform major software enhancements, Express ScriptsNalueRx has been implementing date conversions. All new software developed or purchased must be year-2000 compliant. 13. How does your organization handle the surcharge requirements of New York and Massachusetts? What impact do these surcharges have on your clients (e.g., describe charges, if applicable)? The Sponsor shall be responsible for any governmental or regulatory charges imposed upon the Prescription Drug Program, other than taxes based on the net income of Express ScriptsNalue. It Express ScriptsNalueRx 's performance of its duties under the Agreement is made materially more burdensome or expensive due to a change in federal, state or local laws or regulations or the interpretation thereof, the parties shall negotiate an appropriate adjustment to the fees paid to Express ScriptsNalueRx . Fees and Rate Guarantees 1. These specifications require that any fees quoted in your proposal be firm and guaranteed for a minimum, of 12 months and cannot be changed by recalculation based on actual enrollment. Please indicate your agreement to this requirement. Is your organization willing to provide a multiple year guarantee or a second year cap on fees? Please specify separately for each service Express ScriptsNalueRx guarantees the rates quoted for 180 after submission of the proposal to the City. Upon award of contract the fees quoted are guaranteed for a the length of the contract. 41 Express Scripts® VProgressive Healthcare Management City of Fort Collins 7127199 6 2. The City is requesting that formal renewal notice for all services be received no later than four months or 120 days prior to the renewal date of the program. Please indicate your agreement to this stipulation. Express ScriptsNalueRx will provide formal renewal notice of the prescription drug program to the City four months or 120 days prior to the renewal date. 3. When are fees due and what is the grace period for payment of fees under your agreement? If fees are paid subsequently, is a penalty and/or interest charge assessed? If yes, please explain in detail. Express Scripts' billing options are extremely flexible. Separate billing dates can be set up for different services (network, mail service, or self pay) and for various group and sub -group structures. Billing options can include: ♦ Specific day(s) of the week ♦ Specific day(s) of the month ♦ Specific weeks within the month. ♦ End of the month Express ScriptsNalueRx offers different billing and payment methods from the following options: ♦ Draft Authority: Sponsor will provide Express ScriptsNalueRx with draft forms and authority to deposit them for Express ScriptsNalueRx 's program fees less copayments. Sponsors utilizing the draft authority option agree to pay Express ScriptsNalueRx within twenty four (24) hours of Sponsor's receipt of Express ScriptsNalueRx 's billing. ♦ Wire Transfer: Sponsor will give Express ScriptsNalueRx the phone number and contact person to wire transfer or ACH Express ScriptsNalueRx program fees less copayments. Sponsors utilizing the wire transfer option agree to pay Express ScriptsNalueRx within twenty four (24) hours of Sponsor's receipt of Express ScriptsNalueRx 's billing. ♦ Payment by Check: Express ScriptsNalueRx bills sponsor at least monthly by the twentieth (20th) day of each month for services rendered during the preceding month. All billings received by sponsor shall be paid upon receipt of said billing. Any amounts not paid by the due date set forth shall bear interest at the rate of 18% per annum (1.5% per month) or, if lower, the highest interest rate permitted by law. 4. Are there any options available with respect to the grace period? If so, please AExpress Scripts° VProgressive Healthcare Management City of For[ Collins 7127198 7 explain the option(s) and any charge that is made for them. Yes, the grace period for payment and interest penalties for late payment will be determined during the contract negotiation period. 5. The contracts are to provide that change in fees can only be instituted on January 1. Please indicate whether your company is willing to issue master contracts reflecting this provision. Rate changes will be instituted on January 1 at contract renewal. 6. Can the individual services proposed by your company be purchased separately or are they interdependent upon each other? Please be specific and elaborate on any fee consideration. Express ScriptsNalueRx is offering prescription drug services which include integrated mail and retail network programs Organization Issues 1. Please describe your organization addressing the following items: a. Ownership; Express ScriptsNalueRx is a publicly traded company on the NASDAQ exchange under the symbol of ESRX. b. Length of time in business; Express Scripts was founded in 1986 as a joint venture between a retail chain of more than 100 pharmacies in St. Louis and Sanus Corporate Health Systems. On April 1, 1998, Express Scripts acquired ValueRx from Columbia/HCA, making us now the largest pharmacy benefit management company independent of pharmaceutical manufacturer ownership. c. Affiliated organizations; and In addition to the pharmacy benefit management (PBM) business which is currently providing managed prescription drug services to greater than 22 million 114*Express Scripts° VProgressive Healthcare Management City of Fort Collins 7127198 8 1700 North Desert Drive (� Phhoo 8 Express Scripts" . Valuel jig P.O.Box 521enix, AZ 5072-2161 602-225-0005 http://www.express-scripts.com http://www.valuerx.com City of Ft. Collins Prescription Drug Benefit Program Effective Date: 111199 Implementation Timeline (Projected) Plan Set -Up and Member Deliverables Plan Design and Drug Plan Review Plan verification and/or changes (if applicable) by 1112/98 Plan Design set-up and approved by 12/1198 "Welcome Letter" to Plan for approval by 12/4/98 'Welcome Letter" approved and boilerplate ready by 12/7/98 Eligibility Received Format and Specifications provided by 11/2/98 (E-Format, Client Format, or other form/s of transmission) (on-line access available) Test File received by 11/13/98 Test approved by 11/25/98 Eligibility Applied Initial Load Pre -pass test Initial Apply ID cards requested (if applicable) Final initial load of eligibility Member Kit/ID Card Printing ID printing (if applicable) Member Kit/ID Card Distributed Team Client Services Account Manager (Lead): Client Services Account Manager (Back up): Sales Manager. August31, 1998 Kevin Poncin Colleen Castleman Gary Hattendorf by 11/25/98 by 12/4/98 by 12/7/98 by 12/7/98 by 12/29/98 by 12/8/98 by 12/10/98 800-955-1171 x2069 800-955-1171 x2054 800-955-1171 x2003 CelUPage 602-432-8069 Pharmacy Benefit Management . Informed Decision Counseling . Disease Management Healthcare Information Management . Infusion Therapy Management . Eyecare Management members in the United States and Canada Express Scripts/ValueRx delivers advanced capabilities in several complementary healthcare businesses including: ♦ Express Scripts' Health Management Services, formed in 1997, provides comprehensive demand management (Express Health Linesm Program) and disease management (HealthExpresssm Program) support services through a 24-hour call center staffed by registered nurses and pharmacists. ♦ Express Scripts' Practice Patterns Science, formed in 1994, offers practice variation analysis and disease management support services linking healthcare data from all points of care. ♦ Express Scripts' IVTx, formed in 1990, applies managed care techniques to infusion therapy and injectable drug therapies. d. Include a copy of your most recent audited financial statement. A copy of the Express Scripts 1997 Annual Report and First Quarter 1998 financial statement is located in Exhibit 3. 2. Provide a statement, signed by an Officer of your company, that your firm has adequate personnel and financial resources to provide the services indicated in this Request for Proposal. Please refer to Exhibit 4 for the statement signed by Kurt Blumenthal, Express Scripts/ValueRx 's Vice President of Finance, confirming Express Scripts/ValueRx has adequate personnel and financial resources to provide the prescription drug services offered in this Request for Proposal. 3. If applicable, indicate the location of the claims office where claims would be processed and/or member services is handled. Is a toll -free phone number available for member inquiries? What are the hours? If a toll -free phone number is not available, will you establish one at no additional charge? Include a description of your member services. The City will be serviced from our Tempe, Arizona facility. Express Scripts/Value Rx Customer Service Department offers toll -free assistance 24 hours a day, 365 days a year. Members also have 24 hour access to a registered pharmacist. EN Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 9 Manager Customer Service Client Services Implementation Team Client Executive Director Regional Marketing Director Client Services Sales and Marketing Client Services Representative Client services Trainer Manager Director Manager Provider Relatlona Manager Eligibility Entry and Verificatlm File Maintenance Pharmacy Help Desk MIS and Duality Assurance Eligibility This department handles the daily contact with the account, and monitors the implementation process. The communication during the conversion phase is on- going, as it will be during the life of the contract. Other areas of responsibility include arranging for billing, developing contact lists for Express ScriptsNalueRx and the client and monitoring the process internally and externally. MIS Several representatives will be involved, usually at the Director and Manager levels. A systems person will handle interfaces between computers, eligibility will be handled by another individual, benefit design and implementation will be assigned to another person to work with Client Services. Member Identification Cards will also be developed if needed. Reporting will be a joint effort between the client, the Client Services representative, the sales representative, MIS, and the client representatives. Eligibility Express ScriptsNalueRx 's Eligibility department provides data entry, access and file maintenance to Express ScriptsNalueRx 's on-line system. They will handle the setup of maintenance of eligibility files for groups. Provider Relation Pharmacy network set-up and testing will be handled by a Manager level representative from this department. Pharmacy Help Desk A trainer will be involved, as well a manager for testing and educational purposes. At least one Manager level representative will be involved to coordinate staff requirements and training needs according to client requirements and benefit plan design. Express Scripts* Progressive Healthcare Management City of Fort Collins 7127198 10 Mail Order Operations A director or manager of pharmacy operations will coordinate client unique requirements of the mail service operation. Sales and Marketing Contract terms, information access, clarification on programs and providing general information to all involved will be the responsibility of the Express ScriptsNalueRx Regional Marketing Director involved. The Regional Marketing Director is available for on -site assistance throughout enrollment and implementation as required. Express ScriptsNalueRx 's Client Services team is available to provide analytical and consultative assistance at any time. Additionally, a clinical pharmacist will be available to assist clients in report analysis. The Client Services staff will assist you in administering the type of plan you choose, from on-line eligibility and reporting to customized materials to the day-to-day implementation of the program. There is no concern too small that our Client Services Department will not address for our clients. For example, in addition to handling your day-to-day needs, we provide: ♦ Pro -active consultative services ♦ Financial modeling ♦ Marketing assistance ♦ Information transfer Providing distinctive service to our clients has helped Express ScriptsNalueRx grow to a leader in the Pharmacy Benefit Management industry. Our team of information systems specialists and account management professionals will tailor services to develop an individualized program for each client. Unlike some of our competitors, Express ScriptsNalueRx does not charge for plan design changes. We will customize our independent formularies, establish dedicated customer service phone lines, manage clients' unique eligibility challenges, and design specialized on-line drug usage messages and reporting formats so that you can receive the precise information that is needed, when it is needed. 4. Is your firm licensed in the State of Colorado (if applicable)? Please confirm that your proposal and/or plan design offered is in compliance with all federal and state laws and regulations that pertain to employees benefit programs, relevant state insurance regulations and other related laws. Express Scripts Progressive Healthcare Management City of Fort Collins 7127198 11 Express ScriptsNalueRx complies with all state and Federal laws and regulations applicable to its business, including maintaining any necessary licenses and permits. Please identify the individual responsible for the account in the event of claim disputes, service problems, etc. The Client Services Representative responsible for managing daily operations and providing client service for the City will be determined upon entering into an agreement. However, LeeAnn Dale, Director of Client Services at the Tempe, Arizona facility, is responsible for overseeing these team members and all individuals assigned to your account. LeeAnn joined Express Scripts, Inc. in 1997 and is responsible for all client related operations, including client services, eligibility and claims, and customer and pharmacy phone centers. LeeAnn has twelve years of experience in the evaluation, management and implementation of Health Care and Medicaid Management Information Systems. Previously, she was the Assistant Director of Information Systems at the Arizona Health Care Cost Containment System (AHCCCS). She received her Bachelor of Arts degree in English and Chinese from Colorado University and her MBA from Monterey Institute for International Business. Your Client Services Representative is your "Central Point' of contact to address all of your needs. Express Scripts® Progressive Healthcare Management City of Fort Collins 71271➢8 12 MIS Report Request System Modification System Issues Card Production Benefit Design Benefit Change Drug Plan Change Group Implementation Claims Status of Claims Check Verify Plan Information Claims Processing Client Client Services rf Customer Service General Information Order Tracking Benefit Clarification I LRelations �01 Finance Billing Research Invoice Issues --� Account Maintenance Eligibility Tape Status Card Status Group Implementation Help Desk Help Desk Issues Prior Authorization 6. In the event the City desires employee meetings to present your proposal plan, are representatives from your company available to make presentations? If "yes", are there any additional costs associated with these activities? The Account Manager responsible for the City will be available to conduct presentations at employee meetings detailing the prescription drug benefit implemented by the City. There is not additional cost for this. 7. Do you agree that if this proposal results in your company being awarded a contract and if, in the preparation of that contract, there are inconsistencies between what was proposed and accepted versus the contract language that has been generated and executed, that any controversy arising over such discrepancy will be resolved in favor of the language contained in the proposal or correspondence relating to your proposal? Express ScriptsNalueRx understands that sometimes during the preparation of the contract there are changes agreed to by the parties which may be inconsistent with the Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 13 proposal and the correspondence relating to the proposal. It also is possible that issues addressed in the proposal are handled differently in the contract (whether deliberately or not). Accordingly, it is to the benefit of both parties that we recognize the contract as the controlling document for the services and obligations of the parties described therein. It is incumbent upon both parties to ensure that the contract negotiated and signed represents each of their desires and expectations. 