MEDCO by Shibu Lawrence

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Tome su medicina

Ahorre dinero

Puede confiar en que los medicamentos genéricos aprobados por la FDA1 (Administración de Drogas y Alimentos) son tan seguros y efectivos como sus equivalentes de marca. Y los medicamentos genéricos pueden ayudarle a ahorrar hasta el 60 por ciento de sus gastos en efectivo.2

Actualmente se encuentran disponibles medicamentos genéricos de menor costo para el tratamiento de: Presión sanguínea elevada Colesterol alto Acidez gástrica y úlceras estomacales Insomnio Alergias Artritis Y muchas otras condiciones

Más del 60 por ciento de todas las recetas suministradas son para medicamentos genéricos.3

Pregunte a su médico si un medicamento genérico sería lo indicado para usted.

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1. Administración de Drogas y Alimentos de los EE. UU. 2. Basado en el libro de análisis comercial de Medco para reclamos procesados entre abril y junio de 2007. 3. New York Times, 21 de septiembre de 2007, “Helped by Generics, Inflation of Drug Costs Slows” (“Con la ayuda de los genéricos, la inflación de los costos de los medicamentos disminuye”). www.medco.com

PT909695

Se sentirá mejor

Y a la vez, pagará menos

Los medicamentos genéricos aprobados por la FDA1 contienen los mismos ingredientes activos, calidad, resistencia y pureza que sus equivalentes de marca. Y los medicamentos genéricos pueden ayudarle a ahorrar hasta el 60 por ciento de sus gastos en efectivo.2

Más del 60 por ciento de todas las recetas extendidas son para medicamentos genéricos,3 inclusive los utilizados para el tratamiento de: Presión sanguínea elevada Colesterol alto Acidez gástrica y úlceras estomacales Insomnio Alergias Artritis Y muchas otras condiciones

Pregunte a su médico si un medicamento genérico sería lo indicado para usted.

Variable Logo

PT909748

No need to shop around for low-cost generics. The Medco mail-order pharmacy

Medco has advanced the practice of

delivers savings and convenience.

pharmacy to help improve health and lower the total cost of care for our members.

supply * of more than 400 generic drugs for just $10 or less.†

A convenient 90-day

The Medco mail-order pharmacy delivers low-cost generics and more!

Providing you with lower-cost options to discuss with your doctor is just one way Medco helps you save.

Call 1 877 RxSaveNow (1 877 797-2836) to get started.

* The $10 price applies to a 90-day supply of each generic drug in the commonly prescribed dosages shown on the program drug list. If your prescription is written for a different days’ supply or quantity, your cost may vary. The medications and pricing on the program drug list are subject to change without notice, so visit www.medco.com/lowcostgenerics for the latest information. † If your mail-order co-payment or coinsurance for generics is less than $10, you’ll pay the lower amount. The coverage and pricing of certain medications are also subject to the specific terms of your plan.

or less for 90 days of 400+ generics*

Call 1 877 RxSaveNow (1 877 797-2836) to get started.

Medco delivers low-cost generics. For all of your long-term medications, the Medco mail-order pharmacy is your best source for savings and convenience. More than 400 generic medications in a wide range of therapeutic categories are available for $10 or less for a 90-day supply.

Pay less. Get more. Low-cost generics are available through many retailers, but with your prescription drug and Medco benefit you have unique access to low-cost generics and more.

Access to private counseling

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Arthritis/Pain

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Asthma/Respiratory

Medco pharmacists are on call to offer advice and answer questions regarding your benefit and your medications. Call us when it’s convenient for you.

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Blood Pressure/Heart Health

Specialist pharmacists

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Cholesterol-Lowering

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Diabetes

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Cold and Allergy Therapy

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Heartburn/Ulcers

Medco specialist pharmacists are specially trained in the medications prescribed for chronic conditions. They are available for a private medication checkup, offering guidance on administering your medication, managing side effects, and more.

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Mental Health

Comprehensive safety checks

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Skin Conditions

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Vitamins and Electrolytes

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Women’s Health

Medco conducts safety checks based on all of your medication records on file. Our safety system can check your prescription for potential drug interactions and other possible medication problems.

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And More

Security and convenience

To see if your generic medications are available for $10 or less, visit www.medco.com/lowcostgenerics or call 1 877 RxSaveNow (1 877 797-2836) and speak with Member Services today!

By visiting www.medco.com or calling Member Services, you can quickly and securely request timely refill reminders, order prescription refills, check your order status, and so much more! Counseling and support, refill reminders, quick turnaround, free delivery — that’s Medco.

Why wait? Sign up and start saving. To fill your prescriptions through the Medco mail-order pharmacy simply call 1 877 RxSaveNow (1 877 797-2836), anytime day or night,‡ and we’ll contact your doctor for you. It’s that easy!

OR If you already have a 90-day prescription from your doctor: ■

Log on to www.medco.com.

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Go to “Forms & cards” page to download a mail-order form.

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Complete the form and mail to Medco with your prescription.

Once Medco receives your order, prescriptions will be delivered to you within 10 days§. And as always, free standard shipping is included. ‡

Member Services is available 24 hours a day, 7 days a week, except Thanksgiving and Christmas. Member Services is available in English and other languages. TTY/TDD users should call 1 800 716-3231. § Call 1 877 RxSaveNow (1 877 797-2836) for estimated delivery time.

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Using the Medco Generics Strategy Guide and Generics Awareness Campaign Frequently Asked Questions

the e t o Prom eric Gen nity tu Opporore Sc (GOS)

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Using the Medco Generics Strategy Guide

TABLE OF CONTENTS Generics Strategy Guide ........................................................................................................2 |1| What is the Generics Strategy Guide? ........................................................................................................2 |2| Why was the Generics Strategy Guide developed? ..................................................................................2 |3| What is the Generic Opportunity Score (GOS) and how does it work with the Generics Strategy Guide?................................................................................................................................................2 |4| How do I use the Generics Strategy Guide? ................................................................................................3 |5| How is the Generics Strategy Guide organized? ........................................................................................3 |6| What is the difference between the standard version of the Generics Strategy Guide and the condensed version? Why are there two versions? ....................................................................4 |7| How do I order copies of the Generics Strategy Guide? Is there a charge? ..........................................4 |8| When I receive a Generics Strategy Guide for my client, will it contain the client-specific GOS report? Can I send it directly to my client without further preparation? ..........4 |9| Where do I obtain pertinent client information to prepare the Generics Strategy Guide?................5 |10| After I receive my clientâ&#x20AC;&#x2122;s Generics Performance Assessment, what are my next steps? ..................5 |11| Where can I find more information about the Generics Strategy Guide? ............................................6 |12| May I expect follow-up or more generics sales materials in the future? ..............................................6

