Express Scripts Leads Industry with New HIV Prevention Program

The HIV Care ValueSM program, part of the company’s SafeGuardRx® platform, will drive value and improve cost predictability for employers, health plans, and people at risk for HIV.

ST. LOUIS, March 4, 2020 – Express Scripts today announced a new program to bring simplicity, affordability, and predictability to HIV prevention through increased education and appropriate use of pre-exposure prophylaxis (PrEP) treatments. The HIV Care ValueSM program is the industry’s first value-based program to help prevent the transmission of HIV.

“By taking a single pill once a day, people with an elevated risk can prevent contracting HIV. Yet, with a list price of $24,000 a year, PrEP has been out of reach for many of the people who need it most,” said Candice Michaelson, Vice President, Value Based Solutions, Express Scripts. “With our new program, we will help employers and health plans ensure that every eligible person has the resources and support needed to use PrEP effectively and prevent HIV transmission.”

In accordance with updates to the Affordable Care Act that take effect in July 2020, most employers and health plans will be responsible for providing coverage of PrEP with no cost-sharing for all people in their plans who are at risk for HIV exposure. These changes are based on recommendations from the U.S. Preventive Services Task Force in 2019 that found use of PrEP can substantially reduce the risk of HIV infection in persons at high risk.

Barriers to Access

Even with a zero-dollar copay, significant barriers to effective access remain, including proper use of PrEP therapy and physician awareness of updated rules and guidelines. High adherence to PrEP medication is especially critical to preventing HIV transmission, but is affected by stigma, low-risk perception, side effects, inaccurate information, and the logistics of daily life.

 “The ACA requirement is a big step toward removing the cost barrier for people who can benefit from PrEP with a goal of helping to end a global health epidemic; however, we need to address more than just the patient out-of-pocket costs,” said Michaelson. “Express Scripts can uniquely ensure employers and health plans will be part of achieving the goal of significantly reducing HIV transmission.”

Making Medicine Work Harder

The HIV Care Value program, part of the company’s industry-leading SafeGuardRx platform, includes three core elements to help employers and health plans address key barriers to access and effectiveness:

  1. Cost Predictability:  To help employers and health plans continue to provide affordable, predictable health care coverage, Express Scripts will guarantee a maximum rate of growth of a plan’s spend on applicable HIV PrEP products, and will reimburse plans the amount that exceeds that trend guarantee dollar for dollar. This approach will help ease the strain plans will experience covering 100% of the cost for PrEP, and help prevent plans from having to shift costs to people in other ways.
  2. Patient Support:  Patients on PrEP therapy will have access to specially trained clinicians through Express Scripts’ Therapeutic Resource Center® who will help patients overcome the many unique obstacles to optimal medication adherence with PrEP.
  3. Increased Awareness:  Express Scripts will engage with providers to offer additional resources to help them educate their patients on HIV prevention. These efforts will help connect more at-risk people with PrEP therapy and other preventative measures while increasing awareness about the importance of medication adherence.

Choice and open access also are important to overcoming barriers to PrEP adherence. As such, plans that enroll in the HIV Care Value program will have access to both FDA-approved PrEP therapies. Members can fill prescriptions for PrEP medications at any pharmacy within the plan’s network.

“Prevention and treatment of HIV have come a long way. When I was a medical resident in San Francisco in the late 1980’s, it was the height of the HIV epidemic, and the disease was a death sentence,” said Glen Stettin, M.D., Chief Innovation Officer, Express Scripts. “Today, thanks to these life-saving medications, people with HIV can live healthy lives, and we are now on a path to eliminating new infections. It will take every part of our health care system to see this through.  We’re committed to doing our part.”

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.

Express Scripts, a Cigna company, unlocks new value in pharmacy, medical and beyond to further total health for all.

For more information, visit es.express-scripts.com/corporate or follow @ExpressScripts on Twitter.

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