Express Scripts Data Shows Value-Based Programs Deliver Better Health, Affordability for Costly Conditions
ST. LOUIS, March 27, 2019 - According to new data released today, the Express Scripts SafeGuardRx® offering – the company's first-to-market value-based programs for employers and health plans – improved patient engagement and increased medication adherence while reducing costs for some of the nation's costliest therapies.
The SafeGuardRx® program combines innovative reimbursement strategies with novel clinical initiatives to help plans and patients derive the most value in high-cost therapy classes, such as inflammatory conditions, oncology and diabetes. Express Scripts tailors each program to address the unique characteristics and challenges of the therapy class to ensure the greatest value returned.
Better Engagement, Better Adherence, Better Access
People with a pharmacy plan enrolled in a SafeGuardRx program are on a path toward better health as a result of the clinical interventions built into each program, which includes personalized care from an Express Scripts specialist pharmacist, technology-enabled patient engagement initiatives, and simplified access to high-cost therapies.
In our Diabetes Care ValueSM program we:
- Helped prevent heart attacks through a 19 percent increase in the use of guideline-recommended statin therapy among people with diabetes in 2018. If all Express Scripts plans were to increase statin use similarly, we could prevent an estimated 20,000 heart attacks over the next 10 years.
- Increased engagements with patients through the Mango Health app, where the average user logged in 14 times per week in 2018 to record positive health behaviors, such as taking their medication as prescribed. In addition, Express Scripts pharmacists had nearly 21,000 touch points with patients via phone calls and email last year.
- Improved medication adherence through increased pharmacist interactions at the retail pharmacies that participate in the program's preferred network. Medication adherence for people who filled their diabetes medication at one of these pharmacies in 2018 was six percent higher compared to adherence rates at retail pharmacies in general.
Additionally, our Pulmonary Care ValueSM program reduced rescue inhaler use among people with asthma or COPD by 72 percent in 2018 through the use of remote monitoring technology, which allows for a pulmonary specialist pharmacist to engage with a patient after observing increased rescue inhaler. In addition to improved quality of life, reduced rescue inhaler use means a patient's condition is better controlled and is less likely to require medical intervention at an ER or hospital.
Through our Cholesterol Care ValueSM program, members gained more simplified access to the PCSK9 inhibitor Praluent®. The program also reduced individuals' out-of-pocket costs through the point-of-sale rebates we introduced in July 2018, resulting in as much as $319 in direct per member, per prescription savings.
"Innovations in medicine that deliver potentially break-through treatments but have exorbitant prices require equally innovative reimbursement solutions that ensure value for plans and patients," said Candice Michaelson, Vice President, Value Based Solutions, Express Scripts. "Year after year with SafeGuardRx, we have proven that although healthcare is dynamic and complex, we can deliver to plans and patients a sustainable way to make these high-cost therapies accessible and affordable, and ensure patients achieve the greatest value possible."
Sustainable Benefits for Plan Sponsors
In 2018, plans enrolled in SafeGuardRx programs saved more than $2.4 billion and experienced lower growth rates in drug spending among the costliest therapy classes compared to non-enrolled plans. The greatest difference was in the inflammatory conditions class, where the annual increase in spending on medications for conditions such as rheumatoid arthritis and Crohn's disease was nine times greater for non-enrolled plans compared enrolled plans (7.3 percent vs. 0.8 percent).
The unique indication-based reimbursement design of the Inflammatory Conditions Care ValueSM program – which allows for additional competition to make the therapy class more affordable by shifting market share from market-dominating therapies to other effective medications – is the driving factor in the decreased spending for plans enrolled in the program.
Overall, drug spending in SafeGuardRx programs focused on traditional therapy classes, such as pulmonary conditions and diabetes, was 18 percent less for enrolled plans compared to non-enrolled plans in 2018. For SafeGuardRx programs focused on specialty therapy classes, spending was 5 percent less for enrolled plans compared to non-enrolled plans.
Using data and technology in innovative ways to facilitate the most appropriate and effective treatments, provide high-touch clinical support for patients, and apply value-based payment strategies, SafeGuardRx delivers better medication adherence, higher therapy completion rates, greater compliance with clinical guidelines and substantially reduced wasteful healthcare spending. The current suite of condition-specific SafeGuardRx solutions address some of the costliest therapy classes for payers, including cancer, diabetes, hepatitis C, high blood cholesterol, inflammatory conditions, migraine, multiple sclerosis, pulmonary conditions and rare diseases.
About Express Scripts
Express Scripts is a health care opportunity company. Empowered by our legacy as an industry innovator, we dare to imagine — and deliver — a better health care system with greater choice, predictability, affordability and improved outcomes. From pharmacy and medical benefits management, to specialty pharmacy care and everything in between, we uncover opportunities to make health care better.
We stand alongside our clients and partners, collaborating to develop personalized solutions that make a meaningful difference in the lives of those we serve, whenever and wherever it's needed. We believe health care can do more. We are Champions For BetterSM.
Express Scripts, part of Cigna, unlocks new value in pharmacy, medical, and beyond to further total health for all.
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