The Generics Awareness Campaign ......................................................................................7 |1| What is the Generics Awareness Campaign?..............................................................................................7 |2| How should my clients use these materials? ............................................................................................8 |3| How may I order Generics Awareness Campaign materials for my clients? ........................................8 |4| Can the Generics Awareness Campaign materials be co-branded?........................................................8 |5| Is there a charge for Generics Awareness Campaign materials? ............................................................8

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Using the Medco Generics Strategy Guide

GENERICS STRATEGY GUIDE:

|1| What is the Generics Strategy Guide? > The Generics Strategy Guide (GSG) is the cornerstone of Medco’s B2B Generics Marketing Strategy. The guide is a visible demonstration of Medco’s commitment to helping its clients drive costeffective and clinically appropriate generics utilization. It is also a useful tool and reference to educate clients about how to improve their own generic strategies. > The GSG also highlights the Generic Opportunity Score, Medco’s patent pending metric that identifies a client’s unique generic opportunities. > The GSG is intended to be presented by account teams to their clients and to help account teams present recommendations to clients for improving their generics utilization and performance. > As a reference tool for clients, the GSG contains valuable information and insights about creating an effective generics strategy.

|2| Why was the Generics Strategy Guide developed? > The GSG was created to make it easier for account teams to discuss generic strategies with their clients and to promote plan designs and programs that will increase cost-effective generics utilization.

|3| What is the Generic Opportunity Score (GOS) and how does it work with the Generics Strategy Guide?

> The Generic Opportunity Score (GOS) is a new generics performance metric developed by Medco to reveal to plans their total opportunity for using generics, both generic equivalents and generics alternatives. > GOS allows: ■

A personalized assessment of a plan’s current generics performance and potential generic utilization

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Performance and opportunity to tie to total potential savings

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Prioritization of high-value opportunities by therapeutic class

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Tailored plan design solutions based on value assessment

> GOS is presented in Section 1 of the GSG as the centerpiece of assessing a plan’s current performance, leading into the account team’s assessment of and recommendations for changes to a plan’s generics strategy.

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Using the Medco Generics Strategy Guide

|4| How do I use the Generics Strategy Guide? > The GSG should be used by account teams to: 1) present a client’s current generic performance and opportunities, and then, 2) assist the client in understanding various plan design and program options that may be used to achieve the client’s strategy goals. > Prior to scheduling a meeting with a client, gather all the pertinent information about your client’s current generics performance, particularly with regard to its plan design, program enrollment, and performance metrics. > Have your Financial Analyst run a Generics Performance Assessment. Then use the resulting information to develop recommendations, and complete the guide before presenting it to your client. Learn more about presenting the Generics Strategy Guide through the elearning module available on ASPEN/LMS.

|5| How is the Generics Strategy Guide organized? The GSG is divided into three sections: Section 1: Shape Your Customized Generics Strategy provides materials that you can use to create customized generics strategies with your clients. It includes a section for the insertion of a Generics Performance Assessment, containing key performance metrics such as Generic Opportunity Score (GOS), Generic Dispensing Rate (GDR), and Generic Substitution Rate (GSR). It also includes items that account teams should complete before presenting the guide to their clients, including a Plan Design Checklist and Programs and Communications Checklist. It also provides samples of many of the communication materials included in Generics Advantage. Section 2: Fundamentals for Building an Effective Generics Strategy is a generics strategy primer that will help fill in any gaps in your client’s knowledge about generics. It includes sections on Key Definitions, Assessing the Opportunity (i.e., generics metrics, utilization, pipeline, life cycle), Plan Design and Programs, and Communications. Depending upon the level of your client’s knowledge of generics, you can use this section in its entirety, choose specific topics to address, or leave the GSG for the client as a background reference. Section 3: Supplemental Resources and Case Studies provides additional resources and case studies that promote “best practices” in generic strategies. It also includes Generics Awareness Campaign materials, a set of ready-made communication materials for educating members about the safety, efficacy, and costeffectiveness of generics—including posters, tent cards, pamphlets, newsletter and email content, and web banners. More information on the Generics Awareness Campaign is on pages 7-8.

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Using the Medco Generics Strategy Guide

|6| What is the difference between the standard version of the Generics Strategy Guide and the condensed version? Why are there two versions?

> The two versions of the GSG provide account teams with greater flexibility in how they present generic strategies to clients. > The standard version is the large binder version with the three major sections. Comprehensive, it is intended to be presented to a client after certain client-specific information has been included (see questions 7-8). > The condensed version has excerpts of the major sections found in the standard version. It does not necessarily have to be customized before presenting or sending it to a client. More detail on the two versions is available in eCatalogue or the online elearning module on ASPEN/LMS. Both versions may be ordered at http://medco.genericsaware.com.

|7| How do I order copies of the Generics Strategy Guide? Is there a charge? To order additional copies in preparation for client meetings, please log on to http://medco.generics aware.com. There is no charge to account teams for Generics Strategy Guides.

|8| When I receive a Generics Strategy Guide for my client, will it contain the client-specific GOS report? Can I send it directly to my client without further preparation?

No, the Generics Strategy Guide does not come customized for your client. You need to prepare it by doing the following before giving it to your client: > Create a customized Generics Strategy Guide cover page (available on the Internal Client Support and Training Materials CD or OnMessage). > Obtain a Generics Performance Assessment for your client with the client’s Generic Opportunity Score (available from the account’s financial analyst—see the next question) and include as part of the Assess Your Performance tab in Section 1 of the Guide. > Complete the Plan Design Checklist and Programs & Communications Checklist in Section 1. These are the client-specific recommendations for improving generics strategy.

