Improving Care for Pulmonary Conditions and Multiple Sclerosis

Jun 1, 2017
New Solutions leverage the core strengths of Express Scripts’ independent model, and combine technology, specialized care and strategic industry collaborations, to deliver greater value to payers and improved health outcomes for patients living with asthma, COPD and MS.
Tags
  • Asthma
  • COPD
  • Mutiple Sclerosis

Our independent model affords us the flexibility to work across the industry and supply chain to develop customized solutions that address the specific barriers to cost-effective care that vary by therapy class. Express Scripts is leading the way with meaningful, measurable and effective value-based programs that put medicine within reach of patients.

Today, we’re extending this leadership in innovation with two new Express Scripts SafeGuardRx® programs – The Pulmonary Care Value ProgramSM and The Multiple Sclerosis Care Value ProgramSM – that unite the personalized care model in our Therapeutic Resource Centers® and Accredo® specialty pharmacy with new strategies we’ve developed and tested in the Express Scripts LabSM to address the unique adherence barriers we see in patients with asthma, COPD and multiple sclerosis.

Helping Patients Breathe Easier

The Pulmonary Care Value Program (PCV) helps members who are being treated for asthma or COPD, serious conditions that place a burden on patients’ quality of life and lead to dangerous and costly complications. One in 12 Americans has been diagnosed with asthma; one in 15 has been diagnosed with COPD, the third-leading cause of death in the U.S.

Express Scripts addresses the unique barriers to adherence for patients with asthma and COPD patients through remote patient monitoring, patient engagement via Express Scripts’ exclusive collaboration with Mango Health, and a quality pharmacy network to deliver improved patient outcomes.

Remote Monitoring and TRC Support: High-risk patients with asthma or COPD who are prescribed a controller inhaler will be offered remote monitoring devices to help optimize their medication use. When specialized clinicians at our Pulmonary Therapeutic Resource CenterSM (TRC) observe the data from the monitoring devices, see that a patient is overusing their rescue inhaler or is nonadherent with their controller medication, they reach out and offer individualized care and support to get the patient back on track. Patients with asthma who participated in an Express Scripts Lab pilot program testing remote monitoring were breathing better during the 12-month program, as evidenced by a 60% to 80% reduction in the use of rescue inhalers, and a nearly 10% improvement in adherence with their asthma controller medication.

SGRx Mango

Patient Engagement: Our new patient engagement solution with Mango Health is a daily health platform that increases member engagement by gamifying health and rewarding patients for making healthy decisions leading to better health literacy and improved medication adherence. Through Mango’s app-based approach, powered by Express Scripts’ predictive data analytics and specialized care capabilities, we will deliver high-touch care to the pulmonary patients who need it most.

90-day prescriptions, preferred quality retail Network: Patients can obtain a 90-day supply of medication via the Express Scripts Pharmacy or one of the 10,000 pharmacies in the preferred quality network. Research shows that 85% of Express Scripts patients who fill 90-day prescriptions at retail or by home delivery are adherent, compared with just 67% who fill 30-day prescriptions at retail. Similar to our Diabetes Care Value ProgramSM, pharmacies in the quality-based pharmacy network are held to a higher performance standard by Express Scripts, and are rewarded for delivering on a set of quality metrics, including high medication adherence levels.

MS: Preparing for the Pipeline

Multiple sclerosis was the fourth-costliest drug class in 2016, with the average MS prescription costing more than $5,000. A rich drug pipeline and recently approved products are expanding treatment options for patients, including the 15% of patients with relapsing or primary progressive forms of MS who have not had effective treatment until 2017. These factors, along with high therapy discontinuation rates, contribute to a forecasted 10% increase in annual spending for the class for the next three years.

Patients with multiple sclerosis (MS) experience daily barriers and unpredictable, debilitating symptoms and depression.

The high-touch care model in our Multiple Sclerosis Care Value program will help patients improve adherence and outcomes while shielding payers from costs associated with discontinued therapy. The program features:

  • Early discontinuation reimbursement: Express Scripts will reimburse payers for the first three fills of preferred multiple sclerosis medications dispensed by our Accredo specialty pharmacy if a patient discontinues the medication within the first three months.
  • Accredo’s Multiple Sclerosis Therapeutic Resource CenterSM: Accredo specialty pharmacy delivers enhanced care, helping patients achieve a market-leading adherence rate to their multiple sclerosis therapy – 5% higher compared to other pharmacies. Specialized care at Accredo includes support such as specialist clinician reviews for safety, effectiveness and affordability; evidence-based, proprietary depression screening and counseling; patient-friendly tools, including outbound phone calls, text refill reminders, and online support from the MS community.

In addition to addressing medication nonadherence, each program lowers the net cost of treatment through Express Scripts’ National Preferred Formulary and utilization management programs.

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