8. Are there any outstanding legal actions pending against your organization? If so, please explain the nature and current status of the action(s). Express ScriptsNalueRx is, from time to time, party to legal or administrative proceedings arising in the ordinary course of its business. Any proceedings now pending are not, in Express ScriptsNalueRx ' opinion, material either individually or in the aggregate. Express ScriptsNalueRx has not been the target of any investigations, probes or formal inquiries by financial institutions, government agencies, or private organizations. 9. Please state the time line your company intends to follow to commence work as of January 1, 1999. Please refer to Exhibit S for a detailed timeline for a January 1, 1999 implementation of the City's prescription drug benefit. 10. What is your perspective on the health care industry in five years? What changes do you foresee? Express ScriptsNalue Rx believes that healthcare's reliance on pharmaceutical therapy will continue to grow. Through our own analysis, we estimate that annual drug costs will grow 10 to 15 percent. This was illustrated in Express Scripts/Value Rx Drug Trends Report 1993-1996, released in June of 1997. The report analyzes pharmacy costs and shows the variety of factors that constitute pharmacy cost trends. By examining these factors, it is possible to devise better strategies to both contain the cost and improve the value of pharmaceuticals. The report stated that per -member per -year average wholesale drug ingredient costs rose by 35 percent from 1993 to 1996. One-third of the increase came from medications introduced after 1993. We remained committed in 1997 and today to finding new and better ways to help our clients manage these costs. We offered them powerful tools, such as ExpressPreferencesm, our drug therapy management program that reached a total of 4$ Express Scripts* Progressive Healthcare Management City of Fort Collins 7127198 14 4.7 million lives and ExpressTherapeuticss'", our advanced clinical drug utilization review module, which was introduced late last year and now covers nearly 500,000 lives. Our clinical pharmacists continue to develop tailored programs to address the management needs of our clients. 11. If you have obtained national accreditation, please state through which agency and when it was obtained. IVTx, our home infusion therapy division owns and operates seven sites which are all accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). 4 Express Scripts* 6 Progressive Healthcare Management City of Fort Collins 7127198 15 • k m • •�_LOB A- W'X1 KIVAU In order for your proposal to be considered and accepted, your organization must provide answers to the questions presented in this section. Each question must be answered specifically and in detail. Reference should not be made to prior response, or to your contract, unless the question involved specifically provides such an option. Be sure to refer to the earlier sections of this request for proposal (RFP) before responding to any of the questions, so that you have a complete understanding of all of this client's requirements with respect to the bid. If your proposal is different in any way (whether more or less favorable) from that indicated in this request for proposals, clearly identify those differences in your executive summary. If you do not, the submission of your proposal will be deemed a certification that you will comply in every respect (including, but not limited to, coverage provided, funding method requested, benefit exclusion and limitations, underwriting provisions, etc.) with the requirements set forth in this RFP. If you are unable to perform my required service, indicate clearly: a) what you are currently unable to do, and b) what steps will be taken (if any) to meet the requirement, the timetable for that process and who will be responsible for the implementation, along with that person's qualifications. Please include any additional information in your proposal which you consider useful to the client. However, responses to all of the questions set forth below must be provided. A. General Issues (Experience, Solvency, Membership 1. How long has your organization been providing prescription drug services? How long has your organization been providing retail pharmacy network services? Mail order maintenance prescription drug programs? Prescription drug utilization review services? Express ScriptsNalueRx brings more than 28 years of experience in managing pharmacy benefits, developing expertise in both retail and mail settings. We are a pioneer in the development of products and services to deliver total medication management. As an organization committed to growing and remaining a dynamic industry leader, we've completed strategic mergers and acquisitions that have helped us achieve our vision of becoming the nation's leading medication manager. Express ScriptsNalueRx originated as an outpatient Pharmacy Benefits Manager in 1987, working with public and private industry employers, insurers, managed care organizations, and other purchasers of prescription drug programs across the nation. Express Scripts% Progressive Healthcare Management City of Fort Collins 7127198 16 Valuer merged with Diagnostek, Inc. (which had been in business since 1970) in 1995. The combined strengths of the merger resulted in enhanced mail service capabilities and a new depth of services for ValueRx . In April of 1998, Express Scripts, Inc. announced that it had completed an acquisition of ValueRx . ValueRx has been providing mail order pharmacy services since 1970 and retail pharmacy services since 1985. We have been providing concurrent and retrospective drug utilization review services for 13 years in the retail setting and for 28 years in the mail setting. 2. Is your retail pharmacy network solely owned and operated by your organization? If not, explain the contractual relationship you have. No, we contract with independent and chain pharmacies to be in the Express ScriptsNalueRx PERx network, but do not have own or operate these pharmacies. 3. Is your firm anticipating expansion or reorganization in the next year? Please explain. ValueRx was acquired by Express Scripts, Inc. in April of 1998. Although we do not anticipate any further changes in ownership, we appreciate the City's concern about what the merger of ESI and Express Scripts/ValueRx may mean to the City. We would like to reassure the City that the new organizational structure has included many of Express ScriptsNalueRx 's key managers. Barrett Toan, Express Scripts' President and CEO has indicated that with the acquisition completed and an organizational structure in place, our focus as a company will be on client retention and sales, while integrating our contracting processes and computer systems. The combination of Express Scripts and ValueRx doubles our size and, more importantly, dramatically broadens our capabilities to deliver unmatched medication and healthcare management services. Both Express Scripts and ValueRx share the same goal: to excel in customer service, clinical programs, and leading -edge technology in order to help you better manage your pharmacy costs. As one company, we can now assure clients of a continued commitment to providing the highest standard of service in all core areas: ♦ client service ♦ cost containment ♦ clinical expertise ♦ access to a wide range of pharmaceutical management programs. Express Scripts* Progressive Healthcare Management City of Fort Collies 7127198 17 Our long-term vision for this new partnership rests on the conviction that Express Scripts/ValueRx will bring pharmacy benefit management to a new, higher level — uniquely developed approach that delivers relative consultative and medication management tools that are designed to support our clients' prescription benefit plan goals. We provide clients such as the City with meaningful analysis of claims data that enable you to make informed decisions. By doubling our size, we also have the ability to invest more heavily in new product development and advanced technology. By broadening our pool of leading clinical talent, we will have the ability to develop the most innovative, industry -shaping products and services. By maintaining, empowering, and expanding our outstanding sales, account and customer service teams, we will deliver cutting -edge consultative services and expertise. Here are just a few of the many tangible benefits that the City can expect as a result of this exciting new partnership: ♦ Greater breadth of industry -leading clinical capabilities, including disease and demand management programs and formulary management capabilities ♦ Access to additional call center, mail service and pharmacist -on -call capabilities ♦ Access to a broader range of pharmaceutical manufacturer programs ♦ Enhanced reporting, data mining and knowledge capabilities ♦ Access to an increased range of products and service 4. How many clients use your retail pharmacy program and how many covered persons does this represent? How many clients and covered persons use your mail order pharmacy program? Please provide the information in the following format: 3 years prior, 1 year prior and current. Prior to the acquisition of ValueRx , Express Scripts provided service to the following: Current 1997 1996 1995 # of Clients 8,357 5,010 4,759 3,171 # of Members 22,000,000 12,563,383 9,903,677 7,724,778 Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 18 Number One Pharmacy Benefit Manager for Second Straight Year For the second consecutive year, Express Scripts ranked #1 overall in customer satisfaction in the Pharmacy Benefit Management Institute (PBMI) Customer Satisfaction Survey.* Employers and HMOs representing nearly 20 million covered individuals rated nine Pharmacy Benefit Managers (PBMs) in 21 categories. Express Scripts ranked first overall in customer satisfaction and in the top three for 19 categories. Our top placements include: #1 Lowest Cost of Drugs Independence from manufacturer or provider ownership allows Express Scripts to offer the most cost-effective and efficacious drug mix. The Result - Lower costs for customers. #1 Benefit Management Consulting Services Customized benefit plan designs and cost modelling created to best serve your population. Annual outcomes conference focuses on the impact prescription drugs have on overall medical costs. The Result - Clients have hands-on tools for assessing success and planning future PBM programs. #1 Management Reports Written and on-line reports available that summarize prescription drug use, savings and costs. The Result - Targeted cost analysis that ensures savings are optimized. #1 Generic Substitution Plans include a variety of generic substitution programs. The Result - Lower costs for our customers, with no compromise in quality. Express Scripts® Progressive Healthcare Management #1 Pharmacy Network Quality and Size More than 49,500 pharmacies in the network, representing 98 percent of all U.S. pharmacies. The Result - Convenient coverage for all members results in high satisfaction. #1 Eligibility Data Management Advance technology used to track eligibility. The Result - Covered members - and only covered members - receive the appropriate benefit. #1 ID Card Production and Distribution Personnel and technical resources deliver rapid group installation and ID card production. The Result - Satisfied members; fewer calls to plan administrator. #1 Concurrent Drug Utilization Review #1 Retrospective Drug Utilization Review Clinical assessment programs review utilization for safety, efficacy and cost savings. The Result - Improved quality and safety for members; cost savings optimized. Express Scripts offers complementary healthcare services in pharmacy benefit management, eyecare management, health management services including a 24 hour, seven day a week Express Health Linesm, infusion therapy, and healthcare information management. *Pharmacy Benefit Management Institute 1997 Customer satisfaction Survey To learn more, call 1-800-332-5455, ext. 7777 or visit Express Scripts at http://www.express-scripts.com 5. Is your organization capable of providing a program which integrates the retail and the mail order components, if that is what the City ultimately decides to implement? Yes, Express ScriptsNalueRx will provide a program to the City that integrates retail and mail order components. We maintain a single eligibility file to be used for both retail and mail service programs. The system fully integrates retail, mail service, and paper claims for a complete utilization history on-line, real-time. True on-line integration enables Express ScriptsNalueRx to administer meaningful point -of -sale clinical alerts on high -risk interactions and retrospective drug utilization review. 6. Provide samples of your standard reports which permit analysis of the retail drug program and of the mail order drug program and which display the results of your drug utilization review program. Is there a charge for your standard reports? Are ad hoc reports available? Is there an extra fee? Please see Exhibit 6 for samples of our standard reports. Express ScriptsNalueRx offers our clients a number of reporting options that provide concise and accurate prescription drug information. Our reports demonstrate plan performance, and identify opportunities for improvements. We offer clients a number of choices, including standard printed reports, on-line interactive reports, executive overviews, and customized reports. We work with clients to pinpoint the exact types of information needed and the best method to deliver this information, be it on paper, computer to computer or a combination of options. Flexibility is the key to designing a reporting package that best meets the needs of our clients. The foundation of the reporting package is our plan summary reports that provide financial and statistical information on utilization, cost, and savings. These reports are supplemented by Member, Drug, and Physician reports, all of which are described in the following pages. Our reporting package includes the following categories of reports, which are prepared on a quarterly basis. Our reports are produced within 45 days following the end of the quarter. Additionally, we offer a number of these reports on-line via our RxReports desktop system (described in the following pages), which are available on demand. 4 Express Scripts° 6 Progressive Healthcare Management City of Fort Collins 7127198 19 ♦ Plan Summary Reports include overview and summary documents that provide the basis for assessing the performance of the prescription drug benefit. ♦ Member Reports provide additional detail on utilization and the segment of the covered population that may be driving. costs in the benefit program. ♦ Drug Reports identify the therapeutic classes and specific drugs that drive costs in the benefit program. ♦ Physician Reports are available through our on-line reporting tool, RxReports, and provide details on physician prescribing information and ranking. On-line Reporting via RxReports For clients who require more specialized reports on a specific member, drug or prescriber, additional information is available as part of our on-line RxReports package. RxReports is a desk top Decision Support System (DSS), designed to assist clients in managing the medical and drug benefit. It can be accessed via modem, dialing directly into Express Scripts' computer system, or by using a client -dedicated telecommunication network. RxReports features Graphical User Interface (GUI) technology for understandable top -down access to data. It exists in a Windows environment, so the user can import data into and out of various Windows applications to perform analyses and create reports. RxReports relies on a relational database and utilizes the Oracle software package as the "server" engine allowing various types of access to the data. RxReports is updated regularly with the client's most current utilization data. Users may stipulate parameters and selection criteria to generate reports that provide specific answers about the client's utilization activity at various levels of hierarchy (e.g., group, sub -group, as well as for individual members or drugs). Included in the Plan Summary reports is our Executive Overview Report. This report provides a "snap -shot" high level summary with tables, graphs, and explanatory text describing client cost and utilization experience for a defined time period. Additionally, the Executive Overview Report provides statistics including total plan trends, therapy uses, and cost to members. When appropriate, this data is compared across client sub -groups and/or against comparable client groups. The matrix below describes our management reports, some of which are available as printed reports, and others through our on-line RxReports package. These are suggested packages only. We will work with the City to select the options, frequency and reports that best meet your information needs. Management Reports 4 Express Scripts® Progressive Healthcare Management City of Fort Collins 727198 20 Plan Summary Reports Executive High level summary X Overview information on account Report activity in the form of tables, graphs and explanatory text that describes client cost and utilization experience for a defined quarter. Pharmacy A report showing X Benefit Savings quarterly data for claims and Cost cost and drug cost Summary savings. Comparisons to the previous quarter and year are also included. Claims Activity This quarterly report is a X X Summary summary of claims processed within a certain date range. The data is sorted by month, claim type (network, mail and member submit) and generic type (generic, multi source brands, single source brands). Claim Activity A summary report listing X by Age/Gender claims processed within a certain date range according to specific age and gender breakouts. Utilization An overview of the client's X X Summary by monthly utilization over a Month specified date range, plus industry benchmarks where appropriate. 