Express Scripts implements latest Diabetes Care Value Program


ST. LOUIS - Express Scripts on Wednesday announced the launch of its Diabetes Care Value Program, the industry's most comprehensive approach to improve pharmacy care while controlling plan costs for people with diabetes.

The new program – part of the Express Scripts SafeGuardRx suite of pharmacy solutions – combines a quality-based pharmacy network that includes Walgreens and more than 1,200 independents, a holistic approach to diabetes patient care and cost management and financial guarantees that will significantly reduce participating plans' anticipated increase in diabetes-drug spend for 2017.

"Diabetes is wreaking havoc on patients, and it is also a runaway driver of cost for payers," stated Glen Stettin, SVP and chief innovation officer at Express Scripts. "Our Diabetes Care Value Program helps our clients and diabetes patients prevail over the cost and care challenges created by this terrible disease."

As part of the Diabetes Care Value Program, Express Scripts is guaranteeing per-patient spending caps that will result in participating plans experiencing an average increase in diabetes drug-spend in 2017 that is approximately half of what the industry is currently forecasting for U.S. commercial payers. As reported in Express Scripts' 2015 Drug Trend Report, U.S. diabetes prescription drug spending increased 14% in 2015 and – for those plans not participating in Diabetes Care Value Program – is expected to grow an additional 18% through 2016 and another 17.7% in 2017.

"We plan to increase medication adherence, broaden insulin options for patients and bend down the cost curve of what is currently the costliest class of traditional prescription drugs," Stettin said. "As we have done with our other SafeGuardRx solutions, Express Scripts will assume financial risk for drug spending in excess of the caps to protect our clients from skyrocketing costs and budget uncertainty."

The Diabetes Care Value Program features a network of preferred pharmacies that will deliver on a set of quality metrics, including high medication adherence levels for patients with diabetes. Members of participating plans will be able to receive 90-day supplies of their diabetes maintenance medications from more than 10,000 pharmacies across the United States – including via home delivery at the Express Scripts Pharmacy, at all Walgreens pharmacies and at more than 1,200 independent retail pharmacies.

"As an independent pharmacy benefit manager, we have the flexibility to work with any and all pharmacies to achieve our clients' specific care, cost and geographic access objectives," Stettin said. "With our emphasis on achieving quality metrics, this new diabetes pharmacy network ensures our retail partners are aligned and focused on providing the care that people with diabetes need."

All patients enrolled in the program, regardless of which network pharmacy they choose for filling a prescription, can access additional clinical counseling from the diabetes pharmacists within the Express Scripts Diabetes Therapeutic Resource Center.

The Diabetes Care Value Program is projected to boost the average medication adherence rate for enrolled patients by 5%, reducing downstream health complications and healthcare costs. Currently, $4,690 per diabetes patient is spent each year on medical expenses that could have been avoided if patients had taken their diabetes medications as prescribed.

"Nearly 9 of 10 people with diabetes also have high blood pressure or high cholesterol, and one out of every four is currently taking an antidepressant," Stettin said. "Our Diabetes Care Value Program surrounds each person with the specialized knowledge and support needed to manage increasingly complex therapies that treat diabetes and related conditions."


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