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Southern Scripts simplifies the complexities of navigating through the Pharmacy Benefit Manager world by giving the employer group complete freedom, control, and choice as to how they structure their …

Southern Scripts simplifies the complexities of navigating through the Pharmacy Benefit Manager world by giving the employer group complete freedom, control, and choice as to how they structure their plan. The employer group has the option to choose how they want their prescription benefit plan to function, which pharmacies they want to work with, what reimbursement rates they want to pay pharmacies, what medications they want to cover, etc.

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  • 1. A Louisiana Pharmacy Benefits Manager Southern Scripts simplifies the complexities of the PBM world. It gives the employer group complete control and choice over their plan. A Louisiana Pharmacy Benefit Manager Containing costs, keeping employees healthy.
  • 2. About UsSouthern Scripts simplifies the complexities of navigating through thePharmacy Benefit Manager world by giving the employer group complete freedom, control,and choice as to how they structure their plan. The employer group has the option to choosehow they want their prescription benefit plan to function, which pharmacies they wantto work with, what reimbursement rates they want to pay pharmacies, what medicationsthey want to cover, and so forth.Southern Scripts simplifies the cost of pharmacy benefit management services. Ourpricing structure is clear cut with no hidden tactics. We do not “nickel and dime” clientswith additional fees for essential components of good pharmacy benefit managementincluding Drug Utilization Report, an attentive Customer Service Call Center, and PriorAuthorization Programs. • Straight-forward and clear cut methodology is utilized in all of our pricing • We do not own a mail order facility nor do we force mail order • All rebates are 100% accounted for and disclosed to the plan sponsorOur Mission:To offer employers a Pharmacy Benefit Management option that restores balance betweenthe need for sound prescription management strategies and meeting the health needs oftheir employees and families.Our Goal:Our goal is to provide employers with the tools to provide access to prescription medicationin order to achieve optimal health outcomes. This goal must be achieved through wiseresource management and elimination of unmerited industry practices.
  • 3. We Offer...Claims Processing Specialty DrugsSouthern Scripts will handle processing of all prescription claims including specialty Most specialty drugs may be supplied to a member by any pharmacy in our Preferred Pharmacypharmacy items. Claims will be processed online in a secure, cost-effective, and accurate Network or through our Specialty Pharmacy Partner. Additionally, our Specialty Pharmacy Partnermanner. Southern Scripts will provide members with insurance identification cards they take to has extensive knowledge and expertise in the field of specialty pharmacy in order to insure yourtheir pharmacy. Within seconds, claims will be processed to insure the member’s eligibility, drug members receive exceptional care.coverage, pricing, and detect any potential drug safety concerns. In the rare event a member isnot able to have a claim processed through our online system, Southern Scripts will manuallyprocess the paper claim at no additional charge. High Dollar Claim Review Southern Scripts will work to ensure your prescription benefit resources are closely monitored.Straight-Forward Drug Pricing Any claim equal or greater than the designated amount will require a Prior Authorization. Once a Prior Authorization is completed on an initial fill, additional refills will not require PriorSouthern Scripts uses a straight‐forward and clear cut methodology in all pricing. The retail Authorization for a designated time period of up to twelve months. We feel this is an essentialbrand/generic discount is purely based on the stated discount off of Average Wholesale feature for ensuring sound prescription management and will never charge an additional fee forPrice (AWP). We do not use any other components to determine the retail brand/generic Prior Authorizations.discount. We invoke Maximum Allowable Cost (MAC) pricing in cases