ST. LOUIS, Sept. 8, 2016 /PRNewswire/ -- Express
Scripts (NASDAQ: ESRX) today launched its Inflammatory Conditions
Care Value Program℠, a comprehensive approach to control costs and
improve care for people with inflammatory conditions like
rheumatoid arthritis, psoriasis and Crohn's Disease.
Through the combination of indication-specific formulary
management and refunds for early discontinuation of therapy, this
new program is the nation's most comprehensive approach to better
align a drug's price with the value that drug provides a
patient.
"Painful inflammatory conditions like rheumatoid arthritis can
cripple patients and obliterate payer budgets," said Glen Stettin, MD, Senior Vice President and
Chief Innovation Officer at Express Scripts. "By finding creative
ways to take better care of patients and protect our clients'
budgets, Express Scripts is uniquely tackling one of the biggest
health challenges facing our country today."
Approximately ten million Americans live with an inflammatory
condition. The biologic medications used to treat these conditions
became the country's costliest therapy class in 2015, representing
9.8 percent of all U.S. pharmacy spending. Express Scripts
forecasts that, left unchecked, total U.S. spending on these
medications will nearly double from 2015 to 2018.
Superior, Specialized Care for Patients
The program provides patients access to comprehensive and
clinically appropriate treatment options, while surrounding
patients with specialized care from the Accredo® specialty
pharmacy's Rheumatoid Arthritis and Inflammatory Disease
Therapeutic Resource Center®, where patients' average medication
adherence rate is 8 percent higher than what similar patients
achieve when filling the same medications from retail
pharmacies.
Accredo supports patients from their initial prescription
through highly specialized pharmacy and nursing care. It offers
thorough gap-in-care intervention outreach, proactive
therapy-effectiveness assessments, and extensive patient training
and education, all of which drive better adherence and health
outcomes.
"Specialized care greatly matters for patients with inflammatory
conditions," said Dr. Stettin. "In the same way patients go to a
rheumatologist for arthritis, they should work with expert
pharmacists who uniquely understand the illness and how best to
treat it. Our Therapeutic Resource Centers provide world-class
care, ensuring everyone gets the most out of their treatment."
Early Discontinuation Refunds
An average 30-day prescription for a medication to treat an
inflammatory condition currently costs U.S. plan sponsors
$3,036. Between 21 and 36 percent of
patients discontinue these medications within the first 90 days. In
these instances, the patients receive minimal health benefit for
the medication but employers are still burdened with the high cost
of those initial prescription fills.
As part of the Inflammatory Conditions Care Value Program,
Express Scripts is providing a unique savings guarantee, refunding
participating plan sponsors up to $6,000 if a patient discontinues any preferred
anti-inflammatory medication within the first 90 days. While
Express Scripts has previously offered refunds for early
discontinuation of a single medication, this new reimbursement
approach is the country's first value-based refund to span multiple
preferred medications that treat a group of diseases.
"The high price for these medications has always been a
budgetary challenge, but one of employers' growing frustrations is
paying for an expensive medication that doesn't ultimately help a
patient get healthier," said Dr. Stettin. "By sharing risk and
pursuing novel solutions, Express Scripts is minimizing our
clients' financial exposure if a patient needs to switch
medications or discontinue treatment early."
More Precise, Indication-Based Drug Management
Inflammatory diseases comprise several very different types of
conditions, from rheumatoid arthritis to dermatological conditions
like psoriasis, to inflammatory bowel conditions like Crohn's
disease. Because the industry has historically constructed
formularies to cover the entire range of inflammatory conditions,
many of the medications that are narrowly indicated for one or two
specific conditions have not been able to compete effectively with
the two major nonspecific anti-inflammatory medications, which
together currently represent 73 percent of the U.S. market share
for this therapy class.
As part of the Inflammatory Conditions Care Value Program,
Express Scripts will now manage a formulary category around each
individual inflammatory condition. Niche, single-indication
products will be able to compete head-to-head with the nonspecific
products, and this more precise approach to formulary management
will enable Express Scripts to leverage the additional competition
to make this therapy class more affordable for participating
plans.
Express Scripts is a pioneer in indication-level management of
drugs, which is a core component of our existing Oncology Care
Value Program℠. Rigorous clinical documentation ensures the
appropriate therapy option is used and patients get the medication
they need. As more treatment options become available, the
opportunities increase to drive competition and drive down
costs.
All patients stable on their current therapy will continue to
have access to the medication they are currently taking.
The Express Scripts SafeGuardRx Solutions
The Inflammatory Conditions Care Value Program, which is a free
and optional solution for Express Scripts clients, will be
implemented January 1, 2017. It is
the sixth and latest addition to the Express Scripts SafeGuardRx
suite of custom solutions:
- Announced last week, the Diabetes Care Value Program℠ will
enable patients to fill 90-day diabetes medication prescriptions at
a quality-based pharmacy network, while guaranteeing that payers'
future spend on diabetes medications will remain below a
per-patient cap.
- 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.
About Express Scripts
Express Scripts puts medicine within reach of tens of millions
of people by aligning with plan sponsors, taking bold action and
delivering patient-centered care to make better health more
affordable and accessible.
Headquartered in St. Louis,
Express Scripts provides integrated pharmacy benefit management
services, including network-pharmacy claims processing, home
delivery pharmacy care, specialty pharmacy care, specialty benefit
management, benefit-design consultation, drug utilization review,
formulary management, and medical and drug data analysis
services. Express Scripts also distributes a full range of
biopharmaceutical products and provides extensive cost-management
and patient-care services.
For more information, visit Lab.Express-Scripts.com or follow
@ExpressScripts on Twitter.
MEDIA CONTACT:
David Whitrap
314-684-6514
dwhitrap@express-scripts.com
INVESTOR CONTACT:
Ben
Bier
314-810-3115
investor.relations@express-scripts.com
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