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Using the Medco Generics Strategy Guide

|9| Where do I obtain pertinent client information to prepare the Generics Strategy Guide? > For a client’s Generics Performance Assessment, contact the financial analyst (FA) assigned to your account. This report will provide you with your client’s GOS, GDR, and GSR and with charts showing generics-saving opportunities. > If you have questions about which programs your client is enrolled in, contact individual program owners. For Generics Advantage enrollment information, email Medco Generics Programs.

|10| After I receive my client’s Generics Performance Assessment, what are my next steps? > Based on the results of the Generics Performance Assessment (including GOS) and other particulars known about the client (e.g., plan design, program enrollment, tolerance for member disruption), account teams should develop recommendations for how clients can improve their generics strategy. > Complete the Plan Design Checklist in Section 1. > Complete the Programs and Communications Checklist in Section 1. > Review Sections 2 and 3. They are filled with useful background information and case studies but are not customized. You may use these sections as necessary. > Review the Generics Awareness Campaign in Section 3, a ready-made set of materials clients can use to promote the safety, effectiveness, and savings associated with using generics. Sample materials are contained in a pocket in Section 3.

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|11| Where can I find more information about the Generics Strategy Guide? > An elearning module on the Generics Strategy Guide is available through LMS. > In addition, more information on the guide and how it can be used can be found by visiting the Generics Strategy and Programs section on OnMessage and in eCatalogue. There are many resources to support your generics strategy discussion with clients, including a link to the Generics Strategy webcast of March 5, 2008. > Other resources to help you present the GSG are included on the Generic Strategy Guide Internal Client Support and Training Materials CD provided with the initial distribution of the Guide, and are also available on OnMessage. These resources include the following: ■

Client contact letters and emails

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Generics Strategy Guide client presentation

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Customized Generics Strategy Guide client cover

If you have additional questions, please email Medco Generics Programs.

|12| May I expect follow-up or more generics sales materials in the future? Yes. We will update and expand the Generics Strategy Guide as necessary to provide additional information regarding generics programs, additional case studies, pipeline information, etc. Please refer to eCatalogue and On Message for the latest materials. > We look forward to receiving your feedback about the GSG so that we can continue to improve the materials. > If you have ideas for additional materials or want to provide feedback, please email Medco Generics Programs.

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Using the Medco Generics Strategy Guide

THE GENERICS AWARENESS CAMPAIGN:

|1| What is the Generics Awareness Campaign? The Generics Awareness Campaign is an integrated set of ready-made materials designed to help your clients communicate the advantages of generics to their members. The campaign includes: ■

Posters

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Payroll stuffer

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Tent card

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Pamphlets

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Generics request card

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Newsletter article content

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Internet campaign (e-mail and banner ads)

Materials are available in both English and Spanish, and can be co-branded.

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|2| How should my clients use these materials? These materials may be used in a variety of ways, including at health fairs and benefit fairs, as HR resources, as postings in gathering places, etc. Although each piece can be effective on its own, the various pieces might have a bigger impact if used in an organized campaign. A suggested implementation calendar is included in the Generics Awareness Campaign section of the Generics Strategy Guide.

|3| How may I order Generics Awareness Campaign materials for my clients? > The Generics Strategy Guide (both standard and condensed versions) includes a Generics Awareness Campaign CD that contains PDF samples of the campaign elements, along with word files for newsletter and e-mail article content. Section III of the standard version also includes samples of Generics Awareness Campaign materials. All other materials must be ordered through the clients’ account team. > To order Generics Awareness Campaign materials for a client, visit http://medco.genericsaware.com.

|4| Can the Generics Awareness Campaign materials be co-branded? Yes. These materials can be customized to include a client’s logo. Visit http://medco.genericsaware.com to co-brand materials.

|5| Is there a charge for Generics Awareness Campaign materials? Yes. Costs for materials (including shipping and handling) will be charged to the account team’s business unit number specified when registering on the website. Account teams should check client contracts as to whether such charges may be offset by a client’s communications allowance. Alternatively, account teams may bill the client for the cost of Generics Awareness Campaign materials. Co-branded and Spanish materials are more expensive than standard English versions. Costs are available at http://medco.genericsaware.com.

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Spring 2008 â&#x20AC;˘ Volume 1 â&#x20AC;˘ Edition 1

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Summer 2008

Placement area for story header May fall on two or more lines in length Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Vivamus est. Suspendisse sodales neque eu est. Proin lobortis nulla. Vivamus rhoncus vehicula dolor. Integer diam sem, facilisis vitae, luctus vel, congue eu, mauris. Ut feugiat sollicitudin massa. Vestibulum vulputate nulla in ipsum. Vestibulum semper neque eget leo. Vestibulum sagittis. Phasellus molestie fermentum lorem. In sed lorem non nisi fermentum accumsan. Donec laoreet erat in eros. Proin eu tellus vitae justo laoreet ornare. Nullam vel ipsum sed risus congue aliquam. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Ut tincidunt vehicula tellus. Nulla ipsum. Mauris fermentum velit eu quam. Duis nec Morbi porttitor eleifend erat. Ut pretium nulla ut leo. Cras ali quet vulputate massa. Cras bibendum, elit tempor volutpat gravida, eros purus egestas lacus, eget pulvinar leo enim vitae est. Vivamus bibendum interdum mi. Curabitur sollicitudin, diam et auctor or. â&#x2013;

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PharmacyWise

2008

5 Easy Ways to Lower Your Prescription Drug Costs 1.Consider Using Generic Drugs Generic drugs approved by the U.S. Food and Drug Administration (FDA) are equivalent to their brandname counterparts in quality, strength, purity and dosage. FDAapproved generic drugs can be expected to work as well as brandname drugs because they contain the same active ingredients. They can also provide significant cost savings. Talk to your doctor about generic drugs that are appropriate for you.

2. Choose Over-the-Counter Medications

Some conditions can be treated with less-expensive over-thecounter (OTC) medications. Many prescription drugs have a similar OTC version. For example, an OTC allergy medication, such as Claritin®, Alavert®, Zyrtec® OTC or loratadine, may be just as effective for your condition as an expensive prescription drug. Also, through a special State Health Plan program,

you can receive Prilosec OTC ®, which helps control heartburn and other symptoms, for a $5 copay. To receive Prilosec OTC for a $5 copay, you must have a prescription from your provider. Talk to your doctor about OTC drugs that are appropriate for you

“I was taking Coreg® for my heart, which cost me $40 per month. After reviewing generic alternatives on My Rx Choices, I worked with my doctor to try a generic medicine. It worked great, and I am now paying only $10 a month and saving $360 a year!” – State Health Plan Member

3. Understand Your Coverage You may find ways to save money by simply increasing your understanding of how your health plan works. Visit My Rx Choices® online at www.shpnc.org/ pharmacy-savings.html. My Rx Choices gives you a personalized and confidential comparison of the cost of medications you take on an ongoing basis. You may also call Medco Member Services at 1-800-336-5933.

