Diabetes Care Value Program Guarantees More Affordable, Higher-Quality Diabetes Care

Sep 1, 2016
The Diabetes Care Value Program combines a novel quality-based pharmacy network, a holistic approach to diabetes patient care and cost management, and financial guarantees that will significantly reduce participating plans’ anticipated increase in diabetes-drug spend for 2017.
  • Diabetes

RPh Computer Article

The Diabetes Care Value Program℠ is the industry’s most comprehensive approach to improve pharmacy care while controlling plan costs for people with diabetes.

The new program – part of the Express Scripts SafeGuardRx℠ suite of pharmacy solutions – combines a novel quality-based pharmacy network, a holistic approach to diabetes patient care and cost management, and financial guarantees that will significantly reduce participating plans’ anticipated increase in diabetes-drug spend for 2017.

Diabetes is wreaking havoc on patients, and it is also a runaway driver of cost for payers. Our Diabetes Care Value Program helps our clients and diabetes patients prevail over the cost and care challenges created by this terrible disease.

Delivering Guaranteed Spending Caps and Driving Down Diabetes Drug Spending

As part of the Diabetes Care Value Program, Express Scripts is guaranteeing per-patient spending caps that will result in participating plans experiencing an average increase in diabetes drug-spend in 2017 that is approximately half of what the industry is currently forecasting for U.S. commercial payers. As reported in Express Scripts’ 2015 Drug Trend Report, U.S. diabetes prescription drug spending increased 14% in 2015 and – for those plans not participating in Diabetes Care Value Program – is expected to grow an additional 18% through 2016 and another 17.7% in 2017.

We plan to increase medication adherence, broaden insulin options for patients, and bend down the cost curve of what is currently the costliest class of traditional prescription drugs. As we have done with our other SafeGuardRx solutions, Express Scripts will assume financial risk for drug spending in excess of the caps to protect our clients from skyrocketing costs and budget uncertainty.

Introducing a Quality-Based Pharmacy Network

The Diabetes Care Value Program features a network of preferred pharmacies that will deliver on a set of quality metrics, including high medication adherence levels for patients with diabetes. Members of participating plans will be able to receive 90-day supplies of their diabetes maintenance medications from more than 10,000 pharmacies across the United States – including via home delivery at the Express Scripts Pharmacy℠, at all Walgreens pharmacies, and at more than 1,200 independent retail pharmacies.

As an independent pharmacy benefit manager, we have the flexibility to work with any and all pharmacies to achieve our clients’ specific care, cost and geographic access objectives. With our emphasis on achieving quality metrics, this new diabetes pharmacy network ensures our retail partners are aligned and focused on providing the care that people with diabetes need.

Applying a Holistic Approach to Diabetes Care and Medication Adherence

All patients enrolled in the program, regardless of which network pharmacy they choose for filling a prescription, can access additional clinical counseling from the diabetes pharmacists within the Express Scripts Diabetes Therapeutic Resource Center℠.

The Diabetes Care Value Program is projected to boost the average medication adherence rate for enrolled patients by 5%, reducing downstream health complications and healthcare costs. Currently, $4,690 per diabetes patient is spent each year on medical expenses that could have been avoided if patients had taken their diabetes medications as prescribed.

Nearly 9 of 10 people with diabetes also have high blood pressure or high cholesterol, and one out of every four is currently taking an antidepressant. Our Diabetes Care Value Program surrounds each person with the specialized knowledge and support needed to manage increasingly complex therapies that treat diabetes and related conditions.

Offering Broader Basal Insulin Options for Physicians and Patients

In conjunction with the announcement of the Diabetes Care Value Program, Express Scripts is also announcing that its 2017 National Preferred Formulary will include multiple preferred basal insulins. Pending market entry later this year for the country’s first follow-on insulin, Basaglar® (insulin glargine), Express Scripts plans to add Basaglar as a preferred product for the National Preferred Formulary, alongside the originator product Lantus® (insulin glargine).

Our bold actions have changed the marketplace dynamic in such a way that we can prefer multiple products on our formulary while delivering discounts to our clients typically associated only with exclusive formulary placement. Physicians will have more choice, fewer patients will be disrupted from their existing therapies, and our clients will realize significant savings.

The Express Scripts SafeGuardRx Solutions

The Diabetes Care Value Program, which will be implemented March 1, 2017, is the fifth and latest addition to the Express Scripts SafeGuardRx suite of custom solutions:

  • The Hepatitis Cure Value Program® successfully lowered the cost of curative hepatitis C treatments by nearly 50% and opened up access to previously untreated patients. It continues to deliver high cure rates and savings.
  • The Cholesterol Care Value Program℠ uses a rigorous clinical review process and specialist pharmacist support through the Accredo® specialty pharmacy to ensure that the new PCSK9 inhibitors are accessible when clinically appropriate, while also protecting plan sponsors from incurring unnecessary cost for the majority of patients with high cholesterol who can be successfully treated with more affordable statins that are proven effective in preventing heart attacks and strokes.
  • The Oncology Care Value Program® introduced indication-based formulary pricing for the first time to help better correlate a drug’s price to the value it is likely to provide a patient.
  • The Express Scripts Inflation Protection Program is shielding participating plans from the full cost impact of excessive year-over-year price increases on brand drugs.
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