where it will produce amore favorable result over the stated retail generic discount. Regional/National Pharmacy NetworkNo Repackaging Southern Scripts provides you with the ability to define your own pharmacy networks to leverage greater cost management techniques. Southern Scripts maintains two networks –We will make every effort to ensure that no pharmacy (mail or retail) is being reimbursed on our Prefrerred Regional Network and our Choice National Network. Your plan may elect toany National Drug Code (NDC) other than the original manufacturer’s NDC. Southern Scripts use one or both of these networks. Our Preferred Network includes pharmacies that havewill make every effort to prospectively deny claims for “repackaged” NDCs. Because mail the highest performance standards such as high generic utilization rates and formularyorder pharmacies may have business practices that avert these efforts, mail order will not be compliance rates. Therefore, they have been selected to work closely with us to ensureencouraged. Additionally, Southern Scripts will only partner with a select few mail order that employer groups get the best possible outcomes for members using prescriptionpharmacies who follow reputable business practices and allow close scrutiny of these practices medications through Medication Therapy Management. Our Choice Network is an extensiveby Southern Scripts. national network of retail pharmacies and includes all major chain pharmacies. Rebates90-Day Retail Southern Scripts discloses and accounts for 100% of rebate dollars. We are fully transparent andMail order will be made available, but is not forced. As an alternative to mail order, Southern rebates are never hidden. Southern Scripts retains a portion of the captured rebate dollars toScripts highly encourages the use of the 90-day Retail Network. The Plan Sponsor may choose cover our prescription benefit management services. This percentage is fully disclosed. Southernwhen they feel mail order is an appropriate option to incorporate into their plan or not. Scripts and our Formulary Partner retain a percentage of rebates and the remainder goes back directly to the Plan Sponsor. Southern Scripts will pay rebates to our client on a quarterly basis approximately 180 days from the end of the quarter in which claims were incurred.GenericsBecause achieving a high utilization rate of generics is essential to positively impacting aplan’s overall prescription costs, Southern Scripts maintains a Mandatory Generic Policy. Ifa brand drug is elected when a generic is available, the member will be required to pay thebrand copay PLUS the cost difference between the generic drug and the brand drug UNLESS thephysician specifies name brand only on the prescription.
  • 4. Administrative Fee Structure All Inclusive Southern Scripts administration fees are all-inclusive of every element essential to good pharmacy benefit management: • Initial Plan Set-Up • Implementation and Roll Out • Member Identification Cards • Replacement ID cards • Eligibility files maintenance • Daily electronic submissions • Paper submissions • Connectivity to online system • Customer Service Call Center • Formulary Management • Rebate Program • Member communications pieces including shipping • Clinical and Prior Authorization Programs • Weekly Invoicing • Pharmacy Claim Payment • RxRevue Reporting Southern Scripts uses a simple fee structure to cover administrative costs and services provided to clients. Southern Scripts administrative fees consist of two components – 1) Per Claim Fee and 2) Rebate Allocation. Per Claim Fee: An established “Per Claim Administration Fee” is collected on all paid claims processed through Southern Scripts. The Per Claim Fee does not apply to any reversed or rejected claims. This method of pricing allows for your company to only pay when our services our utilized. Rebate Allocation: Southern Scripts discloses and accounts for 100% of rebate dollars. We are fully transparent and rebates are never hidden. Southern Scripts retains a disclosed portion of the captured rebate dollars to cover our pharmacy benefit management services while the other percentage of rebates goes directly back to the Plan Sponsor. Southern Scripts will pay rebates to our clients on a quarterly basis approximately 180 days from the end of the quarter in which claims are incurred.
