Express Scripts ClearNetwork offers employers and health plans a new option for simple, “cost-plus” pharmacy pricing for brand, generic, and specialty medications.
ST. LOUIS, Mo., November 14, 2023 – Express Scripts, the pharmacy benefits management (PBM) business of Evernorth, a subsidiary of The Cigna Group (NYSE: CI), today announced a new pharmacy network option, Express Scripts ClearNetworkSM, for its clients – including employers, government organizations, and health plans. It is designed for clients seeking an option for cost-based pricing for prescription drugs and pharmacy services and a seamless experience for their employees and members. Through Express Scripts ClearNetwork,clients pay a straight-forward estimated acquisition cost for individual medications, in addition to a small markup for pharmacy dispensing and service costs.
“We are constantly innovating to provide our clients with new options that meet their needs and enable them to build custom pharmacy benefits that best support their plans and members,” said Adam Kautzner, Pharm.D., President of Express Scripts. “The Express Scripts ClearNetwork leverages our scale, relationships, and deep understanding of the pharmaceutical supply chain to create an easy-to-follow option for clients looking to simplify what they pay for prescription drugs, while supporting a seamless, convenient member experience.”
Express Scripts ClearNetwork uses the lowest of several established third-party industry benchmarks – including Predictive Acquisition Cost, National Average Drug Acquisition Cost, and Wholesale Acquisition Cost – to estimate the acquisition cost for an individual drug. Then, pharmacy and administration costs are added. First, a flat fee goes to the pharmacy to dispense medications. Second, a fee of no more than 15 percent of the cost of the drug is added. This fee is shared with participating pharmacies to ensure a reasonable profit for them, and covers the seamless management of claims and network services by Express Scripts.
Available beginning in early 2024, Express Scripts ClearNetwork will apply to all prescription drugs on a plan sponsor’s list of covered generic, branded and specialty medications. Express Scripts is making this reimbursement model available to a broad network of more than 65,000 retail pharmacies in its network to ensure participating members will be able to conveniently access their medications using their pharmacy benefit.
“This new model differs from other pricing options where Express Scripts negotiates discounts with pharmacies to meet guaranteed rates for clients,” Kautzner added. “Express Scripts ClearNetwork is a simple pricing option that reinforces the value of our work to help consumers easily access the medications they need, while also shining a light on the root cause of high drug costs – drug manufacturers who set and raise prices.”
Building on a Commitment to Transparency and Affordability
This latest pharmacy pricing model builds on an existing suite of transparent options offered by Express Scripts. Earlier this year, Express Scripts announced several actions to drive greater transparency and predictability, including ClearCareRx™ which offers another transparent pricing option for clients.
Express Scripts also has a proven history of innovation and industry-leading pharmacy service options to support the individual needs of its clients and help members save on prescription drugs. Programs like Copay Assurance Plan™ , SafeGuardRx®, Embarc Benefit Protection®, and the Patient Assurance Program® combined with effective negotiation and medical management helped save consumers and clients more than $56 billion in 2022 alone.
About Evernorth Health Services
Evernorth Health Services creates pharmacy, care and benefits solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Evernorth capabilities are powered by our businesses, including Express Scripts, Express Scripts® Pharmacy, Accredo, eviCore and MDLIVE, along with holistic Evernorth platforms and solutions that move people and organizations forward. All Evernorth solutions are serviced and provided by or through operating affiliates of Evernorth Health, a wholly owned subsidiary of The Cigna Group (NYSE: CI), or third-party partners. Learn more at evernorth.com.