4 Express Scripts* Progressive Healthcare Management City of Fort Collins 7127198 21 Utilization Summary by Group Group summary of utilization over a specified date range. X X Member Reports Controlled This report identifies X Single Substance members with the highest Drug/Single Utilization controlled substance Member utilization rate based on a Utilization minimum number of prescriptions or a total net cost for a specified date range. High A quarterly report on X X Utilization members with the highest utilization rate based on a minimum number of scripts or a total claim amount for a specified date range. Member This quarterly report lists X X Single Ranking members ranked by Member number of scripts, Activity ingredient cost, or total net cost for specified date range. Member This report details members X Single Ranking by with scripts written by a Member Doctor specific physician, ranked Activity by number of scripts, ingredient cost or total net cost for specified date range. AExpress Scripts* Progressive Healthcare Management City of Fort Collins 727198 22 Member Members with scripts X Single Ranking by written for a specific drug, Drug/Single Drug ranked by number of Member scripts, ingredient cost or Utilization total net cost for specified date range are listed in this report. Single Member Provides claim history for X Activity a single member for a specified date range. Single This report details the X Drug/Single claim history for a specific Member member for a specific Utilization drug within the specified date range. Drug Reports Drug Ranking This is a quarterly X X Member overview of prescribed Ranking by drugs ranked by number Drug of scripts, ingredient cost, Drug or total net cost within a Utilization specified date range. Drug Ranking This report details X Member by Therapy prescribed drugs within a Ranking by Class specified therapy class, Drug ranked by number of Drug scripts, ingredient cost or Utilization total net cost within a specified date range. 4 Express Scripts° Progressive Healthcare Management City of Fort Collins 7127198 23 Drug This is an overview of all Utilization members with scripts for a specific set of drugs within the specified date range. Therapy Class This report demonstrates therapy Ranking classes ranked by number of scripts or total claim amount for specified date range. i X Drug Ranking by Therapy Class Physician Reports (designed to meet client needs for specific physician information) Drug Ranking This report lists a drug prescribed X by Physician by a specific physician, ranked by number of scripts, ingredient cost or total net cost within a specified date range. Physician This report is an overview of X Ranking physicians ranked by number of scripts, total ingredient cost or total net cost for specified date range. Users are also allowed to view member ranking by physician. Physician Physicians prescribing a specific X Ranking by drug, ranked by number of Drug scripts, total ingredient cost or total net cost for specified date range are outlined in this report. PUR This report shows, by physician, the X (Physician average number of Rxs PMPM, Report Card) average Rx cost, percentage of generic medications prescribed, formulary compliance percentage, and "DAW-1" percentage. AExpress Scripts® Progressive Healthcare Management City of Fort Collins 7/27/98 24 7. Can you provide management reports that can isolate the components of cost increases in the prescription drug benefit? For example, leading drugs dispensed, increases in utilization, development of trends, physician outliers, high patient utilizers and/or possible abusers? Is there an extra fee for any of them? Yes, in addition to the standard reports, the Executive Overview Report details client cost and utilization experience for a defined period of time. Please refer to Exhibit 6 for a sample of these reports. 8. Have you implemented innovative cost containment measures for any of your other clients in the last year? If yes, please elaborate upon the progress and what quantitative effect it had. How does this distinguish you from your competitors? Express ScriptsNalueRx has developed and successfully implemented a number of cost containment strategies. These strategies have saved our clients considerable dollars, while maintaining excellent quality of care practices. The strategies are designed to reduce unit costs, promote the use of therapeutically efficacious and less costly drugs, and control drug utilization. Express ScriptsNalueRx 's cost containment strategies include: ♦ Plan design ♦ Discounted network provider rates ♦ Mail service pharmacy ♦ Drug Utilization Review ♦ ExpressPreferenceS' formulary programs ♦ Generic substitution ♦ Therapeutic substitution ♦ Disease management ♦ Physician education programs ♦ Starter prescription program ♦ Prior authorization ♦ Drug information service Plan Design Express Scripts! Progressive Healthcare Management City of Fort Collins 7127198 25 An active approach towards plan design can enhance cost containment without unduly affecting members or quality of care. Critical elements of plan design include differential copays and deductibles for brand drugs versus generic drugs. We currently have greater than 2,000 distinct plan designs in our system. Each has been tested and validated using established computer models. Discounted networkprovider rates Express ScriptsNalueRx has negotiated discount rates with more than 98 percent of the retail pharmacies across the country. Express ScriptsNalueRx has developed this preferred provider network with the goals of providing convenient member access to pharmacies, and maximizing the discount those stores provide on ingredient costs and dispensing fees. Express ScriptsNalueRx offers a network program to identify non -preferred prescriptions dispensed through network providers. When non -preferred prescriptions are dispensed, this automated system identifies the need for an Express ScriptsNalueRx pharmacist to contact the physician and member to indicate a more economical preferred product. This program involves telephone and written communication, detailed rationale, and can include incentives to the member. Mail service pharmacy Express ScriptsNalueRx offers its clients the use of our own mail service pharmacy. This service affords the City the inherent efficiencies and consequent cost savings of volume dispensing, while providing convenient home delivery. The mail service pharmacy is particularly cost effective and convenient for maintenance medications. Appropriate and optimum use of this service can greatly reduce the unit costs of prescription drugs. Drug Utilization Review Express ScriptsNalueRx has a sophisticated Drug Utilization Review (DUR) program that is designed to ensure quality of care and enhance the cost containment features of Express ScriptsNalueRx 's comprehensive pharmacy benefit management program. The DUR program is composed of prospective, concurrent and retrospective components. Express ScriptsNalueRx 's DUR saves approximately 5-8 percent of total plan costs for those clients with no previous DUR history. For clients with a previous DUR program history, 2-4 percent of total plan costs may be saved. ExpressPreference'm Formulary programs 4 Express Scripts® Progressive Healthcare Management City of For[ Collins 7127198 26 In developing formularies, Express ScriptsNalueRx takes special care in considering not only the cost containment aspects of the drugs, but also their therapeutic efficacy and the likely acceptance of the drugs by the physician community. The ExpressPreferencesm program is indicative of Express Scripts/ValueRx 's commitment to providing our clients flexibility in formulary design. Express ScriptsNalueRx has created several programs to meet the cost savings and managed care objectives of every client by successfully increasing the utilization of preferred products. Our independence from pharmaceutical manufacturer ownership allows us to work for our clients' best interest to proactively assist our clients in controlling healthcare spending while addressing the trend toward more restrictive formularies. The result is bottom -line savings for the City. Our Clinical staff and Pharmacy and Therapeutics Committee evaluate drugs impartially, seeking both generic and therapeutic interchange opportunities to optimize quality and cost-effectiveness. A cornerstone of the Express ScriptsNalueRx 's drug cost management effort revolves around the use of generic agents whenever possible. Increasingly, generic products are the first line therapy. Utilization of generic agents lowers the net drug spend but also lowers the potential to achieve a specific level of rebate income. Others promise significant rebates per prescription yet do not encourage generic usage as this would erode rebate income. Express ScriptsNalueRx considers monthly per member per month (PMPM) drug costs a more accurate evaluation tool than rebate per prescription. When generics are emphasized, the PMPM prescription costs are lower than the PMPM prescription costs without concentrating on generic usage. Even with the large rebates delivered by others and subsequent de -emphasis of generics, the net drug cost (drug cost minus rebate income) is lower by concentrating on generic utilization. High rebates appear attractive but also mask an increased net drug expenditure. Cost reductions associated with formulary options depend upon the size of the group and the plan designs chosen, benefit design, and the number and type of drug; member co -payment incentives; and, physician incentives. Open formulary programs, when combined with the Express ScriptsNalueRx Maximum Allowable Cost (MAC) program, form the basis for additional program savings. Restricted formulary options include maximizing use of preferred products and generate greater savings as indicated below: 4 Express Scripts Progressive Healthcare Management City of Fort Collins 7127198 27 The cost effectiveness of the formulary will be illustrated by the Executive Overview Report (EOR) and the Therapy Class Report which show utilization and results of formulary programs, including: ♦ generic fill rates, ♦ mail service pharmacy utilization, ♦ cost per prescription in each therapy class; and ♦ cost per individual Top 20 drugs in each therapy class. Generic substitution Express ScriptsNalueRx uses a variety of methods to increase generic substitution. Express ScriptsNalueRx maintains a high generic fill rate by having registered pharmacists call physicians on all "Dispense As Written" prescriptions and by substitution whenever possible. We supplement direct telephone intervention with physicians with direct mailings, personalized letters and brochures. Our 30 percent intervention rate through the Mail Service Pharmacy results in an average 11 percent savings. Therapeutic substitution Therapeutic substitution opportunities are handled similarly, with direct telephone intervention by registered pharmacists as well as personalized letters. For example, when H2 Antagonists are dispensed beyond eight weeks' duration at acute dosing levels, an Express ScriptsNalueRx pharmacist will contact the prescribing physician to discuss reducing the patient dose to maintenance levels. If unable to satisfactorily complete and resolve the call, a follow-up letter is sent to the prescribing physician requesting a response. In addition, a copy of the National Institutes of Health consensus statement on the use of Antimicrobials in ulcer disease is included in the mailing. Disease management Express ScriptsNalueRx offers a proven methodology to develop and execute comprehensive targeted disease management programs. Clients can select a disease management program to meet cost and quality of care objectives. Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 28 AUG.-31'98(MON) 14:11 EXPRESS SCRIPTS -PROVIDER RELAT'S TEL:314 919 4647 P.001 AEL Express ScriptV U ue IFAX Date 8/31/98 Number of a es Including cover sheet 4 TO: City of Fort Collins Gary Hatendorf Express Scripts C/O: James O'Neill, It Phone 970-221-6775 Fax Phone 970-221-6707 I CC: FROM: Jennifer Marchant Express Scripts, Inc. 14000 Riverport Drive Maryland Heights, MO 63043 E•Matt JMARCHANT@express-scdpts.com Phone 800-332-5455 x7428 Fax Phone 314-770-0164 REMARKS: ❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Please Comment Here is the spreadsheet you requested for Greeley, Fort Collins, and Loveland, CO. If you need further information, let me know. This methodology offers clients an approach to true disease management - a comprehensive, integrated, cost-effective approach to treatment, encompassing clinical guidelines, patient education, provider partnering, behavior modification, and prevention strategies. Physician education programs Express ScriptsNalueRx currently conducts educational programs to inform physicians of preferred and cost-effective therapies. These programs have been proven to drive market share to specific drug products within a therapeutic category. Among other things, our clinical pharmacy department publishes The Express newsletter on a quarterly basis with information on our formularies, preferred products and new medications. We also provide physician prescribing analyses that allow us to target prescribers for education and intervention strategies. Drug utilization criteria are available to manage pharmaceuticals that have a high cost impact on your plan. Each plan identifies parameters to evaluate the performance of plan physicians. Starter prescription program Through the ExpressTrial program, the Express Scripts/ValueRx mail service facility will dispense only a "starter" 30-day supply of medication on new prescriptions where side effects are more common. Subsequent fills may be dispensed in 90-day supply quantities. Since 45 percent of all medications on the initial fill are either changed to a new medication or discontinued, the ExpressTrial program effectively reduces costs due to waste. Prior authorization Express ScriptsNalueRx also encourages clients to implement a prior authorization program. Our prior authorization program provides a mechanism for proactive review of selected medications to insure the proper use of high cost medications that are at times prescribed for purposes for which they were not designed. Drug information service Express ScriptsNalueRx 's clinical staff can recommend guidelines that may be applied to specific medications and programs designed to control utilization. Commonly used guidelines include the following: ♦ a one unit limit guideline for inhalers. ♦ a flat days limit guideline for HZ antagonists, Proton Pump Inhibitors and maintenance medications. Express Scripts° Progressive Healthcare Management City of Fort Collins 7/27/98 29 ♦ a length of therapy limit guideline for antibiotics, specific disease categories and Imitrex. Express ScriptsNalueRx 's clinical pharmacy staff, consisting of a clinical pharmacist and a registered pharmacist, are available to provide our Drug Information Service. We have a clinical library and Micromedix system (CD ROM) that provides us with full line clinical literature access. Express ScriptsNalueRx can also access medical and pharmaceutical literature through an on line literature search. We have a toll -free number available for our clients to use this service. 