4. Begin With Lifestyle Changes Whether you have heartburn, high blood pressure, high cholesterol or another condition, ask your doctor about lifestyle changes that you can make to reduce your symptoms and improve your overall health. If your primary insurance is through the State Health Plan, you may call an NC HealthSmart * Health Coach at 1-800-817-7044.

5. Communicate With Your Doctor Take your pocket-size Preferred Drug List with you to your doctor visits to discuss the most appropriate medication at the lowest possible cost. You may also speak to a pharmacist by calling Medco Member Services at 1-800-336-5933. * NC HealthSmart services are available to members whose primary health insurance is through the North Carolina State Health Plan and who are not on COBRA.

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NC HealthSmart You can call an NC HealthSmart Health Coach for no cost at 1-800-817-7044, 24 hours a day, 7 days a week. These specially trained health care professionals are available to speak to you about a variety of conditions. Find more information at www.shpnc.org/nchealthsmart.html. The Personal Health Portal, powered by WebMD, offers Condition Centers, a Symptom Checker and a Health Risk Assessment. All are important tools that can help you manage your health.

Want to Quit Smoking?

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Specialty Pharmacy Services Do you have a chronic condition — such as rheumatoid arthritis, multiple sclerosis or hepatitis — that requires you to take an expensive injectible medication on a regular basis?

“Accredo has helped me tremendously since I was diagnosed with MS. My patientcare representative is very helpful and makes sure I have all of the drug information and supplies I need.”

If so, Medco’s specialty pharmacy, Accredo Health Group, can provide you with a variety of services that makes obtaining and using your medications more convenient. For example, Accredo provides: • Access to nurses who are trained in specialty medications • A pharmacist available 24 hours a day, 7 days a week to answer questions about your medications • Free expedited shipping • Free supplies that you need to take your medication (needles, syringes) • Refill reminders

To learn more about the specialty pharmacy services, call Medco Member Services at 1-800-803-2523. A list of available medications can be found online at www.shpnc.org/ specialty-care.html. Accredo Health Group, Inc., is a subsidiary of Medco Health Solutions, Inc.

The Learning Zone: Help From Medco Member Services Have you ever gone to the pharmacy to fill a prescription, only to hear: “Your insurance does not cover your medication?” Did you know that within 20 minutes of smoking your last cigarette, your heart rate drops and your body begins a series of other beneficial changes that continue for years? If you’re ready to quit using tobacco, the State Health Plan can help you right now. Receive OTC nicotine patches free! Find out how online at www.shpnc.org/wellness.html or call 1-800-QUIT NOW and say you’re a State Health Plan member.

This happened to Mary one morning when her local pharmacist said that her prescription was rejected in the system. While waiting in the pharmacy for a resolution, Mary called Medco Member Services at 1-800-336-5933 for help. Thomas, a Medco Member Services representative, checked Mary’s account and discovered that the pharmacist had accidentally entered the wrong date of birth into the system. Thomas advised Mary to let him speak with the pharmacist to give the correct date of birth. Her local pharmacist was able to run the prescription through the system successfully. Mary was delighted to get her prescription that morning! If you have a similar experience or for assistance on a wide range of concerns, call Medco Member Services while at the pharmacy. Medco Member Services will give you all the information you need to fill your prescription.

Members eligible for NC HealthSmart services are members whose primary health insurance is through the North Carolina State Health Plan and who are not on COBRA. Federal law prohibits the North Carolina State Health Plan from using your personal health information to discriminate against you in any way or from giving this information to your employing agency/school or other unauthorized third party, unless required by law.

PharmacyWise

GOS Message Platform

November 28, 2007

Prepared By: The Solutions Group Inc. for Medco Health Solutions, Inc.

ÂŠ 2007 The Solutions Group, Inc. The information contained in this document is confidential and proprietary to The Solutions Group and Medco Health Solutions, Inc.

General Overview/Facts Message Plank

Message

Support Points

Positioning Statement

Medco’s Generic Opportunity Score (GOS) is an innovative and proprietary diagnostic tool that provides the most actionable measure of a client’s total generics conversion opportunity.

• Medco has developed a systematic approach to identify viable options for increased generic equivalents and alternatives. • GOS takes into account the clinical appropriateness of generics interchange as well as financial performance. • GOS enables clients to make informed decisions regarding plan design changes, formulary strategies and generic education programs.

Value Proposition

Medco’s GOS is a proprietary diagnostic tool that gives its clients a more comprehensive view into their total generics conversion opportunity than is possible today using only GDR and GSR.

Talking Points

“Essentially, GOS reflects how much of the opportunity to use generics is actually being achieved within a client’s member base.” “GOS provides clients with a measure that is focused on 1) how well they are using generics relative to their total generics opportunity, and 2) the remaining opportunity within their member base to increase appropriate generic utilization through conversions from brand medications to generics.” “Medco will provide clients with their own GOS score, peer group GOS comparisons and develop customized GOS reports that will show clients how well they have captured their generics opportunity to date, and what remaining opportunity exists based on their prescription claims experience and offer an estimate of potential savings associated with programs.”

• Medco analysis of client prescription databases captures current performance of generics utilization for both equivalents & clinically appropriate alternatives. • Medco account teams show clients their current generics performance, their current GOS score, and approaches to improving GOS scores and potential savings through plan design, formulary and generic education programs. • While GDR and GSR provide a “basic” level of generics performance, they do not offer insight into any remaining opportunities to convert qualified brand claims to generics.

General Overview/Facts continued

Message Plank

Message

Support Points

Definition of GOS

GOS is defined as the success rate of generic dispensing when a clinically-appropriate generic equivalent or alternative is available. The GOS formula is expressed as: Number of Generics Claims Dispensed Total number of generic claims + brand claims with a generic equivalent or generic alternative

• GOS is an objective measure that is calculated by using clinically-based criteria and current client data from Medco clients.

