Delivering Value & 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 offers value-based solutions that can help chronic conditions.
in savings for plans enrolled in SafeGuardRx in 2022, covering 86 million customers.7
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.
But 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.
Example: 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.9
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 1 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 1 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.12