9. Will dedicated customer service representatives be assigned to this account? Are customer service representatives separated from the claim processing unit, or do claim processors have customer service responsibilities? Do customer service representatives have on-line access to up-to-date claim processing information? Do customer service representatives have authority to approve claims? Express ScriptsNalueRx offers excellent Customer Service. The Units are staffed utilizing historical data to project the call volume relevant to membership. Currently, 4.2 lives generate one call annually. The resulting estimated call volumes are then input into our staffing calculations (Erlang formulas) which consider length of call, projected service levels, hold times, etc. Express ScriptsNalueRx is fortunate to have superior management and supervisory expertise within our Customer Service Department. These managers and supervisors bring a combined 85 years of direct customer service experience to our clients, while also promoting the development of our Customer Service Representatives. Along with a Quality Assurance Unit in the department, they carefully help structure corporate training efforts and guide individual CSR professional growth. We currently provide an automated interactive telephone communication service. A caller has the option to choose 1 to refill an order, 2 to check the status of an order, or 3 to speak to a customer service agent. A touch-tone phone is necessary to utilize this service, however, if the caller does not have a touch-tone phone, they may hold and the call will be transferred to a customer service agent. The Call Center has been significantly upgraded to enhance the ability of the Customer Service representatives to respond to member questions. Some of the most significant new capabilities are: 44. Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 30 • Improved access to benefit information. - A representative can access member benefit information for deductible, cap, and copay information for network, mail order and self -pay claims on one screen. • Coverage information. - A representative can immediately access coverage information for a specific medication and provide the copay amount to the member. • ID Card Requests. - A representative has the capability of requesting an ID card by clicking a button. If Express ScriptsNalue Rx doesn't produce the card, a message is returned to the representative with the information the member needs to contact their Benefit Office for the request. • Mail Order Status. - Representatives now have immediate access to the status of mail orders and are provided with details on refill amounts, doctor information, and how the prescription was written. These features have significantly enhanced the ability of the customer service representatives to respond to customer queries with accurate, timely information. On-Lilic Service Representatives Patient Profile Yes Name, doctor, allergies, etc. Utilization history Yes Prior prescriptions Plan provisions Yes Co -pay, ded., caps, exceptions, etc. Claims procedures Yes Network, selfpay, mail-order Pharmacy location Yes By zip code, by city Claim status Yes Open, paid, rejected. and amounts, provider, dates, payments, member responsibility Explanation of benefits payments Yes Patient, dates, amount, provider, payment, member responsibility. Explanation of benefit denials Yes Patient, dates, provider, amounts, reason for denial. Mail order claims Yes Status Shipping method Yes Carrier, date shipped Tracking number on overnight packages Yes Carrier, tracking number The customer service representatives do not have authority to approve claims. The claims processing unit is a separate department. 4 Express Scripts® IVProgressive Healthcare Management City of Fort Collins 7/27/98 31 10. How do members select a network pharmacy? Do you provide member support services for selecting and/or locating network pharmacies? Included in the member's information booklet, that is provided upon enrollment, is a list of the national chain pharmacies included in the PERx network. In addition, we can also provide a city and state listing of network pharmacies in the member packets. 11.Describe the member grievance protocols in place. What is the average response time for general plan and eligibility questions? Complicated claim questions? Written inquiries are centralized in the Quality Assurance area within the Customer Service Unit for control and accountability. Necessary research is performed and responses to written inquiries are returned within 48 hours of receipt. As is routine, all performance is tied to standards that are tracked, evaluated and reported by the Quality Assurance Unit. Any needed improvement is quickly identified and enacted. The four most common complaints received through the Customer Service Department are: 1. Why haven't I received my mail-order? 2. Why isn't my eligibility on file? 3. Why isn't this drug covered under my plan? 4. Why did I pay this amount for my medication? To assist our staff in responding to these questions, Express ScriptsNalueRx has streamlined the research approach. Our Call Tracking System has been enhanced so representatives only have to access one system which will interact with all the various platforms and return a direct narrative response. Specifically, our Call Tracking system will receive coded information from the Eligibility, Benefits, Claims, and Mail-order systems, decode the information, and transmit the answer through our Call Tracking System, while providing consistent responses to our customers. Additionally, the Call Tracking System will forward any open requests on-line to the operating area in order to address these issues efficiently. Also, the Call Tracking system acts as a follow-up log to ensure service is delivered in a timely manner. Finally, the Call Tracking System is used to log the calls and serves as a tool for management to develop approaches to minimize the calls. 12. If your organization has offices in more than one city, please state the location of the office which will be responsible for services provided to The City. Express Scripts® Progressive Healthcare Management City of Fort Collins 727198 32 Express ScriptsNalueRx will provide services to the City through our Tempe, Arizona facility. 13. Does your organization mandate plan design? If yes, in what way? No. Our flexibility with respect to customer plan designs is virtually unlimited. Our on-line real-time claims adjudication system ensures that only eligible members are able to receive benefits in accordance with your plan parameters. We currently have more than 2,000 distinct plan designs in our system. Each has been tested and validated using established computer models. B. Coverage Item 1. Provide a list of the standard coverage exclusions and limitations for your network and non -network options. Express ScriptsNalueRx will work with the City to determine drug inclusions/exclusions options. The following are exclusions for the drug benefit: ♦ Non -Legend drugs other than Insulin ♦ Therapeutic devices or appliances, support garments and other non -medical substances ♦ Drugs intended for use in a physician's office or another setting other than home use ♦ Investigational or experimental drugs; including compounded medications for non -FDA approved use ♦ Prescriptions which an eligible person is entitled to receive without charge under any workers' compensation law, or any municipal, state, or federal program 2. Describe the coverage portability for members who temporarily reside or transfer to non -network service areas. Express Scripts offers two national networks - covering nearly 99 percent of retail pharmacies nationwide. The member should not be inconvenienced when traveling. If a member gets a prescription dispensed at a non -network pharmacy, he/she can submit the prescription for reimbursement based on the plan parameters of the City. A. Retail Pharmacy Network Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 33 1. Please submit a current listing of participating pharmacies in the City's service area (i.e., Northern Colorado and the Denver metropolitan area) and their normal days and hours of operation. Exhibit 7 contains a current list of the network pharmacies in Colorado. A network accessibility analysis was completed and can be found in Exhibit 8. 2. Can the plan sponsor or plan participant nominate pharmacies to be considered for inclusion in the network panel? If so, what steps would be required to be made by the plan sponsor and/or participant? Yes, Express Scripts can have a new pharmacy in our system as a participating pharmacy provider within 24 hours after we have received certification and a completed, signed contract from the pharmacy. The plan sponsor can contact the Account Manager who will notify the Provider Relations department of the request for a pharmacy(ies) to be added to our network. The member can contact the Customer Service department with the request which will also be forward to the Provider Relations department for follow-up. 3. What pricing guide does your organization use for your retail pharmacy program? Red Book? Blue Book? Medispan? First Data Bank? Other? How often is this standard updated? Express ScriptsNalueRx uses First DataBank's Blue Book, which is maintained on- line and updated weekly, to determine AWP. 4. Please describe in detail the prescription dispensing routines of your pharmacies. In addition to a description of the overall process, please advise how your pharmacies address the following issues: • plan dispensing limitation including quantity and dosage guidelines • excluded drug lists • physician/pharmacist communications • generic over band name dispensing • irregularities in the prescribing or receiving of drugs The Express Scripts program integrates convenient network pharmacy card programs with management systems to meet the Plan Sponsor's needs: ♦ Discounted drug cost 44. Express Scripts® Progressive Healthcare Management City of Fort Collins 727198 34 ♦ National preferred provider networks ♦ Pharmacies added to the network for member convenience ♦ Flexible plan designs ♦ On-line claims adjudication ♦ On-line Drug Utilization Review ♦ Management reports ♦ Client Service Representatives assigned to each account ♦ Toll free number to Customer Service ♦ Toll free "Help Desk" for pharmacists to call if there are questions regarding the member or the medications prescribed ♦ Comprehensive directory of participating pharmacies All participating PERx pharmacies offer on-line real-time electronic point of sale claims processing. The pharmacist keys in group, member, prescriber and prescription data consistent with the requirements of the plan sponsor. These data elements are merged with eligibility and pharmacy data pertaining to the member and benefit package of the plan. The group number enables our system to know where to send the claim for eligibility verification. Our on-line real-time system analyzes the following elements: ♦ The member's eligibility ♦ The coverage status of the drug (on or off formulary or requires prior authorization) ♦ The status of the member regarding a deductible or benefit limit ♦ The required co -pay amount ♦ Any other requirements of the plan design The electronic adjudication of the claim is accomplished by transmitting data from the pharmacy to Express Scripts via a switching company, ensuring that transmissions adhere to standards established by NCPDP for proper claims adjudication. Express Scripts uses the following switching companies: ♦ Envoy ♦ MedEAmerican (formerly General Computer Corporation) ♦ National Data Corporation ♦ Direct Leased Lines 4 Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 35 If all of the above elements are satisfactorily edited, prior to dispensing the medication, the Express Scripts Concurrent Drug Utilization Review edits are conducted through the on-line system. The patient then receives his/her medication if it is cleared through the pharmacists' on-line system and he/she pays the appropriate co -pay as indicated on the pharmacist's screen. 5. Does your recordkeeping system permit interface with and access to the prescription histories being simultaneously established at other participating pharmacies? If such intrapharmacy communication exists, how are the plan dispensing limitations accommodated? Yes, the Express Scripts' computer system is an integrated configuration of five hardware platforms which were specifically selected for, and dedicated to their specific functions: ♦ The Hewlett Packard MPEX Systems - reporting ♦ DEC Alpha System - Mail pharmacy ♦ An IBM AS400 - Concurrent DUR ♦ STRATUS Continuum Fault Tolerant System - Claims, adjudication, eligibility, billing, ID cards ♦ Hewlett Packard Unix Systems - Data Warehouse and Rx Workbench 6. How are complaints from and problems presented by participants handled? One of the major functional areas of the Provider Relations Department is the Network Auditing Group, responsible for monitoring pharmacy performance in our network of greater than 50,200 providers. A variety of "desk" and "field" audit programs are in place to monitor and manage network performance and to guarantee the daily consistency of a high -quality managed care provider network. Express Scripts aggressively monitors network pharmacies to identify fraudulent claims and ensure the integrity of our networks. The Provider Relations Auditing Department utilizes many different approaches to prevent fraudulent claims from being billed to our clients, including an in-depth, statistically valid review of our entire claims database on an ongoing basis. Part of this review includes daily analyses of all claims exceeding specified dollar parameters to identify unusual or fraudulent claims. 46, Express Scripts® Progressive Healthcare Management City of Fort Collins 7/27/98 36 When a network pharmacy is targeted and potential or actual fraud is uncovered, an Advisory Committee is brought in to review the claims involved, the overall potential impact on our clients, and the appropriate steps to be taken. The Committee is made up of Provider Relations Auditing and departmental management, Express Scripts corporate counsel, corporate Internal Audit management, Pharmacy Department management, and our external auditors, Price Waterhouse. In serious cases, the Executive Vice President is included to address high level client issues. This grouping of individuals is focused on ensuring that a complete investigation into the fraudulent activity is performed, and the best outcome is obtained for our clients. Any fraudulently submitted claims paid by Express Scripts are aggressively pursued through all appropriate legal avenues to recover those funds from the provider in order to return them to affected clients in accordance with our Agreement. Proper notification to governmental bodies is completed to ensure appropriate actions are taken. Monitoring Claims During a written pharmacy audit, the pharmacy will be required to send in a photocopy of the original prescription issued by the physician. During an on -site audit the pharmacy will be required to show the actual prescription issued by the physician to the audit personnel. Monitoring Physicians Our Provider Relations Department routinely performs physician claim verification audits as part of our overall quality assurance program. This program verifies that prescriptions are written only by those authorized to write them. These physician audits are performed when previous data gathering efforts have been unsuccessful or deemed unreliable. We do not routinely verify if the physicians writing these prescriptions are licensed, but we review for DEA numbers or the physician state medical license number on all written (mail) audits. If there is evidence to indicate DEA testing is necessary, the audit group does verify numbers with the local office of the DEA. This occurs when we believe the pharmacist may be submitting fraudulent claims. We have performed ad hoc DEA number checks for clients upon request. Express Scripts is working to move away from the DEA or state license number system for a variety of reasons and will utilize a new physician identifier number system which is currently being discussed by the NCPDP (National Council for Prescription Drug Programs). Once this system is in place, a hard edit on the physician identifier submitted will be more feasible to administer. Express Scripts* Progressive Healthcare Management City of Fort Collins 7127198 37 Monitoring Pharmacies Express Scripts monitors several statistical indicators and produces and distributes Pharmacy Report Cards to all pharmacies that service your members. Specific pharmacy dispensing practices are monitored and reported, including brand/generic/multi-source dispensing rates as a percent of the total, DAW code rates, UCR percent of claims paid, reversal percentages and percent of formulary drugs dispensed. In addition, formulary special messaging identifies opportunities and specific drugs. The results may be used to determine if a pharmacy audit is necessary. Results below national average for our total network are discussed directly with the chain headquarters to mutually develop an improvement program. Our Provider Relations Department receives the State Board of Pharmacy's publications from each individual state. Our auditors carefully review the publication against each of our network providers. If any action has been taken against a pharmacy or pharmacist, the pharmacy must go through the original credentialing and certification process again to remain in the Express Scripts network. 