MEDICATION THERAPY MANAGEMENT PROGRAM (MTMP)

The MD Care Inc. Medication Therapy Management Program (MTMP) is designed to optimize therapeutic outcomes for targeted beneficiaries by improving medication use and reducing adverse drug events.

The MD Care Inc. MTMP program is consistent with the regulatory intent to improve therapeutic outcomes, and has the capability to target beneficiaries as required by the Part D rule.

A. Targeting

The beneficiaries targeted for the MTMP are those individuals who (i) have two (2) or more of the targeted chronic diseases, (ii) are taking at least five (5) covered Part D drugs, and (iii) are likely to incur annual costs for covered Part D drugs in excess of $4000 for 2007.

(a) Multiple Chronic Diseases

MD CARE INC. has proprietary algorithms that will be used to identify individuals with two (2) or more of the targeted chronic diseases for participation in the MTMP. Chronic conditions will be inferred from prescription claim data using proprietary algorithms. The targeted chronic conditions will be:

• Alzheimer's Disease
• Asthma
• Behavioral Health
• Diabetes
• Cardiovascular Disease (including dysrrhythmias, ischemic heart disease, and hypertension)
• Heart Failure
• Chronic Pain
• Osteoporosis

(b) Multiple Covered Part D Medications

Using prescription claims data, Caremark will identify beneficiaries that are actively taking five (5) or more Part D drugs on the Medicare formulary. Any Part D drug on the Medicare formulary will be eligible for targeting.

(c) Beneficiaries likely to incur at least $4000 in drug costs for 2006

Using prescription claims data, Caremark will estimate the likely drug costs that will be incurred by a particular beneficiary in 2007. The MTMP will be limited to those beneficiaries that, in addition to meeting the criteria specified in (a) and (b) are also expected to incur drug costs that exceed the $4000 threshold for 2007. Targeting for this criterion will be run quarterly. All Part D covered drugs will be evaluated as part of the targeting. Targeting will be run during the first month of each quarter and will evaluate gross pharmacy costs from pharmacy claims. An individual will meet the drug spending criteria if any of the following are true:

1. The participant spent $1000 in the preceding 90 days.
2. The participant spent $2000 in the preceding 180 days.
3. The participant spent $3000 in the preceding 270 days.
4. The participant spent $4000 in the preceding 365 days.

B. Enrollment/Disenrollment

The MD CARE INC. MTMP will use an opt-out enrollment method. All eligible Part D beneficiaries that meet the targeting criteria are considered enrolled in the MTMP. A description of the MTMP will be provided in the Part D enrollment materials, including an explanation of the MTMP and eligibility criteria for participation in the program. If the beneficiary does not wish to participate in the MTMP, an 800 number will be provided in the enrollment materials with instructions to call this number to disenroll. The beneficiary can disenroll from the program at anytime.

C. Delivery of MTMP

The MD CARE INC. MTMP, described in detail below, will include targeted educational mailings to eligible enrollees and direct interactions between Caremark clinical pharmacists and/or physicians and the prescribing/treating physicians or case managers. Any pharmacist or physician involved in delivering the program to the treating physician or case manager will be an employee of Caremark, and so will perform these services as part of their job functions for which they receive a salary.

The MD CARE INC. MTMP identifies beneficiaries at risk for adverse medical events and works collaboratively with physicians and case managers to reduce that risk and avoid potential medical costs. The program encourages compliance with national, evidence-based clinical guidelines.

Beneficiary Interventions:

In addition to physician-directed consultations to improve pharmaceutical and medical care, the MD CARE INC. MTMP provides educational support to the targeted beneficiaries through a series of educational mailings addressing both general healthcare issues and disease-specific issues.

A quarterly four-page publication will be sent to all targeted beneficiaries. The purpose of the publication is to increase awareness and provide information and resources for prevention and treatment of common health-related issues. The publication is organized into the following sections:

• Main topic/feature article
• Ask an Expert
• Research Highlights
• Medicine Update
• Staying Healthy
• In the News

In addition, there are four (4) condition-specific publications. Each will be sent quarterly to those beneficiaries with the following targeted chronic condition(s): diabetes, cardiac disease, respiratory disease, or hypertension. Articles include updates on the latest treatments and therapies, reminders on the importance of compliance with medications and the physician's plan of care, and lifestyle and diet tips to help individuals with these conditions better manage their health.