On Jan. 7, 1965, President Lyndon B. Johnson implored the 89th session of Congress to develop a healthcare law to “assure the availability of and accessibility to the best healthcare for all Americans, regardless of age or geography or economic status.”
Six months later on July 30, 1965, with the stroke of a pen, President Johnson changed the history of American healthcare by signing the Social Security Amendments of 1965. With this act, Johnson established Medicare for our nation’s aging population and Medicaid for our nation’s low-income citizens.
These two programs have grown and evolved in the past five decades as our nation and our healthcare industry have grown and evolved. But the essence of their mission and purpose – make healthcare accessible, affordable and available to all – has never changed, and continues to live on in the Health Insurance Marketplace and other aspects of the Affordable Care Act.
At Express Scripts, we share that mission, and it has been the core of our contributions to these remarkable programs for the past two decades.
Medicaid: Decades of Expert Experience
Twenty years ago, Express Scripts began supporting Medicaid patients when legislation in 1990 opened the door for Medicaid Managed Care and the coverage of prescription medications. Since then, we’ve helped our clients – health plans who administer managed Medicaid plans for states – apply our best practices so they can provide their beneficiaries with safe and affordable access to prescription medications within the confines of a limited state budget.
As Medicaid expansion continues as a result of the Affordable Care Act – now in 27 states and Washington, D.C. – managed Medicaid plans are increasingly important to help states meet the demands of their growing Medicaid population while balancing the cost and quality of care.
Currently, we offer Medicaid-specific pharmacy solutions and strategic support to nearly 40 health plans with Medicaid programs in 20 states.
Medicare Part D Success
In 2004, shortly after President George W. Bush signed the Medicare Modernization Act in December 2003, Express Scripts began caring for our nation’s aging population through the Medicare Discount Card Program, and then in 2006, with the beginning of the Part D prescription drug program.
Part D is one of our nation’s greatest success stories – delivering a high quality, affordable and meaningful benefit for millions of Americans, while reducing costs for Medicare. One widely acknowledged reason for the program’s success: Medicare Part D embraces the clinical and cost-saving strategies Express Scripts has used successfully in commercial benefit plans.
Through Medicare Part D, beneficiaries have choice and flexibility to select a plan that meets their needs. Plans have the ability to offer incentives to beneficiaries to encourage good health decisions. Clinical programs, such as Medication Therapy Management (MTM), and quality programs, such as Star Ratings, help to ensure beneficiaries optimize their medication use, continually experience better health outcomes, and receive care from a high quality program.
Express Scripts’ actionable data, clinical and regulatory expertise, and technology innovations deliver impactful solutions, such as Constellation® Ratings Advisor and our Quality Retail Network program, that help plans achieve high quality ratings and remain competitive in the Part D marketplace.
In addition to serving Medicare plans, we serve our own members. As a national Medicare Part D provider, we serve millions of Americans who find value in the Express Scripts Medicare® Plan. As the nation’s leading provider of Employer Group Waiver Plans (EGWPs), serving nearly 4 million retirees, we also help organizations sustain an attractive pharmacy benefit for retirees, which is key to retaining the best talent.
The Next 50 Years
While we celebrate all that these programs achieved over the past 50 years, we remain focused on their future success and challenges, and how we can continue to deliver the best value, care and service for health plans, employers and their members.
These programs have a rich history of change, and that will continue in the years ahead. Our rich history and proven track record with these programs helps ensure clients remain compliant with changing regulation at both the federal and state level. We’ve invested significantly in solutions for all regulated markets and have a team of focused experts ready to help clients continue to succeed.
Medicare and Medicaid also face rapidly growing populations, due to aging Baby Boomers and Medicaid expansion. Compounding that growth are expensive new therapies that treat large populations of patients, many of whom rely on Medicare, Medicaid and the health exchanges for their care. We are acutely focused on these challenges and have the expertise and solutions to help plans tightly manage their costs while providing access to those in greatest need.
As one of Medicare and Medicaid’s leading providers, it’s fitting that our mission at Express Scripts is the same as President Johnson’s mission 50 years ago. We’re proud to be part of this legacy, and believe our contributions to help keep medicine affordable will help ensure these programs celebrate more milestone anniversaries and are here for our children and grandchildren.
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