Humana Pharmacy Solutions Pinellas County Schools 2013 Plan

Humana Pharmacy Solutions: Pinellas County Schools 2013 Plan Benefits Understanding Your Pharmacy Benefits

Contents § Your pharmacy benefit Pages 3 -4 § For your safety Pages 5 -8 § Filling your prescriptions Pages 9 -15 § Maximizing your pharmacy benefits Pages 16 -17 § Humana web and mobile tools Pages 18 -25 § Questions to ask your doctor Pages 26 -27 2

Understanding your Rx 3 Plan § Your Rx 3 Plan assigns prescription drugs into three levels of coverage. Ø Level 1: generic drugs Ø Level 2: preferred brand-name drugs Ø Level 3: non-preferred brand-name drugs and specialty drugs Prescription Drug Level Prescription Deductible Wal-Mart or CVS Right. Source Mail Order Deductible only on Tiers 2 & 3 30 day supply 90 day supply Tier 1 N/A $15 copay $30 copay Tier 2 $250 per individual/$500 per family $35 copay $70 copay $60 copay $120 copay Tier 3 3

How levels are assigned § A committee of Humana pharmacists and doctors evaluate each drug after the U. S. Food and Drug Administration has approved them. This is also done once a year for maintenance. – § The committee looks at medical research and literature to decide how the drug compares to similar products on the market in such areas as: • Effectiveness • Safety • Side effects • Drug interactions • Cost This helps to ensure you get medicines that are safe, effective, and at an affordable cost. 4

For your safety- Prior Authorization § Certain medications require your doctor to ask for and receive approval before they are covered. – This is called a Prior Authorization (PA). § This process helps make sure you receive the right medication in the right dose for the right reason. § Prior Authorization helps keep you safe. § Medications requiring authorizations are: Typically expensive – Only appropriate for specific diseases – Require frequent monitoring – *See page 22 to find out how to verify if your medication requires a PA. 5

For your safety- Quantity Limits § A quantity limit is the maximum amount of medication you can receive for a certain price and for a set period of time, usually 30 days. § Quantity limits help you get the right dose for your condition and help make sure you're safe when you take your medicine. § Quantity limits are based on: FDA guidelines – Abuse potential – Cost/Waste – *See page 22 to find out how to verify if your medication has a quantity limit. 6

For your safety- Step Therapy § Step therapy (ST) is when you are required to try a generic, or lower-cost brand-name medicine, before your benefit will cover the higher-priced brand-name medicine. § Before moving to the higher-priced brand-name medicine, try a generic medicine first. *See page 22 to find out how to verify if your medication require Step Therapy (ST) or has a generic available. 7

Why Generics? § § Because they’re the same: § Dosage § Safety § Strength § Quality § Performance They save you money § They contain the same active ingredient as the brand-name drug but are usually 30 to 80 percent less than their brand name counterparts. 8

Filling your prescriptions § Always use a pharmacy that is in the Pinellas County Public Schools pharmacy network. Those pharmacies are Walmart, Sam’s Club, CVS, Right. Source and Right. Source Specialty. § Networks are groups of pharmacies that agree to give discounted prices to members of certain pharmacy plans. *Don’t forget to show your Humana member ID card! 9

Right. Source & Right. Source Specialty Humana's Mail Order and Specialty Pharmacies 10

Right. Source & Right. Source Specialty § Right. Source is Humana’s Mail-Order pharmacy. ‒ Right. Source fills prescriptions for maintenance medications. • § Maintenance medications are taken regularly and long-term for conditions such as: asthma, high cholesterol, and high blood. Right. Source Specialty is Humana’s Specialty pharmacy. – Right. Source Specialty fills prescriptions for specialty medications. • Specialty medications are used to treat chronic, complex illnesses and are typically highpriced injectable drugs. But can also include expensive tablets, capsules or inhaled medications. These are separate pharmacies that fill different types of prescriptions and operate out of different locations. – If you use both pharmacies, you’ll receive individual invoices and shipments will arrive separately. 11

Why Right. Source? It’s convenient Cost savings Safety Easy to use • There's no need to drive to the pharmacy. You can get up to a three-month supply delivered right to your door and make just four orders per year. • You only pay 2 copays for a 3 month supply of your maintenance prescription. • All new prescriptions are checked by 2 pharmacists. • Right. Source foil seals containers to provide safety and security. • You can convert your retail medications to Right. Source by visiting your claims page on My. Humana at www. My. Humana. com. 12

