Delivering Better Health and Affordability

Mar 27, 2019

SafeGuardRx®, Express Scripts 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.

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Combining innovative reimbursement strategies with novel clinical initiatives, SafeGuardRx® is helping plans and patients derive the most value in high-cost therapy classes. In a recent analysis of the program’s performance in 2018, we found that the tailored approach we take to each program is addressing the unique characteristics and challenges of the therapy class to ensure the greatest value returned.

As a result, people with a pharmacy plan enrolled in a SafeGuardRx program are on a path toward better health while plans saved more than $2.4 billion.

Engaging People with Diabetes

In our Diabetes Care ValueSM program we combine specialized diabetes pharmacy care with technology-enabled patient engagement initiatives to address the diabetes dilemma in ways others simply cannot.

In 2018, our efforts:

  • Helped prevent heart attacks through a 19% increase in the use of guideline-recommended statin therapy among people with diabetes. 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 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 6% higher compared to adherence rates at retail pharmacies in general.

Breathing Easier

Our Pulmonary Care ValueSM program, which addresses the unique barriers to adherence for patients with asthma and COPD patients, reduced rescue inhaler use among people with asthma or COPD by 72% 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.

Simplified Access to PCSK9 Therapy

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.

Sustainable Benefits for Plan Sponsors

In 2018, plans enrolled in SafeGuardRx programs 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% vs. 0.8%). 

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% less for enrolled plans compared to non-enrolled plans in 2018. For SafeGuardRx programs focused on specialty therapy classes, spending was 5% less for enrolled plans compared to non-enrolled plans.

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. 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.

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