ST. LOUIS, Mo., — Express Scripts, the pharmacy benefits management business of Evernorth, a subsidiary of The Cigna Group (NYSE: CI), today announced several actions to further evolve its pharmacy benefit management (PBM) model. The new solutions and capabilities will increase access to affordable medicines, and drive greater transparency and predictability. As part of its long-standing commitment to accelerate pharmacy care and lower the cost of prescription drugs for more than 100 million Americans, Express Scripts is further aligning incentives across the pharmaceutical supply chain, consumers, and clients, with new products available starting in summer 2023.
Driving Down Costs for Consumers
Express Scripts is introducing a new and innovative solution, the Copay Assurance plan, which caps consumer out-of-pocket costs for prescription drugs under a client’s prescription drug benefit. This means 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 every time they fill a prescription. The program will immediately guarantee these lower out-of-pocket rates — customers will not have to wait to meet any deductible levels.
“A prescription drug doesn’t work if it’s priced out of reach. Reducing out-of-pocket costs for consumers is the single best thing we can do to improve the health of those we serve,” said Adam Kautzner, Pharm.D., President of Express Scripts. “Express Scripts was first to deliver a $25 price cap on out-of-pocket costs for insulin and other diabetic treatments, which has saved consumers more than $45 million in two years. Our new Copay Assurance plan builds on this success and aggressively expands our efforts across medications to treat all diseases — providing millions more people with predictability and peace of mind at the pharmacy counter.”
Additionally, Express Scripts is working with employer and health plan clients to offer consultative options to bring better affordability and predictability. This includes: adopting the broadest lists of preventive prescription drugs that are either fully covered or covered at a discount, lower premiums and deductibles, and increased Health Savings Account contributions for lower- income consumers based on IRS income requirements.
Offering Clients a New Level of Transparency
Express Scripts’ new ClearCareRx offers employer, health plan, and government employer clients the option of a transparent economic model by providing clear and predictable costs for prescription drug benefits:
Clients receive 100% of drug rebates that Express Scripts obtains by negotiating with pharmaceutical companies.
Clients pay one simple fee to cover the administration of pharmacy benefits, PBM product services, reporting and analytics, and is 100% auditable.
“Expanding on our proven track record of driving transparency, ClearCareRx drives greater simplicity, with strategies to further reduce costs and improve health and pharmacy care. If we don’t deliver on a client’s goals, they pay less, guaranteed,” Kautzner added. “We are built to work on our clients’ terms. That means constantly coming to the table with innovative pharmacy benefits and tailored approaches that do more for them and the unique needs of their people.”
Enhanced Disclosures and Clarity
Express Scripts is further evolving its transparency to consumers and clients and enhancing its disclosure practices, including:
Demonstrating the value consumers and clients can expect from their pharmacy benefit services: Starting in 2024, prescriptions will include an easy-to-understand digital pharmacy benefits statement for consumers — sharing drug price information, out-of-pocket costs, and the value delivered by Express Scripts. This benefit will be implemented across all 65,000 pharmacies in Express Scripts’ networks, including Accredo® specialty pharmacy, and Express Scripts Pharmacy.
Enhanced financial and fee disclosure for clients utilizing spread pricing: Express Scripts offers different PBM pricing options that clients can select based on their unique needs. Some of these options include spread pricing, a value-sharing arrangement for the discounts Express Scripts negotiates with retail pharmacies for prescription medications. Beginning with the 2023 plan year, Express Scripts will provide clients enhanced financial and fee disclosure regarding their spread pricing arrangements for Form 5500 reporting and other plan administration functions. The Form 5500 Series is a compliance, research, and disclosure tool for the U.S. Department of Labor (DOL), other Federal agencies, Congress, as well as for plan participants and beneficiaries, and the private sector to assess employee benefit, tax, and economic trends and policies. Express Scripts will provide the same level of increased disclosure to its non-ERISA clients to help support them in understanding the services Express Scripts provides.
Launch of a microsite providing disclosures, and filings with the SEC: Concurrent with the release of first quarter earnings by The Cigna Group, Express Scripts will launch a new microsite that will provide additional information about the Express Scripts model. The Cigna Group will also provide additional disclosures regarding its PBM business in its upcoming SEC 10-Q filing.
“Our mission is simple: lower the cost of prescription drugs for the one in three Americans we serve. Today’s actions demonstrate our ongoing commitment to that mission, and helps clients and consumers see the value of their pharmacy benefits at work more quickly in their daily lives. Because at the end of every prescription is a consumer and client putting their trust in us — that’s a responsibility that drives us each day,” Kautzner said.
As a leader in innovative solutions designed to drive meaningful consumer and client outcomes and performance, the initiatives announced today represent Express Scripts’ long-standing commitment to advance the PBM model. Previous programs include SafeGuardRx®, Embarc Benefit Protection®, and the Patient Assurance Programsm — which combined with effective negotiation and medical management, saved consumers and clients more than $56 billion in 2022.
About Evernorth Health Services
Evernorth Health Services creates pharmacy, care and benefits solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Evernorth capabilities are powered by our businesses, including Express Scripts, Express Scripts® Pharmacy, Accredo, eviCore and MDLIVE, along with holistic Evernorth platforms and solutions that move people and organizations forward. All Evernorth solutions are serviced and provided by or through operating affiliates of Evernorth Health, a wholly owned subsidiary of The Cigna Group (NYSE: CI), or third-party partners. Learn more at evernorth.com.
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