What it is

GOS is a new generics performance metric, based on proprietary clinically-based modeling created by Medco Health Solutions, Inc. Total generic conversion opportunity falls into two categories: generic equivalents and generic alternatives. Conversion to a generic alternative requires that a doctor evaluate the appropriateness of the generic therapy and write a new prescription for the patient.

• Generic conversion opportunities are clearly defined to include equivalents and/or alternatives • And excludes prescription volume that does not have a clinically appropriate generic conversion opportunity. • FDA-approved generic equivalents have the same active ingredients in the same strength, purity and dosage form of their brand name counter parts. In most cases there does not need to be a new prescription to substitute the generic. • A generic alternative contains different active ingredients but usually provides a similar effect when given in place of a brand-name medication within the same therapeutic class.

General Overview/Facts continued

Message Plank Why GOS is important and different

Message

Support Points

GOS goes beyond the industry’s current performance metrics of generics (GDR/GSR) and shows Medco’s clients what remaining opportunity exists within brand claims to convert those claims to generics. “With GOS, Medco clients now have a more comprehensive view of their generics performance than what was previously possible with GDR and GSR. Our clients, armed with the knowledge and insight of the opportunities to convert brand claims to generics, now can enhance their generic strategies to improve their total generics conversion opportunity.”

• While GDR and GSR provide a “basic” level of generics performance, they do not offer insight into any remaining opportunities to convert qualified brand claims to generics. GDR • GDR measures generic dispensing as a proportion of total prescription dispensing. • GDR does not clearly indicate how high GDR could go with greater use of generic equivalents and alternatives because there is always a certain proportion of Rx’s dispensed as single-source brands for which no generic would be an appropriate alternative therapy. • GOS overcomes this shortcoming by measuring generic dispensing in a given time period relative only to total dispensing that has a generic equivalent or alternative conversion option available. GSR • GSR measures generic dispensing as a proportion of all multi-source brands plus generics). • GSR rates have reached significant saturation levels (typically in the 90-95% range with mail order programs). This leaves minimal additional generic substitution opportunities for clients relative to that universe. • GOS overcomes these limitations by including generic alternatives as well as equivalents.

General Overview/Facts continued

Message Plank Systematic Approach to Calculate GOS Scores

Message

Support Points

Step 1 – Identify Criteria and Process To determine a GOS score, Rx claims data is summarized for a given period of time and then classified according to four distinct categories: 1. Generic claims 2. Multi-source brand claims 3. Single-source brand claims that have a generic alternative 4. Single-source brand claims without a generic alternative A Generics Alternative Database was created to establish which single-source brand claims had a generic alternative or not (categories 3 and 4). It is a comprehensive listing of identified generically-available therapeutic alternatives for commonly prescribed brandname drugs.

• Categories 1 and 2 are counted according to standard claim coding practices. • The Generics Alternative Database: Defines: Which single-source brand claims have clinically-appropriate generic conversion opportunities, and For those opportunities, an expected rate of conversion to the generic, based on certain clinical and financial considerations. These were based on a mutual agreement of the member and physician making the choice. Composition: 600 single-source brand name drugs Approximately 1,400 available dosage strengths and dosage forms. Represents 95-98% of all branded Rx drug claims volume.

Step 2 – Build-out of the Generics Alternative Database Define the term “generically available alternative” 1. A defined population of single-source brand name drugs with clinically appropriate generic therapeutic alternatives. 2. A definition of qualifying generic alternatives comprised of: a. Generic drugs within the same or closely related pharmacologic and/or chemical category as the index drug. b. Generic drugs in different pharmacologic or chemical classes that shared the same or similar labeled indications, dosage forms, safety and efficacy and relative potency based on available evidence c. Generic drugs that could serve as alternatives to brand name drugs with respect to the drug formularies that have been developed over the past several years.

• Medco’s independent Pharmacy & Therapeutics Committee (P&T) recommendations were incorporated into all criteria and decisions. • The database is the outcome of a thorough assessment process that resulted in an allocation list of the entire 1,400 drugs and dosage strengths for either “no generic alternatives” or the “alternatives identified at the dosage strength and dosage form level.”

General Overview/Facts continued

Message Plank Systematic Approach to Calculate GOS Scores

Message

Support Points

Step 3 – Definition of brand-generic pairs Step 3.1: Identification of drugs without generically available alternatives. 1. Protein-based biologics – the FDA does not yet have a process for approving generic equivalents 2. Non-protein based drugs that belong to unique pharmacologic and chemical classes. Step 3.2: Assignment of the generically available drug(s) 1. If more than one drug is available, the drug with the greater market share or prevalence of use is selected. 2. Dosage strength of the generic alternative are based on a range of approved daily dosages for the index drug and its generic alternative with interpolation where needed. 3. Assignments are made mostly for costing purposes. 4. The process is continued until all drugs are assigned as alternatives or no alternative. Step 4: Determination of expected conversion rates to the alternatives. The likelihood of a true clinical need for the brand drug is the principle determinant for the estimates of conversion rates instead of a patient’s personal preference for the brand. We use a weighted sliding scale for projecting conversion rates. For illustrative purposes, an approximate conversion table could look like: 1. 90-95%: brands and A-rated generics 2. 80-90%: generic alternative is in the same pharmacologic class of drugs as the brand 3. 50-60%: similar pharmacologic classes 4. 20-25%: condition requires the use of several drugs at once

• We control for personal preference by using a scenario of the patient having to pay for the entire cost of the brand drug or choosing the generic alternative.

â&#x201E;˘

Generics Strategy Guide

Generics Strategy Guide Shape your strategy, improve your performance

Your ic Gener nity tu Oppor re* Sco d! e Enclos

*U.S. Patent pending.

Fact sheet

Generics Advantage Program A suite of essential generics communications that will save you money

n the next five years, over $63 billion in brand-name medications will come off patent. To benefit from this great savings opportunity, plan sponsors will need a communications program that encourages members and their physicians to use clinically appropriate generic medications. While plan design plays a key role in influencing members to choose generics, additional education, information, and incentive programs are needed to help members understand their opportunities and achieve optimal savings. That is why Medco offers the Generics Advantage Program, a coordinated and targeted set of communications that help members understand their generic opportunities and potential savings.