7. What is your generic fill rate in the following generic environments? MAC A MAC B MAC C Express ScriptsNalueRx generic fill rate in the network is 42.2% Do you guarantee a generic fill rate? If so, what are the penalties if it is not achieved? A generic fill rate guarantee can be discussed upon the approrpiate plan design implementation. 8. Describe the claims payment process, for retail pharmacy claims, from date of receipt to full adjudication of checks to providers or patients. Will all claims be paid in accordance with the benefit program described in this RFP? Be sure to explain how patient submit/direct pay claims are handled. If the process is different for network and non -network claims, please discuss separately. For example, do you batch process checks to network providers? If so, explain. Network Claim Processing A member either goes to a participating pharmacy and presents his/her identification card to the pharmacist along with the prescription, or the member sends in his/her 4 Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 38 AUG, -31' 98 (MON) 14:11 EXPRESS SCRIPTS -PROVIDER RELAT'S TEL:314 919 4647 P.002 C W cc E .t CL M a Q a N0. y Q Cc 3 m0 � Ln ^OOML�7c (A�7►f��000D�I�-MOI`I�OMf�-T00 N �t r (ONNI�COMt�0T-LOco Ln 0 (O M r r �- CO � M �' O] (00I-,N0LO r L() L� p CO�rJ ONMOM ►n O M w m N N Cn N O O In ('M r- O� Cn prescription to the mail service pharmacy. The pharmacist keys in the group number and member identification number into the on-line system. The Express Scripts system checks the following eligibility elements on-line in real-time with an average response time of .89 seconds: ♦ Group Eligibility - Verification of the plan parameters of the group including copay requirements and maximum supply limitations. ♦ Patient Eligibility - Patient eligibility is identified by Social Security number, Claim number, name and date of birth and/or suffix number. ♦ Drug Eligibility - This verifies that the pharmaceutical product ordered is covered by the plan as pre -determined by the plan administrator. Mail order prescription requests for medication not covered will either be returned to the patient or, if the patient requests, the order will be filled and the patient will be invoiced. After eligibility is confirmed, the Express Scripts system conducts on-line Drug Utilization Review (DUR). If there are no serious interactions or allergies, the pharmacist will dispense the medication. The member is responsible for paying the appropriate copay as indicated on the pharmacist's on-line computer. If the above eligibility elements cannot be confirmed at the point -of -sale, the pharmacist receives a message to telephone the Express Scripts Help Desk to ensure the accuracy of the data entered by the pharmacy and to verify the Express Scripts' eligibility file. If the information validates eligibility, Express Scripts' Help Desk will provide the appropriate code to the pharmacist to allow the prescription to be filled. The pharmacist cannot override the system without a code from the Help Desk. In the event eligibility cannot be validated, the pharmacist handles the situation in accordance with the City plan parameters, as determined during account implementation. Member Submitted Paper Claim Processing Express Scripts/ValueRx provides a member submitted claims option to plan participants who choose not to use a participating network pharmacy or the Express Scripts/ValueRx mail service pharmacy. The participant may obtain prescribed medications at any pharmacy, complete a standard claim form and submit it to Express Scripts/ValueRx for processing according to pre -determined guidelines. The standard turnaround time for a member submitted claim is five days. 4 Express Scripts® IV Progressive Healthcare Management City of Fort Collins 7127198 39 Prescription reimbursement for member submitted claims from non -participating pharmacies may be set according to the objectives of the plan sponsor. Many clients elect to charge members for using non -participating pharmacies by requiring higher co -payments and/or a lower percentage reimbursement rate. Following is a detailed description of Express Scripts' standard for processing paper claims: Batching: Step I Claims are date stamped, for accurate tracking of turnaround time. Step 2 Claims are bar coded and scanned, creating an electronic version of the claim which can be easily retrieved for verification or further processing. Step 3 Member eligibility is verified to insure the claim is for an active member. Step 4 Claim form and claim receipts are reviewed to ensure all required information is included (If not, claims may be returned to the member.) Rate of reimbursement is determined, based on the pharmacy where the prescription was purchased. Step S Based upon inquiry into an on-line NDC file, the NDC Code is determined Processing: Step 1 Claims are entered into and processed in the Express ScriptsNalueRx system. The same system edits, including all edits utilized by the on-line pharmacy network, are undertaken. Step 2 Operator verifies claim payment or rejection. A review is done to ensure all data entered is correct. Final Review: Step I A claim proof showing the processing results of all claims processed the previous day is generated. Step 2 After all claims have been reviewed and corrected, the batch is released for payment. Each standard Express ScriptsNalueRx claim form lists the directions and requirements on the back side. Each form must be signed by the insured and must include the member's identification number as well as patient name and date of birth. 4 Express Scripts® 1WProgressive Healthcare Management City of Fort Collins 7127198 40 Also, the pharmacy receipts must be attached unless the claim form has been completed and signed by the dispensing pharmacist. If the claim form is missing any information required for processing, the claim is Pulled from the processing sequence. At this time, a unit leader will review the problem and decide if it can be handled effectively via a phone call to the pharmacy or member. If the situation cannot be resolved via phone, the claim will be returned to the member along with a letter advising why the claim(s) could not be processed and/or requesting the additional information needed in order to adjudicate the claim. Quality of member -submitted claims is maintained and audited on an on -going basis. Every claim processed is checked and rechecked prior to payment. In addition, there are a number of system controlled audits including the drug type, strength, quantity, cost, and the dispensing pharmacy's NABP number. A daily proof report is checked against the claims that were keyed the previous day. Claims personnel also screen each claim during the selfpay adjudication process looking for possible evidence of tampered documentation. Any claim that looks suspicious is referred to the unit leader for review/investigation. Express ScriptsNalueRx can send data to the City for reimbursement and Explanation of Benefit (EOB) generation. If desired, Express ScriptsNalueRx can produce the EOBs and checks. The EOBs include only the member submitted claim information processed one to two days prior. Claims are processed and EOBs are mailed within five working days from the time the claim is received. All claim counts are verified to make sure all claims are accounted for (initial proof report to final proof report, which represents final claims adjudication as they appeared on the EOBs and checks.) The cost for Member Submitted Claim option is $1.50 per prescription. This fee includes adjudicating the claim using all of the on-line technology, preparing an Explanation of Benefits (EOB), cutting a reimbursement check if appropriate and mailing the EOB and check to the claimant's address. 9. Describe in detail the auditing program and procedures maintained by your organization. Will you permit an audit by an external auditor at the request of the client? Many areas of pharmacy activity are reviewed by the Express Scripts audit staff to ensure quality and cost effective service for the member and client. Express Scripts° Progressive Healthcare Management City of Fort Collins 7127198 41 The Express Scripts provider contract requires pharmacies to permit Express Scripts or a third party authorized by Express Scripts to inspect, review, audit, and reproduce any business, financial, and prescription record maintained by the provider pertaining to Express Scripts' members. This provision is valid for up to five years from the date a prescription is dispensed to an Express Scripts covered member (whether or not the client is still an Express Scripts client). Such audits must take place during regular business hours and without charge. The pharmacy must cooperate and participate with Express Scripts in any and all quality assurance procedures, peer review, credentialing processes, audit systems, and any complaint resolution procedures established by Express Scripts. Express Scripts' Provider Relations Department performs audits on an ongoing basis. Daily, we review 100 percent of claims over a specified dollar amount; therefore, all stores submitting claims exceeding that cutoff are reviewed. We also perform several full scope, on -site audits and several desk audits annually. These audits are triggered by a continuous review of targeted pharmacy dispensing indicators, or triggers, using a statistically valid approach. Audit Triggers The Express Scripts audit program is supported by continuous in-house analysis of statistical dispensing triggers. These triggers include, but are not limited to: ♦ Generic, multi -source brand, and single source brand fill rates ♦ Generic substitution ♦ Dispense As Written (DAW) code use ♦ Average claim amount ♦ Package Size submitted ♦ Quantity dispensed versus days supply and FDA guidelines ♦ Days supply versus quantity dispensed and FDA guidelines ♦ Usual and Customary Retail Prices ♦ Concurrent DUR Intervention ♦ Reversals ♦ Formulary Compliance ♦ Physician Profiling ♦ Controlled Substance Dispensing ♦ Compound Dispensing ♦ Fraud ♦ Return to Stock Other non -statistical audit triggers include, but are not limited to: 4$ Express Scripts* Progressive Healthcare Management City of Fort Collins 7127198 42 ♦ Referral from plan members ♦ Referral from plan sponsor ♦ Random selection The Expre$$Check program is a newly designed program that provides continuous in- house analysis of statistical dispensing indicators using the statistical software package, SPSS. The Network Auditing Group performs analytical reviews across the entire Express Scripts book of business, using several Expre$$Check audit programs to review pharmacies and claims selected, including: ♦ Site Audits - An auditor visits the network pharmacy to perform a comprehensive review of claim and quality assurance documentation, pharmacy procedures, and credentialing ♦ Daily Screen Reviews - Claims exceeding set criteria are analyzed daily for proper utilization and submission ♦ Quest Audits - Targeted pharmacy documentation is requested by telephone, fax, or mail and compared to historical claim submissions ♦ System Audits - Prescription receipts and specific claim information are verified through member and prescriber contacts Overpayments on previously paid claims uncovered through pharmacy audits are returned to the City. Express Scripts will retain a small percentage of recoveries to cover administrative and audit costs. The audit group works closely with clients, Express Scripts' Client Services, Pharmacy Help Desk, Customer Service Department, and the Express Preference team, in investigating pharmacy compliance issues on a regular basis. The primary goal of the Provider Relations auditing area is to increase the overall quality and performance of the Express Scripts pharmacy networks and enhance the confidence level of our clients regarding their pharmacy benefit and claims payments. On -site audits are normally scheduled with two weeks' notice. However, under certain circumstances, less advance notice may be given. If any claim was paid based on incorrectly submitted data, Express Scripts will disallow payment for that claim. Audit Guidelines ♦ Quantities Dispensed: Always submit the quantity prescribed, and submit the exact calculation of days' supply per the prescriber's dosing instructions. "As directed" or "PRN" prescriber directions must be clarified with prescriber or patient. Verifying pharmacist must enter and initial the information on the prescription. Express Scripts° VProgressive Healthcare Management City of Fort Collins 7127198 43 ♦ Di%2ense As Written odes: Submission of DAW 1 or 2 codes must be supported by prescription hard copy documentation on the original prescriber prescription, the telephone order, or prescription update, and subject to local regulations. Express Scripts will disallow payment for any claim submitted with missing or incorrect DAW codes. ♦ Formulary Compliance: The pharmacist should make his/her best effort to comply with Express Scripts formularies, respond to messaging, and dispense the Express Scripts formulary product; and except for generic substitution or for reasons of medical necessity, never switch a patient from the formulary product to the non -formulary product when filling a prescription for any Express Scripts member. Should a formulary product be switched to another product, other than a generic, for any reason other than documented medical necessity, payment for the non -formulary product may be disallowed. ♦ Signature All prescription claims paid by Express Scripts are subject to signature log verification. Claims not properly supported by documentation verifying receipt of the medication will be reversed on audit. ♦ Compliance with Audit Procedures: Failure to comply with any Express Scripts quality assurance or audit process will result in reversal of all applicable paid claims and may result in termination of the Pharmacy Provider Agreement. ♦ Audit Response: Pharmacies are given the opportunity to respond to audit findings within 30 days from receipt of the final audit report. Express Scripts at its sole discretion, may consider certain follow-up documentation. Findings relating to missing or incorrect Dispense As Written Codes, days supply or quantity, and Usual and Customary Retail Pricing are not subject to response. Signature Log Requirements Each Pharmacy must maintain a signature log for all claims in chronological order as prescriptions are received by the patient, including off -site delivery, with the following information: Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 44 The signature log must be kept for five years from the date a prescription is dispensed. Audit Savings Because of the volume of prescriptions Express Scripts processes, expressing the savings as a percentage of total ingredient cost may not be as meaningful as looking at the average yearly recovery per pharmacy chain. For example, at a pharmacy chain with $1 million in filled prescriptions, Express Scripts audits would recover, on average, $100,000 or 10 percent per year. In 1997, $2,791,446 was saved through our On -Site, Written, and Next Day Audits programs. 10. How often are pharmacy directories updated and dispersed to plan members? Express ScriptsNalueRx updates the pharmacy directories annually. We will notify the City when independent and chain pharmacies are added to the network. Members can contact the customer service department to get information on pharmacies in their vicinity. 11. Are there financial incentives to network pharmacies that are tied to utilization rates, compliance goals, quality of care outcomes or other performance results? If so, please explain. For pharmacists in our retail network, Express ScriptsNalueRx has an incentive program which helps drive market share to preferred products. This is done by using our on-line computer programs to inform the pharmacist of a preferred product within a therapeutic drug class, and by offering a financial incentive to the pharmacists to call the doctor to modify the prescription. Each time a provider transmits a request for a non -preferred product, in real time, Express ScriptsNalueRx messages back the preferred product (based on the program selected) to maximize the preferred product utilization. 