  • 5. Prescription Benefit Plan Designs Southern Scripts offers three different options that Plan Sponsors may choose from in designing their Pharmacy Benefit Plan – RxPremier, RxTraditional, and RxCustom. Each plan design and its features are described below.Option1 Option 2 Option 3RxPremier RxTraditional RxCustom 100% Customized Plan Design• Two Pharmacy Networks: • One Pharmacy Network • Pharmacy Networks – designed according to your – Preferred Pharmacy Network – Choice Pharmacy Network specifications – Choice Pharmacy Network • 90-Day Retail • 90-Day Retail – your choice to include 90-day retail• 90-Day Retail – limited to Preferred Pharmacy Network • Mail order available, not forced • Mail order available• Mail order available, not forced • Southern Scripts Specialty Pharmacy Network – Your decision to include• Southern Scripts Specialty Pharmacy Network • 100% Disclosure of all rebates • Specialty Pharmacy Network – your decision• 100% Disclosure of all rebates • No Spread Pricing to limit specialty to specific pharmacies• No Spread Pricing • Payment for Services is a flat per paid claim fee • 100% Disclosure of all rebates• Payment for Services is a flat per paid claim fee • Rebate Allocation • No Spread Pricing• Rebate Allocation • Mandatory Generic Policy • Payment for Services is a flat per paid claim fee• Mandatory Generic Policy • Southern Scripts Formulary • Rebate Allocation• Southern Scripts Formulary • Three Tier Copay Structure • Mandatory Generic Policy• Three Tier Copay Structure – Generic • Southern Scripts Formulary can be customized – Generic – Preferred Brand • Copay Structure set by plan – Preferred Brand – Non- Preferred Brand • All inclusive services – Non- Preferred Brand • All inclusive services• All inclusive services
  • 6. Free AnalysisThe goal of Southern Scripts is to offer you the best tools to provide prescription medication to your employees sothey remain healthy and productive. We feel strongly that our services accomplish this and in a manner that is alsofiscally responsible for your company. Just like you though, we want to see it in black and white. Our Free Analysisaccomplishes this by taking your past claims and prospectively applying a detail claims analysis to see how yourprescription benefit plan would function under our structure.
  • 7. Optional ServicesMedication Therapy Management Wellness PortalMedication Therapy Management (MTM) is a partnership of the pharmacist, the patient or Employee Wellness and Prevention are vital components totheir caregiver, and other health professionals that promotes the safe and effective use of keeping a strong workforce. Through our Wellness Partner’smedications and helps patients achieve the targeted outcomes from medication therapy. state-of-the art program, we reach people through multipleMTM includes the analytical, consultative, educational and monitoring services provided by approaches to health. Our Wellness Partner will work closelypharmacists to help consumers get the best results from medications through enhancing with Southern Scripts’ clients to create a custom wellness planconsumer understanding of medication therapy, increasing consumer adherence to that is not reactive – waiting until after an employee is strickenmedications, controlling costs, and preventing drug complications, conflicts, and with illness or injury – but rather proactive in emphasizinginteractions. This is the side of pharmacy giving value to cognitive services and removing prevention and good health promotion.the pharmacist from a solely distributive function. There are many topics/disease states thatcan be improved by MTM, including, but not limited to Diabetes, Asthma, and Senior Care. The program brings together a robust collaboration of health professionals including doctors, pharmacists, dieticians, andA basic set of services provided through MTM includes a pharmacist’s review of all the exercise therapists. Through this team of wellness professionals,patient’s medications in order to identify any potential drug interactions, duplications of we focus on tackling the core problem of modifying a person’sdrugs from the same family, doses, routes of administration, and the form of drug the negative behaviors and creating new positive behaviors. Itpatient is using. This review will also include evaluating the patient’s medication habits is based on working through an individual’s attitude towardsincluding compliance with current therapies. health, teaching the tools and knowledge base to be healthy, and setting personal health goals.The plan has the option to provide MTM services to the portion of their populationresponsible or at greatest risk for incurring the highest cost. Fees charged are specific tothe specific intervention type and/or disease state. MTM is reimbursed based on pharmacisttime using national CPT codes. Current CPT code valuations are based on pharmacist timeusing national CPT codes. Southern Scripts will collect a disclosed percentage to coverservices. MTM is highly proven to be successful at generating improved patient outcomesand savings to the overall health plan for employer groups on both the medical andprescription portions. Savings will be calculated and MTM performance will be justified. Aplan sponsor may also elect to use their portion of the rebate allocation to fund their MTMand/or wellness program.Southern Scripts has a network of pharmacists that have been at the forefront of providingMTM for Medicare beneficiaries and employer groups for ten years.
  • 8. A Louisiana Pharmacy Benefit Manager318-214-4764 • boyd@southernscripts.netVisit us on the web at www.southernscripts.net