The Generics Advantage Program promotes generic equivalents and generic alternatives Generics Advantage is designed to encourage the appropriate use of generic medications and, therefore, increase savings through higher generics utilization. Generics Advantage communications address both types of generic utilization opportunities — generic equivalents and generic alternatives. Generic equivalents are FDA-approved medications that contain the same active ingredients as the original brand-name medication and are identical in strength and dosage form. Generic alternatives contain different active ingredients but usually provide a similar effect when given in place of a brand-name medication from the same therapeutic class. Once a

generic equivalent is in wide use, most of a plan sponsor’s savings opportunity comes from increased use of generic alternatives. Different types of communications are needed to address generic-equivalent and generic-alternative opportunities. Notifying members of the availability of a generic equivalent can help speed up the transition to using the generic, particularly for members with prescriptions that can be filled only with the brand-name medication. Switching to a generic alternative, however, requires a new prescription and calls for greater engagement and more proactive effort on the part of the member and physician. This requires special communications with more in-depth information and a more educational tone. Medco’s Generics Advantage Program provides a full suite of targeted communications to encourage the use of both generic equivalents and generic alternatives at virtually every appropriate opportunity.

Generics Advantage offers education and incentives to encourage members to use generics To substantially increase generic substitution rates, targeted member communications must educate members about the safety and efficacy of generic medications, as well as inform them about their specific savings opportunities. Strong financial incentives to choose generics often boost the impact of these programs.

The following table provides an overview of the Generic Advantage Program’s suite of communications. These materials are developed to work together to get the most out of every generic opportunity — before, during, and after a brand-name medication comes off patent. The co-payment waiver communications provide additional incentives for members to choose generics, but may not be available for some clients. Please speak to your account team about these communications and your specific savings opportunities.

Generics Advantage Program is a key component of broader engagement strategies Generics Advantage is an ideal complement to other Medco member and physician engagement programs that also encourage the use of generic medications. These include: • My Rx Choices™: Shows members all of the savings opportunities available to them by choosing generics, preferred brands, and the mail-order channel, Medco By Mail. Members can request that a Medco pharmacist contact their physician for any needed prescriptions. • Clinical programs: Programs such as step therapy allow clients to pinpoint areas of great savings potential and institute strong measures to encourage use of the more cost-effective medication. • Preferred channel communications: Medco By Mail mail-order pharmacies consistently achieve faster and greater generic

Fact sheet

substitution rates than retail pharmacies, particularly when major brand-name medications come off patent. Encouraging use of the mail channel provides a potential boost to generic utilization rates. • Physician education: Medco helps physicians stay current on generic

Communication

availability by providing updates on new generics and reports on generic availability in specific therapeutic classes. Physicians are also informed about specific opportunities to help their patients save by considering the financial as well as clinical implications of their prescribing decisions.

Contact your account team to discuss how the Generics Advantage Program or any of Medco’s member and physician engagement programs can help you expand your efforts to take advantage of your potential generics savings opportunities.

Generics Advantage Program: Suite of communications Educational communications Description Timing

2008 Calendar

1. Generics launch notification

Notifies members who have a savings opportunity created by a new generic equivalent for a specific brand-name medication. Patients are contacted via mailings and Web messaging. Top prescribing physicians are also notified via fax.

One-time mailing targeted within 2 weeks of generic availability

2008 Target off-patent drugs: • Fosamax® (February) • Risperdal® (July) • Depakote® (September) • Paxil CR® (October)

2. Multisource brand notification

Mailings to members on multisource brands informing them that they can save money by switching to available generic medications.

Quarterly mailings (maximum of 2 letters per patient in a calendar year)

3. Therapy-specific generics education

Mailings to all members taking brand-name medications in a therapeutic class where generics are available. Informs them about generic options and includes recommendations from Consumer Reports Best Buy Drugs.

4 to 6 mailings (one time each) based on therapeutic chapters

2008 Therapy chapters may include: calcium channel blockers, high cholesterol therapy (HMGs), overactive bladder, osteoporosis therapy, prostate therapy, and sleep aids.

4. Preferred Drug Management

Communicates to all members taking nonpreferred medications in a therapeutic class, to let them know the available preferred medication options, including generics.

4 to 6 mailings (one time each) based on therapeutic chapters

The chapters targeted in 2008 could include: proton pump inhibitors (PPIs), osteoporosis therapy, sleep aids, hypertension, erectile dysfunction, and depression therapies.

Incentive communications 5. Off-patent migration co-payment waivers

Offers co-payment waivers (up to a defined dollar amount) to members taking medications that are expected to go off patent within 6 months or are recent first-time generics. Medco-funded waivers are available for members who move their prescriptions to Medco By Mail.

Quarterly mailings (maximum of 2 letters per patient in a calendar year)

6. Brand-to-generic co-payment waivers

Targets members who have opportunities to convert their brand-name prescriptions to generic prescriptions and/or to obtain generics from mail order or retail. (Funding depends on waiver targets.)

Depends on timing of clientspecific waiver offering

Note: Each mailing is targeted and there is coordination between mailings to prevent overlap and mailings to the same member. Additionally, individual initiatives are subject to change based on how they fit in the overall generics strategy. Consumer Reports Best Buy DrugsTM is a public education project of Consumers Union. Consumers Union and Medco have a non exclusive arrangement that allows Medco to provide this independently produced information.

<Month> 2007

™

About Medco Career opportunities Integrated benefit plan Our locations

Working for Visit the company website www.medco.com

Medco, the leading pharmacy benefit manager

About Medco One of the nation’s leading prescription drug benefit managers (PBM), Medco manages and administers prescription drug programs for both private- and public-sector clients. We service approximately 60 million patients from our corporate headquarters, call centers, and pharmacy sites. Both a pioneer and leader in healthcare services, Medco:

Our locations Franklin Lakes, NJ (corporate headquarters) Cincinnati, OH

Pittsburgh, PA

Columbus, OH

Spokane,WA

Dublin, OH

Tampa, FL (2)

Las Vegas, NV (2)

Willingboro, NJ

Irving/Fort Worth, TX (2)

Richmond, VA

• Owns and operates 14 state-of-the-art Medco By Mail pharmacies (including call center pharmacies) • Employs more than 15,000 people nationwide • Services one third of the Fortune 500 companies • Trades on the NYSE under the symbol MHS

Career opportunities If you're seeking an environment that encourages growth and utilizes your training, education, and experience, consider Medco. We’re seeking talented and creative individuals to contribute at all levels of the organization. A dynamic, fast-paced organization, Medco is looking for talented individuals to implement its vision of controlling healthcare costs while maintaining quality patient care. If you share this vision, Medco may be the right place for you.

