Better Decisions Stronger Alignment

Feb 21, 2014
Express Scripts solutions leverage clinical expertise, use of data and understanding of human behavior to drive better decisions and healthier outcomes.
  • Accountable Care Organization (ACO)

A look at healthcare headlines these days shows a deck stacked against plan sponsors and members. Branded drug inflation is skyrocketing, in particular for specialty drugs that provide unique solutions for the most complex and chronic conditions. The regulatory burden is increasing, adding overhead for payers. Once-in-a-generation changes in American healthcare are confusing providers and patients alike. Meanwhile, our inefficiency in medical care and spending is among the highest in the world – in fact, Express Scripts has identified more than $418 billion in pharmacy-related waste alone.

But there are solutions. Express Scripts’ mission is working with all types of payers – from health plans and private employers, to labor unions and the federal government – to control costs while improving health outcomes. We are aligned with the interests of payers and patients, and uniquely positioned to pull levers that make a difference.

Here are a few examples:

Managing the Growing Trend in Specialty Medications

Spending on specialty medications those to treat more complex and rare conditions such as multiple sclerosis or cancer – has increased at an alarming rate. While utilization only represents 1% of drug volume, these medications drive 35% of the overall drug spend. Specialty trend forecasts say specialty will comprise half of total drug spend by 2015.   

Through our specialty pharmacy, Accredo, we are uniquely positioned with products that focus on delivering best-in-industry member care from specialist pharmacists and nurses, the broadest medication access and a suite of tools for trend management.

Solutions, such as Medical Benefit Management and our oncology decision support module, provide a comprehensive overview of costs and appropriate care. Clients that implement these solutions have seen their annual specialty drug spend increase at rates half as high as companies that do not.

Supporting a Clear Regulatory Path for Biosimilars

With the increase in specialty drug spend, Express Scripts sees great potential for lower-cost, clinically equivalent biosimilar drugs. Unfortunately, biosimilars are not yet available in the U.S. At Express Scripts, we developed a financial model projecting that the U.S. would save $250 billion between 2014 and 2024 if just a handful of biosimilars were to enter the market. We advocate for a clear regulatory path to bring these drugs to market. 

Reducing Costs for Patients, Clients and the Country With Home Delivery

Express Scripts data found that the country could save and additional $96.3 billion if every patient used home delivery for their maintenance medications. Additionally in an audit of the TRICARE mail-order pharmacy, the Department of Defense inspector general found that the program reduced errors, enhanced patient safety and saved the government 16.7% by using our home delivery rather than retail pharmacies.

Optimizing Through Narrow Networks

Meeting members’ diverse needs is our goal and that includes providing the best retail options. Optimizing retail pharmacy networks to create the highest quality, most cost-effective network is one way payers can address the balance between cost and care for nonmaintenance medications. The Express Advantage NetworkSM is a choice-based solution that combines tiered retail networks with member cost-sharing. The result is a more affordable pharmacy network – without sacrificing patient choice, access or care.

All of these solutions – and more – leverage our clinical expertise, use of data and understanding of human behavior to drive better decisions and healthier outcomes for patients and payers alike.

Author Bio

Lab Staff
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