The Pharmacy Benefit Management Institute

1. The Pharmacy Benefit Management Institute Presents AUTOPROä The Automated PBM Proposal Evaluation Program

2. AUTOPRO - What is It? What is It Good For? How Does It Work? Who Cares? What Makes AUTOPRO Unique?

3. AUTOPRO - What is it? Set of PC-based Software Tools Automates the PBM Solution Process Uses Sophisticated Computer Algorithms PBMI Proprietary Format

4. AUTOPRO - What is it? AUTOPRO is Useful For - Bid Issuance Bid Evaluation PBM Selection Contract Negotiation Ongoing PBM Performance Management

5. AUTOPRO - What is It Good For? Saves 50-80% of the Time and Expense of RFP Process Faster Decision Making Dramatically Reduces the Volume of “Fluff” Isolates Pertinent Facts Saves Employee Person-Years Saves Large Consulting Fees

6. AUTOPRO - What is It Good For? Higher Quality Decisions Based on Objective Focus of Specific Needs Requires ALL Vendors to Respond in Consistent Format Performance Guarantee Oriented Lowest Overall Benefit Cost Requires Little PBM Expertise

7. How Does the Process Work? Prepare RFP & Question Set PBMI Contract = TO VENDORS Needs ID RFP on Diskette PBM Ranking Reports Vendor Response Doc’s Evaluation Software Decision = Responses on Diskette Weighting Criteria

8. What Makes AUTOPRO Unique? Designed with Extensive Industry Expertise Constantly Updated Most Advanced Process Available Uses PBMI Proprietary Formats Provides Uniform Roadmap for Evaluation Requires Performance Guarantees with Penalties Focuses on Total Bottom Line Cost

9. When Do You Use AUTOPRO? Plans to Issue a PBM RFP PBM Contract 2 + Years Old Concerned with Vendor Performance Limited Time and/or Expertise with PBM’s

10. Select and respond to each section of this proposal. Network Development Background Information Network Development Network Management Mail Order Pharmacy Claim Processing Eligibility Processing Customer Services Member Services Management Reports Concurrent DUR Retrospective DUR Formulary Finance The AUTOPRO RFP is divided into sections that represent the primary functions of pharmacy benefit managers.

11. Each section of the proposal requires the vendor to guarantee levels of performance, identify the functions it will perform, and identify information submitted as exhibits. Network Development Response Select each of the following RFP sections and identify the performance levels guaranteed, the functions you will perform, and the information submitted. Required And Guaranteed Levels Of Performance Functionality Requested Information Requested Performance Penalties

12. Network Development -- Performance Guarantees Enter the performance level you guarantee. 1. The percentage of employees living in urban areas that will have access to at least 1 pharmacy within 2 miles of their homes. 95.2% 2. The percentage of employees living in suburban areas that will have access to at least 1 pharmacy within 5 miles of their homes. 87.7% 3. The percentage of employees living in rural areas that will have access to at least 1 pharmacy within 15 miles of their homes. 75.2% The Performance Guarantee subsection requires the vendor to specify the performance it guarantees. Guarantees are requested for the functions having the greatest impact on the vendor’s performance and on your satisfaction.

13. Network Development -- Functionality Requested Identify the functions you agree to perform. Pharmacies are required to submit all claims via point-of-sale. Pharmacies are required to submit claims using version 3.2 of the NCPDP standard. Pharmacies are required by contract to submit their lowest usual and customary price. By contract, pharmacies are not allowed to independently implement therapeutic substitution or utilization management programs of any type. The Functionality Requested subsection asks the vendor to identify which of the other functions requested it will perform. Identifying the functions desired eliminates the need for the vendor to submit and for you to review long, written descriptions of the vendor’s capabilities.

14. The Information Requested subsection asks the vendor to identify which of the items requested it is submitting. Network Development -- Information Requested Identify the exhibits submitted with this proposal. (1) Provide a file on diskette (in the format specified) that identifies the participating pharmacies. (2) Provide a copy of the contract between the vendor and the pharmacies. (3) Provide a copy of the pharmacy communication plan. (1) Some exhibits can be evaluated using AUTOPRO tools, (2) some should be reviewed manually to verify the accuracy of certain aspects of the vendor’s proposal, and (3) some need only be reviewed for the vendor selected.

15. Network Development -- Performance Penalties Failure to provide network access at the guaranteed levels will result in a 2% administrative fee penalty. Each function guaranteed in the Performance Guarantee subsection has an associated performance penalty. In some cases the penalty is a percentage of the administrative charges. In others it is equal to the excess cost you incur; for example the cost of drug utilization management savings promised but not delivered. Collecting a financial penalty is poor compensation for the impact of your vendor’s failure to perform. The intent of the penalties is to also ensure the vendor understands your requirements for performance and make the vendor much more conscious of its performance.

16. Please assign weights to each section. Network Development 5 Network Management 15 Claim Processing 3 Total Points 100 The AUTOPRO evaluation program evaluates the PBM proposals and calculates a score for each PBM based upon their responses and the weights you assign to each proposal section and question. With AUTOPRO, you can model different weighting schemes allowing you to emphasize different functions.

17. Network Development Network Management Mail Order Claim Processing Grand Total Vendor1 ###.# ###.# ###.# ###.# ###.# Vendor 2 ###.# ###.# ###.# ###.# ###.# Vendor 3 ###.# ###.# ###.# ###.# ###.# Vendor 4 ###.# ###.# ###.# ###.# ###.# AUTOPRO’s evaluation program combines the vendors’ responses with the weights you assigned to create a score for each question and proposal section.

18. AUTOPRO Contract Options One-time License Fee You do the Work with PBMI Assistance Telephone Interviews for Needs Identification Question Set Definition RFP Diskette Preparation Ongoing Coaching/Assistance Evaluation Software Weighting Scheme Overall Process Assure Your Complete Satisfaction

19. AUTOPRO Contract Options Full-Service Contract All of the Above + PBMI Does All the Work with Your Decision Making Assure Your Complete Satisfaction

20. Call the Pharmacy Benefit Management Institute, Inc. at (480) 730-0814 for information about this exciting new capability.