Members in Consumer Directed Health Plans Need Tools to Make Informed Decisions

Express Scripts takes a holistic approach to supporting members enrolled in Consumer Directed Health Plans.
Preventative medications

It’s estimated that more than 9 out of 10 employers are offering a consumer directed health plan (CDHP) to their employees this year. Also known as high-deductible health plans, CDHPs can be designed in a variety of forms. Typically, a CDHP offers a high-deductible health plan with a spending account for out-of-pocket costs, such as a health savings account (HSA) or health reimbursement arrangement (HRA). Most employers still offer a CDHP as a choice alongside a traditional PPO or HMO.

Plan sponsors are turning to CDHPs as a way to lower premiums and shift more costs to consumers with the belief that patients will take a more proactive approach to purchasing health care and make the most informed choices possible as they bear more out-of-pocket expenses.

Express Scripts is in front of these trends and we take a holistic approach to supporting CDHP members. We work to ensure that members who have greater financial responsibility for managing their care are able to do so effectively in terms of making better decisions that deliver healthier outcomes.

The Power of Preventive Medications

One of the key ways CDHP members receive support is though a Preventive Medications program. This helps improve member adherence to medications, reducing the risk of worsening conditions and lowering overall healthcare costs.

Express Scripts’ recently released Drug Trend Report shows that out-of-pocket costs for patients with diabetes in high-deductible plans were cut in half when insulin is included on the preventive drug list.

Diabetes is just one of several covered conditions. Our standard set of preventive medication lists may include the following:  

  • Asthma/COPD medications
  • Blood pressure lowering medications
  • Blood thinners
  • Cavity prevention agents
  • Certain vitamins and fluoride supplements
  • Cholesterol lowering medications
  • Colonoscopy preparation agents
  • Diabetic medication and supplies
  • Migraine prevention
  • Miscellaneous antivirals
  • Osteoporosis prevention agents
  • Respiratory syncytial virus prevention agents
  • Smoking cessation agents
  • Vaccines
  • Weight loss agents

Tools to Make Informed Decisions

CDHP members need access to clear information about their healthcare options and the function of their benefit. We help simplify the complexities of a plan by:

  • Deploying the right tools and support to help members make better decisions when using their pharmacy dollars. This support includes a team of patient care advocates, dedicated to CDHP members, and prescription benefits review statements, which analyze recent prescription activity, predict a member's future costs, and help identify ways members can save money. In addition, our mobile app allows members to compare medication costs to drive members to the lowest cost option.
  • Providing clinical safety nets to support adherence to prescribed therapies. In addition to preventive care, we’ve implemented a member outreach tool. ScreenRx uses a proprietary, predictive model that identifies non-adherence before it begins. After identifying members at risk of non-adherence, we can intervene proactively and avoid any gaps in care. 
  • Educating members on the dynamics of CDHP plans. Industry-leading advocacy tools incorporate behavioral science-based member communications (website, chat function, educational materials, mobile app) to empower members to use their benefit effectively.

CDHPs are now the predominant plan design in the marketplace. In fact, it’s estimated 30% of employers will offer a CDHP as the only plan option available to employees this year. It’s essential that members have the support needed to successfully navigate these plans and make informed health care decisions.

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