Express Scripts program uses tech, interventions to aid care

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A data-driven program that uses new reimbursement strategies and tailored clinical initiatives is demonstrating positive results for costly therapies.

A program developed by Express Scripts, a pharmacy and medical benefits management company, is aimed at health plans and employers that are seeking help in managing the care of patients enrolled in value-based care who have conditions that traditionally have been expensive to treat, such as diabetes and pulmonary conditions.

The program, combining high-touch and high-tech capabilities, offers a glimpse of how technology companies, employers and payers can work together to improve care and achieve financial savings.

Express Scripts says its SafeGuardRx program includes clinical interventions built into each program, giving patients personalized care from a specialist pharmacist, technology-enabled engagement initiatives and simplified access to high-cost therapies.

"Innovations in medicine that deliver potentially breakthrough treatments but have exorbitant prices require equally innovative reimbursement solutions that ensure value for plans and patients," says Candice Michaelson, vice president of value based solutions, for Express Scripts, which merged with Cigna this past December.

With diabetes patients, program participants reported a 19 percent increase in the use of guideline-recommended statin therapy in 2018, reducing chances for heart attacks. In addition, increased engagement with the Mango Health app enabled patients to boost positive health behaviors, such as taking medication as prescribed, and Express Scripts had nearly 21,000 contacts with participating patients, either through phone calls or email, in 2018.

In treating pulmonary patients, the program reduced rescue inhaler use among people with asthma or chronic obstructive pulmonary disease by 72 percent in 2018 through the use of remote monitoring technology, which enables a pulmonary specialist pharmacist to engage with patients after they see increased rescue inhaler use. Less use of rescue prescriptions decrease the likelihood that patients will need medical intervention at a hospital or emergency department.

Benefits accrued to health plans as well. Express Scripts data show that in 2018, plans enrolled in SafeGuardRx programs saved more than $2.4 billion and experienced lower growth rates in drug spending among the costliest therapy classes compared with non-enrolled plans. The greatest difference was in the inflammatory conditions class, where the annual increase in spending on medications for conditions such as rheumatoid arthritis and Crohn's disease was nine times greater for non-enrolled plans, compared with enrolled plans (7.3 percent vs. 0.8 percent).

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