12. Do you track and collect data on reimbursements to specific pharmacies? What data are captured and tracked? Are pharmacies terminated for abusive or excessive billing practices? Yes, the Express Scripts audit program is supported by continuous in-house analysis of statistical dispensing triggers. These triggers include, but are not limited to: ♦ Generic, multi -source brand, and single source brand fill rates 44Express Scripts VProgressive Healthcare Management City of Fort Collins 7127198 45 ♦ Generic substitution ♦ Dispense As Written (DAW) code use ♦ Average claim amount ♦ Package Size submitted ♦ Quantity dispensed versus days supply and FDA guidelines ♦ Days supply versus quantity dispensed and FDA guidelines ♦ Usual and Customary Retail Prices ♦ Concurrent DUR Intervention ♦ Reversals ♦ Formulary Compliance ♦ Physician Profiling ♦ Controlled Substance Dispensing ♦ Compound Dispensing ♦ Fraud ♦ Return to Stock Other non -statistical audit triggers include, but are not limited to: ♦ Referral from plan members ♦ Referral from plan sponsor ♦ Random selection If fraud is detected, it is grounds for immediate termination. The client is notified and given the choice of accepting or terminating the pharmacy. Clients must then inform plan participants if they choose to terminate the pharmacies. 13. How is eligibility verified? Can your system accept the eligibility list on tape or must it be on hard copy? How often can eligibility be updated? Express ScriptsNalueRx can accept member information from the City in a variety of formats. Express ScriptsNalueRx has developed the processes and tools which allow for quick translation of data into formats, codes, and parameters required by Express ScriptsNalueRx 's systems. The goal and experience associated with client implementations is a seamless, almost invisible transition in the eyes of the clients' membership. On-line real-time eligibility Express ScriptsNalueRx 's on-line access system allows the City to dial directly into the Express ScriptsNalueRx system and enter adds, changes, terminations, and card requests to their membership files. On-line eligibility data additions or changes to the Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 46 master file are available immediately. Various screens are available to the user, including: ♦ Group ♦ Member Eligibility ♦ Member Alpha Search ♦ Claim History ♦ Rejection Codes ♦ Drug Lookup ♦ Pharmacy Lookup ♦ Member Inquiry (current information on member, group and deductible) ♦ Prior Authorizations Although there is no limit on the number of Electronic Data Interchange (EDI) eligibility feeds, AT&T assesses a $0.10 per minute charge for use of the Information Access System service. No other fees are associated with the service. The City would only be billed for time used. Express Scripts/ValueRx will bill the client for this fee, so the client does not have to process an additional bill. On-line updates on an emergency basis can be handled by our Eligibility Phone Unit, at-800-332-2239 or by Fax: (602) 225-2861- Monday through Friday, 7 a.m. to 5 p.m., Mountain Standard Time. Remote Eligibility Users of Express Scripts/ValueRx 's remote eligibility services can administer additions, changes, terminations, and card requests for their benefit plan on a PC - based program. The remote program and Procomm Plus software is supplied at no charge to customer. Turnaround time is 24 hours from the time the information is received. The City can send changes on a daily basis. Data File Transfer (Modem) Express Scripts/ValueRx can receive subscriber and dependent enrollment data via a Procomm Plus Bulletin Board System. Turnaround time from receipt of data to application for standard files is 48 hours. Frame relay and AS400 are additional options to the Client. Tape, Disk, or Cartridge (3480 only) Clients can also use tape, disk or cartridge to submit eligibility. The average turnaround time between receipt of eligibility information and information applied in 44Express Scripts® VProgressive Healthcare Management City of Fort Collins 7127198 47 the system for standard files is 48 hours upon receipt. If the City is currently using a Pharmacy Benefit Manager, eligibility should be available on tape, disk, or cartridge to eliminate the need for manual eligibility. Manual Eligibility There is no restriction on the volume of manual eligibility data. There is, however, a $1 fee per cardholder record for Express ScriptsNalueRx to load new group member information. We do not specify a format on manual eligibility as long as the required data is provided in a legible format. The average turnaround for standard files is three days from the date the information is received in the Eligibility Department. 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If not, name the mail order company you are proposing to use. Where is the facility located? What is the relationship between your organization and the mail order company? How are claim systems, billing systems, and reporting systems linked? Express ScriptsNalueRx owns and operates five mail service facilities. The City will be served by our mail service facility in Tempe, Arizona. Claim, billing, and reporting systems are linked through our on-line, real-time adjudication system. 15. What is the turnaround time between receipt of a prescription and shipment of the filled prescription? The characteristic which separates Express Scripts from other mail service companies is our attention to detail and cost -containment balanced with the need to provide prompt service and turnaround on prescriptions shipped. Express Scripts dispenses and ships 95 percent of all new fillable prescriptions (those not requiring intervention) within an average of four working days. If a prescription requires intervention, a supervisor assists to assure that it is processed and shipped as quickly as possible. 16. Describe in detail the process involved in getting a mail order prescription filled. List each step beginning with the initial contact with the mail order pharmacy. Clearly identify the parts of the process that involve written communication by the participant. Do you offer any alternative to communications in writing? Identify who performs each step (pharmacist, technician, etc.). The Express Scripts prescription dispensing process is designed to provide the highest level of quality through the integrated use of Licensed Registered Pharmacists, closely supervised Pharmacy Technicians, computerized technology and specialized data systems. Once an order has been entered into the system, it can be immediately traced and continually monitored as it proceeds through the dispensing and shipping processes. - e Express Scripts® Progressive Healthcare Management City of Fort Collins 7127/98 49 ♦ All prescriptions are routed from the Express Scripts mail room to the Proofing Department. ♦ Prescriptions are proofed for completeness and legibility by Pharmacy Technicians under the direct supervision of a Licensed Registered Pharmacist. ♦ Prescriptions requiring resolution are documented in the member's order file and routed to the Telephone Verification Unit, supervised by a Pharmacist and staffed by Pharmacy Technicians who contact the prescribing physicians. Pre-disgensine quality control ♦ Patient profile information is entered into the Express Scripts patient history database for eligibility verification and establishment of order record. Member drug allergies and any special handling instructions are also noted on the member's profile for future use. ♦ Prescription information is interpreted and entered into patient's medication history. Prescription Quality audit process System DUR edits flag prescriptions raising clinical concerns. Licensed Registered Pharmacists review these prescriptions and, when necessary, contact the prescribing physician. Express Scripts' Pharmacists contact physicians on more than 30 percent of all new prescriptions. This also includes interventions to increase generic substitution and to discuss lower cost therapeutic alternatives. Each new prescription is then completely verified by a registered pharmacist. The following data elements are checked against the physician hard copy prescription: 0 Patient Name 0 Patient home and shipping address 0 Drug prescribed 0 Quantity prescribed 0 Directions for use 0 Prescribing Physician 0 Generic Substitution Requirements 0 Date Written The verification pharmacist in this step must check all of the above items for accuracy before the prescription may be dispensed in the pharmacy. Each prescription record must be recorded as "Approved by Pharmacist" in the member prescription profile, otherwise, no further processing of the prescription may take place. All prescriptions which are "Approved by Pharmacist" are placed in an electronic processing queue 44. Express Scripts® Progressive Healthcare Management City of Fort Collins 7127199 50 which is immediately available for dispensing in the pharmacy. Orders are electronically queued in order by receive date so that the oldest in-house orders are given priority. Quality prescription dispensing ♦ In the dispensing area of the pharmacy, the electronic order queue is called up at the print station. As an empty tote bar-code is scanned, the paperwork for the next order in the queue is printed and assigned to the scanned tote. When the paperwork printing is complete, the technician places the paperwork in the empty tote and places the tote on the routing conveyor system. The paperwork which is produced includes: Prescription Labels, Member Invoice, Member Reorder Form and Patient Education Materials for each prescription. ♦ As the tote moves along the conveyor, the pharmacy conveyor system reads the tote bar-code and routes the tote to the pharmacy location for each product to be dispensed. ♦ Drug selection at Express Scripts' pharmacies is accomplished in various ways depending on the frequency of utilization of the drug products. For those drug products dispensed most frequently, automated equipment is utilized for dispensing. This automated equipment varies from the Optifill0 system, A -Frame technology or Baker automated dispensing cells. The goal at Express Scripts is to create a processing environment that maximizes accuracy and efficiency. Through the use of automated equipment, Express Scripts pharmacies drug product selection is accomplished 90 percent of the time without manual picking. This translates into a much higher level of accuracy for our pharmacists and members. If the drug is not selected by automation, the product package NDC# bar-code is scanned and compared to the NDC# code on the actual system prescription record to verify that the correct product has been selected. ♦ In the case of the Optifill0 system or A -frame drug products, the vials are automatically dropped into the order tote. For manually counted drugs, the pharmacy technician places the counted drugs into the tote and the tote is placed on the conveyor system for additional processing. ♦ Once all the drug products for the order have been picked, the tote is routed to the dispensing pharmacist for checking, final verification and shipping A pharmacy technician prepares the contents of the entire prescription order for the dispensing pharmacist verification check. All paperwork is separated, including the medications which have been counted for the order and the necessary prescription labels. The dispensing team technician then reviews the prescription label information in comparison to the medication to be dispensed, Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 51 and if all aspects of the order are correct, the medication containers are labeled by the technician and passed to the dispensing pharmacist for final review. The dispensing pharmacist will then review all of the same information which has been verified by the technician for accuracy. The contents of the bottle are compared to the bottle label and verified, and if there were any clinical concerns related to the prescriptions, the dispensing pharmacist verifies that these have also been addressed and resolved. Once the entire order has been approved, the dispensing pharmacist places the medication vials in a polybag which is then heat - sealed. At this point, the order is ready to be invoiced and packaged for shipping. Prescription invoicing and shipping ♦ The packaging and shipping technician, who works in proximity to the dispensing pharmacist, then prepares the order for shipping. ♦ The order number bar-code is scanned to allow the shipping technician to verify specific details concerning the order. Items which are verified at this station include the member shipping address, the piece count of the order in the computer system must match the actual piece count being shipped and the method of shipment according to the computer system is determined. ♦ If all of these items are approved, the order is ready to be invoiced. The actual invoicing of the order is required in order for a prescription to be billed to the client. Thus, no prescription will ever be billed to our client unless it has proceeded to this stage and has been approved. ♦ If the member is paying for the order by credit card, an authorization transaction during the invoicing process is transmitted for credit card approval. The approval code for the transaction becomes part of the historical order record. ♦ Reorder forms and an Express Scripts Mail Service envelope are enclosed with the prescriptions in the package for the member's subsequent order. ♦ Packages are then either heat -sealed or tamper evident tape is used to secure corrugated boxes. The return address label indicates only the return address of the facility to protect the confidentiality of the package and its contents. ♦ Sealed packages are then forwarded to the mailroom. Mailroom processing Each package is processed in the mailroom according to the specific shipping requirements of the order. Express Scripts ships its orders either according to the package requirements or specific member or client request. At a minimum, Express Scripts will ship packages by First Class U.S. Mail. Overnight shipment is available, if necessary. 4 Express Scripts® Progressive Healthcare Management City of Fort Collins 7/27/98 52 ♦ Each package is posted and logged to the member's order history file for future reference. This includes the weight of the package, the shipping method utilized and the tracking number of the shipper if available. Mail Service Dispensing Process Prescriptions are received and checked for completeness and legibility. Prescriptions After verification, a patient profile is created for requiring resolution eligibility verification and record of order and are routed to the prescription data is entered into Telephone Verification Unit. the patient's medication history. The prescription is checked for clinical concerns, generic substitutions and lower cost therapeutic alternatives. If concerns are raised, a licensed registered pharmacist Once all conflicts are resolved, works with the prescribing physician _pl� the prescriptions are sent to ensure quality care. into the pharmacy for dispensing Labels are printed, affixed to the bottles, and placed with the prescription in a tote, which travels via conveyor to a pharmacy technician who places the electronically -counted medication in a vial. A licensed registered pharmacist verifies the prescription information and amount of medication and makes sure all clinical concerns have been resolved and other quality checks are made. Each prescription is packaged according to the packing and shipping requirements of the contents, marked for billing and the member's account is updated. Express Scripts' generates an internal report tracking the actual time to fill processable mail -service prescriptions, reviewing the percentage of prescriptions filled on day of receipt, next day, etc. Call interventions are also recorded to show the impact of calls to physicians or others in terms of generic substitution, dosage changes, etc. When a doctor must be contacted, the order cannot continue processing until the issue has been resolved. The doctor may be difficult to reach, however, Express Scripts will leave telephone messages and communicate via facsimile. Orders are tracked using these internal tracking reports to make sure that all orders are shipped to our members in a timely fashion. Problems that require a pharmacist to intervene and contact the doctor include: 44. Express Scripts® Pmgressrve Healthcare Management City of Fort Collins 7127198 53 ♦ Quantity missing from the prescription ♦ If the prescription is a narcotic ♦ If the prescription is faxed ♦ If the prescription is not legible ♦ Drug Interaction, and ♦ Duplicate therapy Mail service pharmacy automation ♦ All plan parameters relating to prescription fills, controlled by system edits, are part of the on-line adjudication system. ♦ Prescriptions which raise a clinical concern as a result of DUR are placed on system hold and will not be dispensed until reviewed/resolved and released by a pharmacist. ♦ The routing of prescription containers in the mail service pharmacy dispensing area is controlled by bar-coding and laser scanners. ♦ Printing of labels and dispensing of medications is controlled by bar-coding and laser scanners. Label printing is done automatically 100 percent of the time, and 90 percent of all medications are counted by automated counting equipment. 