2017-528-E HR - Envision Pharmaceutical Services, LLC for pharmacy benefits

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DocuSign Envelope ID:E8C538EF-9595-4E36-A4C9-2CA66C7BE34A Additional Clinical Program Services (priced separately) Medication Therapy Management/Drug Therapy Management Envision's Medication Therapy Management/Drug Therapy Management ("MTMfDTM") Program is designed to achieve appropriate therapeutic outcomes for targeted patients through improved medication use. This includes the involvement of patients, caregivers, care providers, pharmacists, physicians, educators, and care coordinators. The Program is consistent with evidence based-guidelines, including guidance from the Centers for Medicare and Medicaid Services ("CMS"). Prospective candidates for the DTM/MTM Program are those patients who have multiple chronic conditions, are taking multiple medications, and will most likely incur high annual drug costs. In addition, specific patients that fall outside of the previously mentioned identification criteria may be identified as eligible for DTM/MTM intervention due to significant therapy care gaps. The MTM/DTM Program consists of 2 basic elements: Therapy Care Gap interventions and Adherence and Persistence (A&P) interventions. A) Therapy Care Gap Management Therapy Care Gaps are interventions designed to identify patients who have a gap between their current therapy and the ideal therapy needed to achieve optimal clinical outcomes. Therapy Care Gap recommendations are developed based on current clinical guidelines and clinical evidence. Patients with therapy gaps are identified using full prescription drug claims history as well as patient demographics, concurrent disease states and concurrent medications. Therapy Care Gaps are then reviewed for clinical relevance by clinical pharmacists, and the prescribing physician and patient are notified as appropriate. Patients will also receive educational materials on a quarterly basis. Outcomes reporting at 6 months and annually will quantify the number of Therapy Care Gaps identified, changes in physician prescribing post-identification and communication, and the change in actual patient medication history post-identification. B) Medication Adherence and Persistency (three disease states) Medication Adherence and Persistency ("A&P") interventions identify members who are not properly following the prescriber's instruction regarding medications ("adherence") or are -' not remaining on the prescribed therapy for the recommended time period ("persistence"). The Program targets medication for chronic diseases such as hypertension, diabetes, and high cholesterol. Additional (greater than 3) disease states can be selected for an additional fee. Potential medication non-adherence is identified in a target patient population using four major parameters: Medication Possession Ratio ("MPR"), Median Gap, Persistence, and Days of Therapy. This service seeks to identify and resolve issues related to compliance and/or persistency by offering patients quarterly progress reports on their adherence and notifications to providers and/or disease management firms for further interventions that foster compliant and persistent behavior. In addition to the individualized quarterly member progress reports, annual outcomes reports documenting the change in adherence parameters \Pass-through PBMSA(041917) ©Envision Pharmaceutical Services,LLC Page 35 of 41