The list prices for prescription drugs are higher in the United States than anywhere else in the world. Despite these high prices, the work of Express Scripts by Evernorth and other pharmacy benefit managers (PBMs) significantly reduces the amount individuals pay for the medicines they need by negotiating lower costs and creating broad pharmacy networks that widen access.
“For medications treating some of the most common conditions, Express Scripts members pay far less than commonly used public benchmarks,” said Harold Carter, senior vice president, pharma trade relations. “This is made possible because PBMs are continuously working to negotiate lower net prices for prescription drugs. We drive competition to lower the net costs paid by members and their plan sponsors, including federal programs and employers who provide health care benefits for their workforce.”
As an example, he pointed to Eliquis and Xarelto – two potentially lifesaving blood thinners which prevent blood clots in patients. Across our commercial book of business, Express Scripts members pay less for these vital medicines compared to the average wholesale price (AWP) and the Medicare-negotiated maximum fair price (MFP). The average amount an Express Scripts member paid out of pocket for a 30-day supply of each blood thinner was less than 10% of the list price and less than a third of the price negotiated by Medicare.
Another example is Imbruvica, which treats several forms of blood cancer. On average, Express Scripts members paid out-of-pocket costs that were less than 4% of the list price and less than 8% of the Medicare-negotiated price. These savings demonstrate the dramatic markups that manufacturers will set for their medicines and the intrinsic value the PBMs provide to members and plan sponsors.
Express Scripts is a leader in ensuring that people living with diabetes have greater access to more affordable prescriptions. “Express Scripts has been an industry leader in driving down the net cost of diabetes medications, which includes non-insulin medications for people living with type 2 diabetes,” said Kasey Raetz, vice president of product and pharma contracting and strategy for Evernorth. “Long before the federal government stepped in to negotiate prices for many of today’s most prescribed medications, our teams have worked hard each and every day to deliver lower net costs for those we serve.”
Our pharmacy benefit services leverage different programs to hold manufacturers accountable on their prices and deliver affordable access, Raetz shared. That is the case with glucagon-like peptide-1 drugs – widely known as GLP-1s – which have swept headlines and are used to treat common, prevalent conditions like diabetes, manage obesity, and reduce the risk of cardiovascular events. GLP-1s also have been shown to slow the progression of kidney disease in patients with type 2 diabetes.
Demand for GLP-1s has soared in the last few years, creating widespread shortages and unmet patient needs. “That’s why we launched a data-driven program that gives clients optionality and predictability in managing costs by offering the first-ever GLP-1 financial guarantee from a PBM,” Raetz said.
One such GLP-1, semaglutide (better known as Ozempic, Rybelsus, or Wegovy), was selected for Medicare price negotiation earlier this year.
Through Express Scripts’ negotiations, programs to lower net prices of drugs, and prescription benefit designs, members pay only 4% to 5% of the list price for these medications. Just as Express Scripts took steps to lower the net price of insulin years before government intervention, it’s working to do the same with GLP-1s years before a Medicare-negotiated price would take effect.
These medications are just a few examples of the significant and quantifiable out-of-pocket savings Express Scripts is enabling for its members, said Adam Kautzner, president, Evernorth Care Management & Express Scripts.
“We pride ourselves on our culture of innovation,” Kautzner said. “PBMs are a vital part of the health care system, and we are proud to work tirelessly to meet the ever-evolving needs of the clients and patients we serve.”
