DELIVERING VALUE and AFFORDABILITY TO CONSUMERS
Express Scripts saves consumers money.
A prescription doesn’t work if it is priced out of reach for consumers
Express Scripts relentlessly advocates on behalf of our clients and their members to make lifesaving therapies and medications more affordable. Navigating the health care system can be hard. Express Scripts simplifies access to the most clinically effective medications and helps people stay on them—to help prevent disease progression and costly downstream interventions.
Express Scripts and other PBMs work to evaluate a drug’s clinical effectiveness and negotiate lower costs to help drive out-of-pocket savings for patients—by $1,0401 annually, on average.
In addition, Express Scripts creates unique programs, such as the Real-Time Prescription Benefit Tool that allows providers and customers to see if a medication is covered, how much it will cost, whether home delivery is available, and, if searching for a brand name drug, see the costs for any generic or biosimilar medications.
Express Scripts enrolled members enrolled pay:
per prescription with Medicaid prescription drug coverage2
Express Scripts offers value-based solutions that can help chronic conditions
More than 125 million Americans suffer from chronic conditions. Poor management of these conditions—including lack of medication adherence—can lead to dire consequences, including hospitalizations and even death. In fact, medication nonadherence contributes up to nearly $300 billion in health care costs annually.3
Express Scripts’ SafeGuardRx program seeks to address this issue through a suite of solutions across eleven complex and costly disease states, including oncology, inflammatory conditions, multiple sclerosis and other conditions.
Specifically, SafeGuardRx provides proactive medication adherence monitoring and condition-specific coaching services to customers. Through this program, Express Scripts pharmacists are available to talk through topics such as: medication options, side effects, barriers to medication adherence and possible interactions.
As a result of SafeGuardRx, clients and consumers have seen not only substantial savings, but also higher therapy completion rates and improved clinical outcomes:
higher adherence than industry averages for participants with chronic illnesses.4
higher medication adherence for patients with pulmonary hypertension enrolled in the Rare Conditions Care Value Program, compared to patients not in the program.5
of consumers enrolled in the Weight Management Care Value and Diabetes Care Value lost an average of 3.6% of their body weight through our digital tools.6
in savings for plans enrolled in SafeGuardRx in 2022, covering 86 million customers.5
Lowering the cost of diabetes care and insulin
For people living with diabetes, the high list price of insulin and other diabetes drugs has the potential to create financial burdens. At Express Scripts, it is our job to support access to safe treatments at a cost patients and employers can afford, so we got to work. Since 2020, our Patient Assurance Program (PAP) has ensured people with diabetes in participating plans do not pay more than $25 for a 30-day supply of insulin—well before government mandates and recent insulin manufacturer moves.
We haven’t stopped at insulin.
Because diabetes management doesn’t always require insulin, particularly for Type 2 diabetes, our Patient Assurance Program (PAP) has expanded to include non-insulin diabetes treatments, such as DPP-4 inhibitors, GLP-1 agonists, and SGLT2 inhibitors, capping out of pocket costs at $25 for up to a 34-day supply.
By capping the cost of diabetes medications—thereby addressing cost as a barrier to care—the PAP has significantly improved adherence and patient clinical outcomes.
Today nearly two-thirds of Express Scripts members pay $35 or less for their insulin at the pharmacy counter – either through the Patient Assurance Program or their plan’s benefit design.
For patients, their total diabetes-related cost share—inclusive of medical and pharmacy costs—decreased by 50.5% since 2020.
In 2022, medical cost savings for plan sponsors totaled $244+ million—close to $2,500 in savings per patient—due to increased adherence and improved outcomes.7
The Patient Assurance Program resulted in more than $18 million in patient savings at the pharmacy counter for insulin in 2022—and more than $200 million in total patient savings since 2020.
A look at diabetes
For patients with diabetes, Express Scripts has worked to address costs for insulin, including the Patient Assurance Program where patients spend no more than $25 for a 30-day supply—well before government regulations and recent insulin manufacturer moves. Consumers taking insulin saved more than $18 million with point-of-sale discounts in 2022 alone, part of more than $45 million in member savings on insulin since the program launched.8
In 2020, the average out-of-pocket cost for diabetes patients enrolled in coverage through one of Express Scripts’ clients was $12.36 for a 30-day supply9
Semglee, the first interchangeable biosimilar insulin, was preferred on the Express Scripts National Preferred Formulary in 2022—resulting in ~$20 million in savings for clients and customers10
Express Scripts helps provide stability for consumers by capping out-of-pocket costs
Recognizing the importance of prescription drug affordability in today’s economic environment, Express Scripts has introduced an innovative solution, the Copay Assurance Plan, which caps out-of-pocket costs for medications for people that have employer-sponsored health insurance (with limited or no cost increases to plan sponsors based on their benefit design).
Starting in 2024, customers enrolled in the program will pay no more than $5 for generics and specialty generics, $25 for preferred brand drugs, and $45 for preferred specialty brand drugs when they fill a prescription, even before they meet their deductible.
Express Scripts helps improve population health, reduce waste and increase medication adherence
Express Scripts processes more than one billion pharmacy claims annually, helping people live their healthiest lives. We harness real-time data, insights, and care management programs, such as patient and provider interactions, to help patients start and stay on the most effective treatments.
Studies show that approximately one percent of pharmacy costs are attributable to fraud, waste, and abuse, amounting to billions of dollars in unnecessary costs. Express Scripts uses drug utilization reviews to reduce waste and helps ensure the prescribed medication is appropriate for the individual patient.11
The Coming Wave of Biosimilar Medications
Averages based on Express Scripts entire book of business
Risk Management and Healthcare Policy, “Adherence and health care costs,” February 20, 2014
Value-based Health Care Solutions to Contain Costs | Evernorth (SafeGuardRx Data)
Weight Management Care Value Program | Express Scripts (SafeGuardRx Data)
Savings estimated based on 2022 Evernorth study of plans enrolled in Patient Assurance
Affordable Cost of Diabetes Medication Can Improve Health Outcomes | Evernorth
Express Scripts Will Unlock $20 Million in Savings for Clients in 2022 by Preferring the First Interchangeable Insulin Biosimilar | Evernorth and FDA, “FDA Approves First Interchangeable Biosimilar Insulin Product for Treatment of Diabetes,” July 28, 2021