Integrated benefit plan

As a concerned member of the business community, Medco strives to: • Provide a work environment that attracts the best people to our organization • Provide our employees with an atmosphere that encourages development and advancement • Recognize that long-term growth and operating efficiency depends on the skills and talents of its employees. • Fulfill our social responsibility to provide equal employment opportunities to all qualified applicants • Ensure company compliance with federal, state, and local laws

Working for a large corporation means access to enhanced quality-of-life benefits, including: • Competitive salary • Comprehensive benefits including; health, dental, prescription, and vision plans • Broad-based eligibility for an annual bonus and long-term incentive awards • Employee stock purchase plan (ESPP) • Tuition reimbursement • Cash balance pension plan • Flexible spending accounts • Life and Accident Insurance • Additional special offers and services

For more information and access to all our open positions, visit our website at www.medco.com.

â&#x201E;˘

Take Your Medicine | Keep Your Money

Lower-cost generic medications 4 are now available to treat:

Arthritis, Insomnia High blood pressure Allergies High cholesterol Stomach ulcers And many other conditions

Ask your doctor if a generic drug would work for you. You could save up to 60% of your out-of-pocket costs.

™

You’ll feel better about paying less.

Generic medications are safe and effective treatment for: • Arthritis • High blood pressure • High cholesterol • Sleeplessness • Allergies • Stomach Ulcers • And many other Conditions

The U.S. Food and Drug Administration has approved generics to be the same as brand-name drugs in quality, strength andpurity. Yet, generics could save you up to 60% of your out-of-pocket costs. Ask your doctor if a generic drug would work for you.

Reply Today and Save on Your Next Prescription! A service provided by <Code> <Member Name> <Address 1> <Address 2> <City>, <State> <Zip> <Bar Code>

You could save <$00.00>*

Dear <Member Name>: Medco administers your Medicare prescription drug benefit both at retail and through mail order on behalf of Educators Mutual Insurance Association. We are providing you with this important money-saving information to make sure you get the most from your coverage. Savings on your prescriptions Your personal savings analysis below indicates that you may save <$ 00.00>* for a 3-month supply of your prescriptions through Medco By Mail, your 24/7 mail-order pharmacy. Simply ask your doctor to write a prescription for a 3-month supply, with refills up to 1 year, as appropriate, instead of a 30-day supply. You can save with our service because you pay less for the medications you refill on a regular basis (those you will take for at least 3 months) over the course of a year. Of course if youâ&#x20AC;&#x2122;re only going to be taking a medication for a short time, such as 1 month, mail order may not be right for you, as you may pay less at a retail network pharmacy.

Save Money Save Time 24/7 Pharmacy

Prescription savings for <Member Name>: < $00.00>* in the <Member Medicare Plan Stage> stage of your Medicare Part D benefit Medication

3-Month Retail Pharmacy Cost <$00.00> <$00.00> <$00.00> <$00.00> <$00.00> <$00.00> <$00.00>

3-Month Medco By Mail Cost <$00.00> <$00.00> <$00.00> <$00.00> <$00.00> <$00.00> <$00.00>

TOTAL POTENTIAL SAVINGS FOR A 3-MONTH SUPPLY

YOU SAVE* <$00.00> <$00.00> <$00.00> <$00.00> <$00.00> <$00.00> <$00.00> <$00.00>

Some medications you take on a regular basis may not appear above. Feel free to call us to discuss your potential savings on those medications. REF: <0000000000> LT999552

Convenience— FREE delivery to your door Mail order is a service that is included as a part of your benefit plan at no extra cost. You save time by having your medications delivered right to you. What’s more, there’s no extra charge for standard shipping. We even make getting started easy. Just ask your doctor’s office to complete the enclosed forms. Please be sure you have enough medication until your first order arrives—usually within 3 to 5 days after we receive the form. Around-the-clock pharmacist access You can speak to our licensed pharmacists 24 hours a day, 7 days a week, and get answers to all your prescription questions by calling our toll-free number. You also have the peace of mind of knowing that your medications will be checked for potential drug interactions anytime you use your prescription drug ID card, no matter where you have your prescriptions filled or how you order them. It's easy to get started Bring the enclosed forms to your doctor's office today and start saving on your medications. Please be sure to ask your doctor for a 3-month supply of medications (typically a 90-day supply), as a lower days’ supply may not result in savings. Or you can call toll-free 1-800-841-3351 and we'll contact your doctor on your behalf. (TTY/TDD users should call 1-800-716-3231.) Customer Service is available in English and other languages, Monday through Friday, 8:00 a.m. to 8:00 p.m., and Saturday, 9:00 a.m. to 6:00 p.m., eastern time (except Thanksgiving and Christmas). Sincerely,

Tracy L. Furgiuele, R.Ph. Vice President of Pharmacy Practice Medco

P.S. To start saving, simply ask your doctor’s office to complete the enclosed forms or call us today.

*Savings estimates are based on your total cost using the maximum days’ supply at mail order (usually 3 months) and a 3-month supply at a retail pharmacy after you have reached your deductible. Subject to state law, a generic equivalent of brand-name medications may be dispensed. Savings amount is estimated and actual savings may vary. Savings projections are based upon your Medicare benefit stage and formulary in effect at the time your analysis was prepared. Your potential savings will vary per benefit stage and by medication. Please contact Medco for details. To confirm your savings and learn how you can continue to save in each benefit stage using Medco By Mail, call 1-800-841-3351 (TTY/TDD users should call 1-800-716-3231), Monday through Friday, 8:00 a.m. to 8:00 p.m., and Saturday, 9:00 a.m. to 6:00 p.m., eastern time (except for Thanksgiving and Christmas). Customer Service is available in English and other languages.

Important information about generic drugs

Take Your Medicine | Keep Your Money

• How generics compare to brand-name drugs FDA1-approved generic versions of brand-name medications can be expected to have the same active ingredients, the same quality, and the same strength as their brand-name counterparts.