0 Express Scripts provides auxiliary label codes to our dispensing pharmacists for each prescription filled. The pharmacists will place the appropriate auxiliary labels on each prescription according to the codes displayed. In this manner, members receive consistent auxiliary labels on each prescription dispensed. ♦ Generation of invoice and reorder forms is controlled by bar-coding and laser scanners. ♦ Orders posted in shipping system are tracked through bar-codes read by scanners. Shipping ♦ After a final pharmacist review of the prescription information, the medication vials are labeled, placed in a tamper resistant heat sealed poly bag, then inserted into a brown padded envelope (or other appropriate shipping container) which is also heat sealed. ♦ External labeling only indicates name and address of addressee and Express Scripts return address. ♦ Indirect deliveries (temporary mailing addresses) can occur under special circumstances, but must be approved by the participant. 4 Express Scripts° 6 Progressive Healthcare Management City of Fort Collins 7127198 54 ♦ If a prescription is reported "not received" by the participant, Express Scripts will immediately call the participant's prescribing physician to gain permission to reship the prescription. Upon approval, the prescription is reshipped at no charge. The participant's file is marked "unsafe mailbox" and a Signature Required label is attached to the package. This process is repeated for future shippings for a specified (usually 6 months) period of time. ♦ The shipping system prompts the Mail Service employee whenever special handling, either as a result of the medication requirement or participant needs, is required on an order. Shipping procedures for temperature sensitive items are noted when items are shipped. Follow-up ♦ Pharmacists are available 24 hours a day via a toll -free line in Express Scripts' Customer Service area to handle any of the customer's questions. ♦ If there is a drug recall down to the patient level, Express Scripts contacts the participants who have received the questionable product and authorizes a return designated by the manufacturer. 17. What pricing guide is used for your mail order prescription drug program? Blue Book? Red Book? Medispan? First Data Bank? Other? How often is it updated? Express Scripts/ValueRx uses First DataBank's Blue Book, which is maintained on- line and updated weekly, to determine AWP. 18. Describe the claims payment process for mail order claims. Will all claims be paid in accordance with the benefit program described in this RFP? What form of payment can you accept from the claimant? Can refills be phoned in with purchases made by credit card? How many working days do you recommend that a patient submit a claim prior to the run out of the current prescription supply in order to ensure that the new prescription reaches the member before the existing supply is depleted? What is the average time in days between receipt of claim and delivery to patient? (include delivery time) Yes, mail claims are paid in accordance with the benefit program described herein. Members then choose the most convenient way to pay for the prescription: ♦ Check or money order ♦ MasterCard, Visa, or Discover Card Express Scripts' Progressive Healthcare Management City of Fort Collins 7127198 55 To order a refill by mail, members may send a completed refill order form to Express Scripts. Members will receive their medication within two weeks of mailing their order form. Refills by Phone Members may save the expense of inbound postage and also receive prescriptions sooner by ordering their refills on our toll -free 800 number. Telephone orders also will decrease the turn around time on orders. To place a refill order by phone, members may use the toll -free number 24 hrs a day. These members should follow these steps: 1. Have the Refill Authorization form handy for reference. Each member receives a copy of this with each order. 2. Call Express Scripts at the appropriate toll -free number printed either on the prescription label or the refill authorization form. 3. Give the representative the following information. ♦ Member ID number (on Refill Authorization) ♦ The refill number (on Refill Authorization) ♦ Number of prescriptions ordering ♦ Method of payment (Mastercard, VISA, Discover) ♦ Delivery address Currently, over 60 percent of refill prescriptions are ordered by phone. Members can either contact our re -order department or they can use our 24-hour automated ExpressRefill lines. Utilizing our Re -order Department Express Scripts offers refills by phone through the assistance of our order processing department. To place a refill order by phone: ♦ Have the Refill Authorization form handy for reference. Each member receives a copy of this with each order. ♦ Call Express Scripts at the appropriate toll -free number printed either on the prescription label or the refill authorization form. ♦ Give the phone refill representative the following information: 0 Member ID number (on Refill Authorization form). 0 The refill number (on Refill Authorization form). 0 Number of prescriptions ordering. 0 Method of payment (MasterCard, VISA, Discover). 0 Delivery address. Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 56 Utilizing ExpressRefill lines Members can also re -order their prescriptions by utilizing ExpressRefill, a toll -free automated refill ordering system for use with a touch-tone telephone. This capability offers members the ability to re -order prescriptions 24 hours per day, 365 days per year. 19. How long can a drug be dispensed before a new prescription is required? Is it possible to dispense a small initial supply, then the balance of the 90-day supply after it is certain no drug reaction has occurred? Prescriptions are valid for one year. Express Scripts' offers ExpressTriarm, a mail service starter dose program, which discourages waste of medication by dispensing a 30-day starter supply on new prescriptions where side effects are more common. Approximately 45 percent of all medications reduced to a lesser quantity or dosage on the initial fill, are either changed to a new medication or discontinued. Through the utilization of this program, Express Scripts is able to control potential medication waste and minimize our clients' prescription drug expenditures. 21. What is your generic fill rate for mail order drugs? Express ScriptsNalueRx 's generic fill rate in the mail is 3 1. 1 % 22. If an individual has lost eligibility under the Plan, is it possible for the participant to continue to receive maintenance drugs with your company and be billed directly? If so, what is the cost to the individual? Ineligible members can receive maintenance drugs on a "cash and carry" basis. 23. How are patients advised that their prescriptions are about to run out? How much advance notice is given? With prescriptions written with refills, Express ScriptsNalueRx includes a refill authorization form in the package. This form informs the member when to re -order their prescription, ususally when 66% of the current prescription is used. Please refer to Exhibit 9 for a sample of the information enclosed with the member's prescription. 24. What delivery system do you use (UPS, Postal Service, Federal Express)? If you use the Postal Service, do you use first or third class mail? Is there a charge to the participant for the delivery service? 4 Express Scripts° Progressive Healthcare Management City of Fort Collins 7127198 57 More than 80 percent of mail order prescriptions are shipped via U.S. Postal Service First Class Mail, with the balance being delivered by a package delivery service. External labeling only indicates the name and address of addressee and Express Scripts' return address. Approximately 10 percent of all mail service prescriptions require next -day delivery due to the requirements of the medications. Heat sensitive medication, packaged in vials or other containers, is placed into a tamper resistant sealed poly bag, then inserted into a brown padded envelope (or other appropriate shipping containers) which is also heat sealed. Some medications are shipped along with frozen gel blocks or dry ice. Under normal operating procedures, Express Scripts will pay for the shipping of medications. If, however, the member desires a rush placed on their order, Express Scripts will use an express package delivery service, and the member will pay the difference in cost between regular shipping charges and the express mail charges. In case of an emergency, the member may have their maintenance prescription filled (wholly or in part) at a retail network pharmacy. 25. How is eligibility verified? Can your system accept the eligibility list on tape or must it be on hard copy? How often can eligibility be updated? Express Scripts/ValueRx can accept member information from the City in a variety of formats. Express Scripts/ValueRx has developed the processes and tools which allow for quick translation of data into formats, codes, and parameters required by Express Scripts/ValueRx 's systems. The goal and experience associated with client implementations is a seamless, almost invisible transition in the eyes of the clients' membership. On-line real-time eligibility Express Scripts/ValueRx 's on-line access system allows the City to dial directly into the Express Scripts/ValueRx system and enter adds, changes, terminations, and card requests to their membership files. On-line eligibility data additions or changes to the master file are available immediately. Various screens are available to the user, including: ♦ Group ♦ Member Eligibility ♦ Member Alpha Search ♦ Claim History 44. Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 58 AUG. -31' WNION) 14:12 EXPRESS SCRIPTS -PROVIDER RELAT' S TEL:314 919 4647 P. 004 OMll� Lo too tr � Ln cp atn0 9~yp LDCDCaNCOT- M w O M m � oOCDbl �WOt ccf) ul prpp7�cpDcpWppi�pp�MppNW m M Mm ccccpp7ccn�cw 0 �ppp O O O O O O 0 0 0 0 0 0 0 0 0 �— M M e- M C9 M I` M O M co M O M ti M ti M ti M ti co M M h co f� M c0 0000000000000000 w c0 w Lo M Lo ►n Lo LA ►o Ln Lo Lo LO Lo 00CDmm00000000m00 co00000000co OOUOQO�VC0))C 0.%00010OOV V O C 1C7 C 'o C 'a C "m C ZI C 'O C 'O C 'o C 'o C 'O C m C a)ma�cocvm c^vco R mmm m mW a� m m 0000000000a00 a� a� m m m m m m— a� w C9 C 9 C 7 C7 J J J J J J J J J J J J .O > mo3 L L .r ..� �'co r_ss 3oai co Q� h m N y C�Q aw w cu y W� W W N N U' O W�SLLlm�N �WZ.E cp NOOOLoImNMOMNNOOCMO 0 0 M r- ►f] 47 M uj ui �Y T- Q LU M J Lo M CY) OOu'1LnC70u7�U'j NNNT- Nao rn Cr) ui co L0 i `" M cQrWW *m L1 f0 to N � 10 to v co0. m cva m E L �� m Z a W E€ � r 0 0.� m n. •C o c g ro a m o M>> $ _ U : o�, M V E c H oc_ M Ac w g �II O 07 D O O 1 C 0� la) .DC w W (0 F- aQ00YYM cocn3:1 T ♦ Rejection Codes ♦ Drug Lookup ♦ Pharmacy Lookup ♦ Member Inquiry (current information on member, group and deductible) ♦ Prior Authorizations Although there is no limit on the number of Electronic Data Interchange (EDI) eligibility feeds, AT&T assesses a $0.10 per minute charge for use of the Information Access System service. No other fees are associated with the service. The City would only be billed for time used. Express ScriptsNalueRx will bill the client for this fee, so the client does not have to process an additional bill. On-line updates on an emergency basis can be handled by our Eligibility Phone Unit, at-800-332-2239 or by Fax: (602) 225-2861- Monday through Friday, 7 a.m. to 5 p.m., Mountain Standard Time. Remote Eligibility Users of Express ScriptsNalueRx 's remote eligibility services can administer additions, changes, terminations, and card requests for their benefit plan on a PC - based program. The remote program and Procomm Plus software is supplied at no charge to customer. Turnaround time is 24 hours from the time the information is received. The City can send changes on a daily basis. Data File Transfer (Modem) Express ScriptsNalueRx can receive subscriber and dependent enrollment data via a Procomm Plus Bulletin Board System. Turnaround time from receipt of data to application for standard files is 48 hours. Frame relay and AS400 are additional options to the Client. Tape, Disk, or Cartridge (3480 only) Clients can also use tape, disk or cartridge to submit eligibility. The average turnaround time between receipt of eligibility information and information applied in the system for standard files is 48 hours upon receipt. If the City is currently using a Pharmacy Benefit Manager, eligibility should be available on tape, disk, or cartridge to eliminate the need for manual eligibility. Manual Eligibility There is no restriction on the volume of manual eligibility data. There is, however, a $1 fee per cardholder record for Express ScriptsNalueRx to load new group member information. We do not specify a format on manual eligibility as long as the required Express Scripts® IVPragreeerve Healthcare Management City of Fort Collins 7127198 59 data is provided in a legible format. The average turnaround for standard files is three days from the date the information is received in the Eligibility Department. E. Claims Paying Services and Abilities For non -network claims, what is the number of working days for a claim to be processed (check issued) from the date of receipt, without coordination of benefits? On what basis do you make that representation (e.g., average turnaround time over the past 12 months)? Describe separately for network and non -network claims, if results vary by type of provider. The percent of claims processed within 10 working days: The percent of claims processed within 30 working days: Express ScriptsNalueRx processes member submitted paper claims with five business days. 2. For the claim office proposed, please provide the following for the last two calendar years: a. Financial accuracy as a percent of total claims dollars paid (include over and underpayments). Express Scripts' Member -Submitted Claims Processing Department boasts more than a 99 percent claim processing accuracy rate overall and has not had to pay any penalties due to errors. b. Coding accuracy as a percent of total claims submitted. Financial and coding accuracy are not tracked as separate issues. 3. How do you avoid duplicate payments in the same claim? If duplicate payments or overpayments are made, what are your procedures for recovery of the overpayments or duplicate payments? The member submitted claims are processed on the Stratus system. Duplicate claims will be denied when processed. 4. Describe the methods used to track claims. If on-line, can claim tracking be made available to clients? 44. Express Scripts® Progressive Healthcare Management City of Fort Collins 7177198 60 Express ScriptsNalueRx has the ability to code and track claims by member number, provider number (using DEA number or state license codes). It is possible to code and track claims by the place and type of treatment and by the sites and facilities if the plan design permits. Please explain your COB procedures (include all options offered) and the average savings that you obtain and how COB savings are calculated. How do you know if there is other coverage? How often are records updated for new information on other coverage? What information is required from the plan sponsor in order to administer this provision? Is there an additional fee involved? If so, what is the cost? Express ScriptsNalue Rx administers coordination of benefits routinely, in accordance with a client's plan design when clients provide COB information as part of the eligibility data. To ensure a cost effective program, all claims received from individuals under the COB group must have an attached EOB from the primary carrier before claims may be adjudicated. COB group members may present an Express ScriptsNalue Rx card at a participating network pharmacy and receive the discount rate at the point of service. However, these individuals will be required to pay for the prescription in full if the plan sponsor is the secondary carrier. The individual will submit the prescription to us with the primary carrier's Explanation of Benefits attached for the claim to be processed according to your benefit design. There are three commonly used plan designs that provide both the ease of admini- stration as well as the results desired by the policy holder. ♦ "Lesser of" COB: Express ScriptsNalue Rx calculates its normal liability. determined by plan design, and pay the lesser of- t. Balance owed/remaining on prescription after the primary carrier's payment or 2. Our normal liability. ♦ Plan COB: Express ScriptsNalue Rx calculates the normal plan liability, determined by plan design, based on the remaining balance owed after the primary carrier has processed the claim. 