Your Right. Source experience § Right. Source receives the prescription order. Doctors can send new prescriptions by fax, phone, or electronically. – You can send new prescriptions by mail with an order form or visit your claims page on My. Humana to transfer an existing prescription. – § Right. Source technicians Check the Humana pharmacy benefits coverage – Add the profile to a secure database – Scan the order – Create a unique shipment number – § Doctor’s instructions and prescription orders are loaded into Right. Source computers. § A Right. Source pharmacist reviews the prescription order for accuracy and possible drug interactions. If there are concerns or questions, a Right. Source pharmacist contacts the doctor for clarification. 13

Your Right. Source experience § Approved orders go through the payment process. – If for some reason your benefit doesn’t cover the medication, a technician will review the rejected claim. – Right. Source will resolve the issue or return the written prescription with an explanation about why they couldn’t process it. § An automated system dispenses the medication and a Right. Source pharmacist makes sure the product matches the label before it’s sealed. § Right. Source mails the order to your home, along with an invoice, and all of the necessary medication information. 14

Right. Source Specialty § Right. Source Specialty pharmacists are available 24 hours a day, seven days a week to answer questions and listen to concerns. § Members receive a 30 -day supply delivered to their home or doctor’s office, along with any required administrative supplies such as needles or syringes. § Every new patient is contacted by a nurse. Nurses specialize in the patient’s condition and medications. – The patient’s condition is assessed and a follow-up outreach is determined. – Patients are provided with nurse contact information and may call as often as needed. – § Learn more online at Right. Source. Rx. com/Specialty 15

Maximizing your pharmacy benefits Choose Generics • Generic drugs contain the same active ingredients as the brandname drug. • Generic drugs undergo rigorous FDA review before they can be approved. • Generics may cost 30 - 80% less than brand-name drugs. Consider an over-thecounter (OTC) alternative Apply for a Prescription Drug Assistance Program • OTCs are available for many common conditions, including allergies, heartburn, pain management, and more. If currently treating these conditions with a prescription drug, consider switching to an OTC. • OTCs are cost-effective and convenient, often saving you the time of meeting with your doctor and the cost of your office visit. • Patient assistance programs are run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine. • Visit the Patient Assistance for Rx page located within the Rx Resources on Humana. com for more information. 16

Want cheaper or free medications? § Publix Not a network pharmacy, so no need to show your Humana card, but you can still get these medications for FREE Lisinopril (blood pressure medication) § Metformin (diabetes medication) § Certain Antibiotics such as: § § Amoxicillin § Walmart § $4 prescriptions: (on a 30 day supply) § Always show your Humana card at Walmart, and when you choose medications from this list your generic copay is only $4 instead of your regular $15 generic copay! For a full list of these medications please visit: http: //www. walmart. com/cp/PI-4 -Prescriptions/1078664 § Ampicillin § Cephalexin (capsules and suspension only) § Sulfamethoxazole/trimethoprim (SMZ-TMP) § Ciprofloxacin (excluding Ciprofloxacin XR) § Penicillin VK § Doxycycline Hyclate (capsules only) For more information including limitations please visit http: //www. publix. com/pharmacy/Free-Medications. do 17

Humana Web and Mobile Tools 18

24 - Hour online pharmacy resources What is My. Humana? It’s Humana’s secure website that gives you access to your information anytime you want it. If you haven’t registered for My. Humana: 1. Visit www. My. Humana. com 2. Have your Humana ID card handy 3. Go to Humana. com 4. Click “Register for My. Humana” 5. Follow the easy steps to register 19

My. Humana is Your Humana 20

Pharmacy locator § Select the Wal-Mart or CVS pharmacy locations based on address and/or zip code. § View pharmacy information (24 hour location, drive-thru, 90 days at retail, etc. ). 21

Drug pricing tool on My. Humana Locate drug level and copay amount. § Find generic or lower cost alternatives. § Please find the coverage information on your drug in the highlighted areas below. § 22

Pharmacy claims information 23

Switching to Right. Source is easy 24

My. Humana Mobile • You can: Determine if plan covers prescriptions – Find prices at Right. Source and retail pharmacies – Identify alternatives – Sign up for text message refill reminders – • Available in: Android Store – i. Tunes – Mobile device browser at m. humana. com – • Future enhancements: Medication adherence alerts – Biometric monitoring – Order Right. Source refills at the click of a button – 25

Questions to ask your doctor or pharmacist 26

Questions • How will this medication help me? • How long should I stay on this medicine? • Is there anything I shouldn’t take while I’m on this medication? • What side effects can I expect? • Is there a generic available? 27

Humana Pharmacy Solutions 28