To find out if a generic drug is available for your medication:

Heartburn and stomach ulcers

Visit www.medco.com/choices. You’ll learn how you can order your medications at the lowest possible cost.

Insomnia

My Rx Choices® lets you:

Allergies

• Discover lower-cost medication options for you and your family

Arthritis

• What doctors think about generics

And many other conditions

Want to save on your medications? Ask your doctor if generic drugs are right for you. FDA-approved generic drugs are safe and as effective as their brand-name counterparts, and they typically cost much less.

www.medco.com Medco and My Rx Choices are registered trademarks and At the heart of health is a trademark of Medco Health Solutions, Inc. © 2007 Medco Health Solutions, Inc. All rights reserved. TC904484-10/07

Lower-cost generic medications are now available to treat:

High cholesterol

It’s expensive to create a new drug and market it to the public. Generic drug manufacturers do not have those expenses, so the medications they produce can cost significantly less for the exact same ingredients, strengths, and doses.

1. U.S. Food and Drug Administration. 2. New York Times, September 21, 2007, “Helped by Generics, Inflation of Drug Costs Slows.”

How much could you save with generics?

High blood pressure

• Why generics cost so much less

Last year, more than 60 percent of all prescriptions were for generic drugs, so they are widely accepted.2

Are your medications available as generics?

Variable Logo

Ask your doctor if a generic medication would work for you.

• Compare out-of-pocket costs for all your medication choices • Order the lower-cost option, or print your results so you can discuss these choices with your doctor

Take Your Medicine

Keep Your Money Pay less for your medications— use safe, effective generics. Compared to their equivalent brandname drugs, FDA1-approved generics: • Contain the same active ingredients • Have the same strength and purity • Meet the same FDA manufacturing standards • Could save you as much as 60 percent of your out-of-pocket costs2

Variable Logo

Over 60 percent of all prescriptions dispensed are generics,3 including those used to treat: High blood pressure High cholesterol Heartburn and stomach ulcers Insomnia Allergies Arthritis And many other conditions

Ask your doctor if a generic medication would work for you. To see how much you could save on your medications, visit My Rx Choices® at www.medco.com/choices.

1. U.S. Food and Drug Administration. 2.Based on Medco book of business analysis for claims processed April–June 2007. 3.New York Times, September 21, 2007, “Helped by Generics, Inflation of Drug Costs Slows.”

Variable Logo

Medco has advanced the practice of pharmacy to improve health and lower the total cost of care for our members. Providing you with lower cost options to discuss with your doctor is just one way Medco helps you save.

Your doctor can help you save. All you need to do is ask.

How to talk to your doctor about saving with generic drugs

Most doctors want to help keep their patients’ healthcare costs affordable. However, some doctors may not know when generic drugs become available and that they typically cost 50 percent to 70 percent less than brand-name drugs.

Why pay more than you need to for your medications?

Take a few minutes today to speak to your doctor about lower-cost generic drugs.

We encourage you to talk to your doctor about generic drugs and how you could reduce your prescription costs. Here are three questions you can ask whenever your doctor prescribes a brand-name drug (and why it is okay to ask).

Fast facts about FDA-approved generic drugs

1. Is there a generic drug that I can take instead of the brand-name drug you’ve prescribed? Doctors often have several medication options they can prescribe for your condition. Generic drugs account for more than half of all prescriptions. If your brand-name drug does not have an equivalent generic drug, there may be another generic available to treat your condition.

2. Will a generic drug provide effective treatment for me? The FDA has indicated that generic drugs can be expected to work as well as the original brand-name drugs, because generic drugs have the same active ingredients. FDA-approved generic drugs also have the same quality and strength as brand-name drugs. You and your doctor can determine if generic drugs are right for you.

3. Would a 90-day supply of medication be appropriate for me? If you use a medication on a long-term basis, you could save the most money by ordering a 90-day supply of a generic drug through Medco By Mail, your plan’s convenient mail-order pharmacy. To get started with mail order, call us toll-free at 1 800 MEDCO-MAIL (1 800 633-2662). We will help you get started.

If you need additional information: ■ Visit us online at www.medco.com.

■ Generic drugs have the same active ingredients as the original brand-name drugs.

■ Call the Member Services toll-free number shown on your prescription drug ID card.

■ Generic drugs have the same quality and strength as brand-name drugs. ■ Generic drugs must meet the same strict FDA manufacturing standards as brand-name drugs. ■ Generic drugs cost up to 70 percent less than brand-name drugs.*

*Centers for Medicare & Medicaid Services.Testimony of Mark McClellan, M.D., Ph.D., Administrator, Centers for Medicare & Medicaid Services, on Medicare Prescription Drug Discount Program before the Senate Finance Committee [press release]. Available at: http://www.cms.hhs.gov/apps/media/press/testimony.asp?Counter=1091. Accessed August 9, 2006. Source: U.S. Food and Drug Administration Center for Drug Evaluation and Research.

Take Your Medicine

Keep Your Money Lower-cost generic medications are now available to treat: FDA1-approved generic medications can be expected to be safe and as effective as their brand-name counterparts. And generics could save you up to 60 percent of your out-of-pocket costs.2

High blood pressure High cholesterol Heartburn and stomach ulcers Insomnia Allergies Arthritis And many other conditions

Over 60 percent of all prescriptions dispensed are generics.3

Ask your doctor if a generic medication would work for you.

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1. U.S. Food and Drug Administration. 2. Based on Medco book of business analysis for claims processed April–June 2007. 3. New York Times, September 21, 2007, “Helped by Generics, Inflation of Drug Costs Slows.” www.medco.com

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You’ll Feel Better

While Paying Less

FDA1-approved generic medications have the same active ingredients, quality, strength, and purity as their brand-name counterparts. And generics could save you up to 60 percent of your out-of-pocket costs.2

Over 60 percent of all prescriptions dispensed are for generic medications,3 including those that treat: High blood pressure High cholesterol Heartburn and stomach ulcers Insomnia Allergies Arthritis And many other conditions

Ask your doctor if a generic medication would work for you.

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1. U.S. Food and Drug Administration. 2. Based on Medco book of business analysis for claims processed April–June 2007. 3. New York Times, September 21, 2007, “Helped by Generics, Inflation of Drug Costs Slows.” www.medco.com

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