100 percent Differential COB: Express ScriptsNalue Rx reimburses the remaining balance after the primary carrier has processed the claim. These claims AExpress Scripts® Progressive Healthcare Management City of Fort Collins 7127198 61 are submitted as prescriptions with no EOB attached. The prescription charge shown on the receipt is actually the copay charge incurred by the member. There are two standard procedures for handling these claims. Express ScriptsNalue Rx will either: 1. Consider the prescription copay cost as the total charge and process according to the standard benefits of the plan based on this amount, or 2. Pay 100 percent of the copay charge shown on the prescription. The plan administrator must select the COB plan that best fits their needs. Savings are visible to the clients rather than to Express ScriptsNalue Rx. The payors determine the maximum benefit amount to avoid duplication or to avoid payment above the primary benefit limit. Less than 1 % of all claims are member -submitted with approximately 20% of those requiring coordination with the primary coverage provider. Express ScriptsNalue Rx is saving plan sponsors greater than $2,000,000 per year, or approximately, $15 per COB claim through our COB administrative process. 6. Please explain your standard subrogation policy provisions and procedures and any options that are available, along with their advantages and disadvantages. Since Express ScriptsNalueRx is not an insurance carrier, and does not have access to insurance claim information, this is not applicable. 7. Describe the degree of flexibility, and any limitations, of your system in handling various plan designs. Express ScriptsNalueRx 's state-of-the-art, on-line computer system is capable of accommodating percentage and/or dollar co -pays, deductibles, annual maximum benefits, and out-of-pocket limits as well as the restricted card/mail program. Design features include, but are not limited to, the following: ♦ Multiple copay options ♦ Drug inclusions/exclusions options ♦ Days' supply options ♦ Member/family stop loss ♦ Claim dollar maximums ♦ Member ingredient cost differentials ♦ Deductibles 4 Express Scripts® 4 Progressive Healthcare Management City of Fort Collins 7127198 62 ♦ Combined deductible and member/family stop loss ♦ Combined deductible and claim dollar maximums Express ScriptsNalueRx 's computer system is capable of setting up all of the programs listed above at point of sale and through the mail service pharmacy. Single fixed, two -tiered fixed and three -tiered fixed co -pays are currently being used by many of our clients. The system is capable of percentage co -pays, drug specific deductibles, annual maximum benefit, and out-of-pocket limits as well as the restricted card/mail program. The information is set up at the corporate office in the computer and the on-line system that allows the plan design the be carried out to the specific standards as set up and requested by the Plan Sponsor. To date, there has been no plan design asked for by a client which Express ScriptsNalueRx could not administer. Plan design variables available for your consideration include: Plan Design Variables Dispensing Options Control how and when brand or Types generic drugs are provided to your include:members. Options include:•dispense as written Cla mandatory generic bmittedD.AW II any pharmacyWithin tion of the three/// each selectbn, copayment amounts are established. A multiple tiered option is available. Member Additional Copayments P rovis ions Copayments are Deductible/maximum established by type of benefit caps/stop loss service used. They can be provisions options are available that can be the same or vary on the tracked by individual or basis of: •dam type family and by the type of • brand or generic claim being processed. •tytype *plan Plan type 4 Express Scripts° Progressive Healthcare Management City of Fort Collins 727198 63 F. Drug Utilization Review DUR) The City desires a prescription utilization review program that would provide monitoring of both the retail prescription program and mail order maintenance drug program. 1. Please describe your prescription drug utilization review program separately for pharmacy network and mail order claims. In addition to a description of the program and how it functions, please advise how your drug utilization review program addresses the following issues: — quality and cost of patient's recommended therapy — physician prescribing patterns — pharmacy dispensing practices — therapeutic and dosing regimes — generic monitoring — member education Since 1986, Express ScriptsNalueRx has utilized its sophisticated Drug Utilization Review system to ensure quality of care and enhance the cost containment features of Express ScriptsNalueRx 's comprehensive drug benefit management program. Express ScriptsNalueRx 's Drug Utilization Review is identical for mail and retail networks and consists of prospective, current, and retrospective programs. These programs help ensure patient safety and contain costs through efforts to increase utilization of preferred products. Each prescription is screened by our system to detect potential problems. Approximately 22 percent of prescriptions fail one or more edits due to our concurrent review process. Monthly claims processed by our Concurrent DUR system average 2,126,840, as follows: Allergy Check .006% Compliance Check 5.400%7 Dose Check 8.600% Drug Age or Sex Check .020% Dup. Rx/Dup. Therapy Check 3.700% Duration of Therapy Check 1.700% Inferred Diagnosis Check .550% 44. Express Scripts° Progressive Healthcare Management City of Fort Collins 7127198 64 Drug Interaction Check .440% Maintenance Dose Check .740% Drug Specific (Toradol) Check .120 % Too Early Refill 3.000 % On a retrospective basis, Express ScriptsNalueRx 's clinical pharmacists evaluate a physician's prescribing behavior to identify opportunities to encourage prescription cost -control. Express ScriptsNalueRx 's reports enable our clinical staff to identify physicians and members that are "outliers" in terms of prescribing and utilization patterns. Prescribers can be analyzed and compared to specialty peers in terms of the magnitude of scripts written, controlled substance prescribing, generic fill rate, and formulary compliance. At a suitable interval after retrospective DUR programs have been implemented, a follow-up monitors the degree to which the physician actually changed prescribing patterns to meet acceptable standards. On average, our clients experience a 7 percent dollar cost savings generated by our utilization review program. This percentage varies according to many client -specific elements, for example, group demographics, previous group experience in either an indemnity or carve -out setting, and plan design. We require reliable information and appropriate analysis of each of these elements to calculate cost savings. Prospective Drug Utilization Review Express ScriptsNalueRx 's Prospective Drug Utilization Review system is focused on efforts to control drug utilization before a prescription is written. Prospective DUR is composed of these essential elements: ♦ Drug Formulary: A formulary can be very restrictive and limit coverage to only certain drugs or can be less restrictive and provide member co -payment incentives to utilize preferred products. In conjunction with sound prior authorization, a formulary can generate substantial savings through the directing of prescribing practices. ♦ Physician Education: Physicians are ranked within their specialties on generic utilization, drug utilization, cost, and formulary compliance. Certain prescribers that fall outside of the norm are targeted for academic detailing, education and intervention strategies with a consulting clinical pharmacist. ♦ Pharmacist Education: The Express ScriptsNalueRx Pharmacy Incentive program includes the network pharmacist in efforts to drive market share. Our on- line computer programs inform the pharmacist of a preferred alternate product within a therapeutic drug class. Express ScriptsNalueRx offers a financial incentive to pharmacists who call the doctor to modify the prescription. 4 Express Scripts® IVProgressive Healthcare Management City of Fort Collins 7127198 65 Member Education: The three -tiered co -pay structure involves the member in drug product selection and in informing the physician of preferred products. Generics have the lowest co -pay, preferred drugs the middle tier, and non - preferred drug products the highest. This type of program removes the majority of cost burden from the plan when physicians prescribe off -formulary, non -preferred products. Concurrent Drug Utilization Review Express ScriptsNalueRx 's Concurrent Drug Utilization Review System consists of a series of edits and analyses that are designed to identify potential problems with a given prescription prior to the prescription being filled. These edits/analyses take place at the time the prescription is given to the pharmacist, but before the pharmacist actually fills the prescription. In the Express ScriptsNalueRx on-line, real-time electronic point of sale claims management system, the pharmacist will key pertinent data on the prescription and the recipient. This information is transmitted on-line to Express ScriptsNalueRx 's main computer and merged with historical eligibility and pharmacy data on the client. The Express ScriptsNalueRx 's DUR program provides immediate feed -back to the pharmacist on up to 160 different edit fields. If there is a conflict regarding prescriptions, the pharmacist will receive an on-line message indicating that there is a problem associated with the prescriptions. Pharmacists are expected to intervene and discuss the message with the prescribing physician and/or the member and take the appropriate action. The pharmacist can report back to Express Scripts, on-line, indicating the action undertaken. Retrospective Drug Utilization Review Retrospective DUR involves the systematic accumulation and analysis of dispensed prescriptions for maintenance medications. The goal is not to influence patient care immediately but to identify dispensing, prescribing and usage patterns that may be improved through intervention. There are five levels of retrospective drug utilization review: ♦ Contract Compliance: Compares the dispensed drugs with the established formulary and monitors price. ♦ Fraud/Abuse Monitoring: Reports duplicate prescriptions, usage patterns of controlled substances, and reports the use of high-volume/high cost medications. ♦ Drug -Centered Screens: Monitors the therapeutic use of drugs where overuse or underuse can lead to moderate to severe consequences. 4 Express Scripts° Progressive Healthcare Management City of Fort Collins 7/27/98 66 ♦ Patient Drug Profiles: Identifies possible drug -induced illness or hospitalization, wrong dose of correct drug, correct dose of wrong drug for diagnosis, and overuse/underuse of maintenance medications. ♦ Regimen of Patients Evaluation: The diagnosis or disease -state data are linked to patient drug use profiles. There are 3 to 6 month follow-up reviews on the quality and quantity of prescriber's drug therapy and 6 to 12 month follow-up to determine if the identified problem(s) have been resolved. The data provided from Retrospective DUR can be effectively used by a pharmacist during academic detailing sessions to influence physician prescribing habits. At a suitable interval after such academic detailing, these same reports can be used to monitor the degree to which the physician in fact changed prescribing patterns to acceptable standards. At the member level, referral to a client's case management program provides an opportunity to intervene and correct the negative impact of these risk situations. 2. Please list the staff that performs the prescription drug utilization review and describe their roles in the process. What are their qualifications? The DUR management is performed by our Health Managment Services division of Express ScriptsNalueRx . Health Management Services provides the client with the tools to enhance healthcare delivery while controlling costs. The Health Management Services team includes doctors, nurses, researchers, analysts, pharmacists, and sociologists. Most of the staff has direct patient care experience and understands the elements of treating and managing disease. This team offers a unique perspective for analyzing and improving healthcare. The Health Management Services staff examines, analyzes, and communicates information to the healthcare provider so that the best decisions can be made concerning a member's health. The Health Management Services division is comprised of six distinctive areas: ♦ The Pharmacy Trade Relations department handles formulary policy and development, pull -through programs, and manufacturer contract negotiations. The Pharmacy Trade Relations department acts as a liaison between the medical community, the pharmaceutical industry, and Express Scripts. ♦ The Research/Reports department analyzes the utilization and cost experience of clients, simulates the financial impact of plan design changes, directs outcomes research activities, and performs capitation analysis. Express Scripts® Progressive Healthcare Management City of Fort Collins 7/27/98 67 ♦ The Scientific Affairs department is responsible for the development of educational pharmacy programs, marketing of clinical services and drug information services, and serves as a liaison to academic centers. The Scientific Affairs department includes Drug Information Services which provide clients with literature on new drug products that are in development. This service gives clients an opportunity to make formulary decisions based on both what is available today and what will be available in the future. Drug Information Services maintains a full -service medical library with Micro -Medics reference service and is on-line with two major university medical school libraries and the St. Louis College of Pharmacy. This department also offers reference publications, continuing medical education, monographing services, Internet medical reference services, and literature searches. ♦ The Clinical Pharmacy Services department is responsible for physician profiling and academic detailing. This includes on -site collegial one-on-one educational sessions with targeted physicians. This department also attends and directs client Pharmacy and Therapeutics Committee meetings. The Clinical Pharmacy Services department developed ExpressTherapeuticss` ' a proprietary on-line drug utilization system that targets inappropriate drug utilization and provides a quality improvement process. ♦ The Express Health Linesm program provides members with toll -free telephone access to registered nurse and pharmacist care counselors to address healthcare questions 24 hours per day, seven days per week. The care counselors role is to provide medical support and options to assist the member in making the most informed decision regarding their healthcare. Members who use the service become better educated about their health options. The Pharmacy and Therapeutics (P&T) Committee oversees all activities related to the development and management of the Express ScriptsNalueRx formulary. The P&T Committee maintains, updates, and modifies existing formularies as new products enter the market and other products change to an over-the-counter status. Health Management Services offers an integrated approach to address the healthcare cost challenges in today's market. Healthcare costs are interrelated, so how costs are managed in one area will affect costs in other areas. Therefore, Express ScriptsNalueRx has adopted an integrated approach to successfully control costs and reduce inappropriate utilization. Our inhouse staff of 23 pharmacists, some with advanced degrees, is lead by Michael E. Thomas, Pharm. D. Express Scripts® Progressive Healthcare Management City of Fort Collins 7127198 68