Together with our clients, we’ve changed the industry by actively taking steps to address increasing cost trends while delivering the highest standard of care.
Continuing on that mission, we’ve made enhancements to our ground-breaking SafeGuardRxSM programs focusing on hepatitis C and cancer.
Expanding Treatment Options, Lowering Costs for Hepatitis C
Beginning Jan. 1, 2017, the company’s game-changing Hepatitis Cure Value Program® will include Viekira Pak/XR™ (dasabuvir, ombitasvir, paritaprevir, and ritonavir) and Harvoni® (ledipasvir 90 mg/sofosbuvir 400 mg) as preferred products. With this update, Express Scripts leverages the success of the Hepatitis Cure Value Program to negotiate better pricing for Harvoni and thereby expand treatment options for patients and physicians in 2017, while continuing to lower the cost of treatment by nearly 50%.
Coincident with this change to the Hepatitis Cure Value Program, Express Scripts’ National Preferred Formulary, covering more than 25 million Americans, is extending preferred coverage of hepatitis C treatments to include both Viekira Pak/XR and Harvoni.
Since this program began in 2015, we’ve helped more than 50,000 patients gain access to curative therapy across the Express Scripts customer base. Without our program, the cost to cure these patients would have been substantially greater and many payers would have needed to aggressively ration care to ensure affordability of their pharmacy benefits.
Key to the Hepatitis Cure Value program’s success has been the care and attention provided by the specialized pharmacists and nurses at the Hepatitis Therapeutic Resource Center at Accredo®. A recent analysis examining the sustained viral response among patients treated by Accredo shows a cure rate of greater than 95% for patients in the Hepatitis Cure Value program treated with Viekira Pak therapy in 2015 with follow-up hepatitis C testing in late 2015 or early 2016. The analysis also shows a similar cure rate for patient who completed Harvoni therapy in 2015.
Expanding Indication-Based Management for Oncology
In 2017, Express Scripts Oncology Care Value Program – which aligns the cost of medication by indication, enables varied drug price by efficacy and guarantees plan refunds for early discontinuation of treatment – will expand its novel, value-based approach to managing oncology spend to additional medications, offering a solution that addresses 23% of all oncology pharmacy spend, up from 5% in 2016. Indications covered by the program include multiple myeloma, non-small cell lung cancer, prostate cancer and renal cell carcinoma.
Patients will continue to receive best-in-class care through Accredo, supported by our Oncology Therapeutic Resource Center, which delivers 5% greater adherence for cancer medications vs. other pharmacies.
Superior Adherence for PCSK9s
The Cholesterol Care Value Program℠, which uses a rigorous clinical review process and specialist pharmacist support to ensure PCSK9 inhibitors are accessible when clinically appropriate, has demonstrated industry leading medication adherence rates among patients cared for by Accredo.
Specifically, members who filled a prescription for Praluent® (alirocumab) or Repatha® (evolocumab) via Accredo, as part of the Cholesterol Care Value Program, demonstrated an adherence rate of 89.3% compared to 82.1% for the same time period at retail and other specialty pharmacies combined.
Protecting payers from unnecessary spend means ensuring the appropriate use of PSCK9 inhibitors by only those patients who are not responsive to lower-cost statin therapy, and ensuring that those who do use this therapy achieve an optimal outcome. Given the cost of these medications, and the severity of disease among patients who use them, it’s important to see high medication adherence rates.
Our suite of SafeGuardRx solutions helps payers address the latest and most significant challenges to affordable pharmacy care. We vow to continue enhances our current solutions and developing new innovations that address the new and different challenges to our clients and members face when it comes to affordable pharmacy care.
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