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Express Scripts rolls out value program around inflammatory conditions


ST. LOUIS, Mo. — In a move it says is aimed at controlling costs and improving care for patients with such conditions as rheumatoid arthritis and psoriasis, Express Scripts is rolling out a new Inflammatory Conditions Care Value Program. The program, which will be added to Express Scripts’s SafeGuardRx suite of solutions in January 2017, combines indication-specific formulary management and refunds for early discontinuation to align a treatment’s price — biologic treatments for inflammatory conditions made up 9.8% of U.S. pharmacy spending in 2015 — and the value it provides, the company said. 


“Painful inflammatory conditions like rheumatoid arthritis can cripple patients and obliterate payer budgets,” Express Scripts SVP and chief innovation officer Dr. Glen Stettin said. “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.”


The new program offers clinically appropriate treatment options and specialized care from Accredo specialty pharmacy’s Rheumatoid Arthritis and Inflammatory Disease Therapeutic Resource Center, which provides specialized pharmacy and nursing care. 


"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."


The program also provides a guarantee to refund plan sponsors up to $6,000 id a patient discontinues a preferred anti-inflammatory medication within the first 90 days of therapy. Additionally, Express Scripts will manage a formulary category around each inflammatory condition, which the company says will allow for more precise formulary management, enabling it to use the resulting competition to make the therapy class more affordable. 


The Inflammatory Conditions Value Program’s announcement follows that of the Diabetes Care Value Program, which will enable patients to fill 90-day diabetes scripts at a quality-based pharmacy network while ensuring payers’ spending stays below a certain per-patient cap. They join the company’s Hepatitis Cure Value Program, the Cholesterol Care Value Program, the Oncology Care Value Program and the Express Scripts Inflation Protection Program in its SafeGuardRx suite. 


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