Reducing Diabetes Drug Spending and Health Risk

For our clients, caring for members with diabetes is a significant challenge. As we noted in Diabetes Dilemma: U.S. Trends in Diabetes Medication Use, a research report we published last year, diabetes has been the most expensive traditional therapy class for our client’s pharmacy plans for six consecutive years. Payers spend about $9,000 more in total medical expenses per person with diabetes, nearly three times more than those without diabetes.

With 30 million people in the U.S. currently diagnosed with diabetes, and another 84 million (one-in-three) considered prediabetic, the challenge for payers and patients will only continue to escalate.

For the 800 plan sponsors who enrolled in our Diabetes Care Value® program, however, that trajectory is changing. By combining specialized diabetes pharmacy care with benefit strategies, such as utilization management and quality pharmacy networks, we are tackling the diabetes dilemma in ways others simply cannot.

Greater Savings, Greater Outcomes

An analysis of the inaugural year of our innovative program shows we delivered a 19% reduction - $360 per member per year - in drug spending for diabetes. In 2017, the program delivered a total savings of $42.6 million.

In addition, Express Scripts diabetes specialist pharmacists, using advanced clinical analytics, improved compliance with recommended treatment guidelines by starting an additional 15 percent of enrolled patients at risk for heart attack or stroke on statin therapy. If all Express Scripts plans were to similarly increase statin use among their members with diabetes for better cholesterol control, they could prevent an estimated 13,000 heart attacks over the next 10 years.

Holistic Approach

The SafeGuardRx^® platform provides the highest level of clinical care and more affordable healthcare benefits while helping to ensure our clients, who pay the majority of the cost of treatment,  get the most value from the medicines their members take for this far too prevalent and devastating condition.

Earlier this year, Express Scripts enhanced the Diabetes Care Value program with two patient engagement tools:

• Active and connected blood sugar monitoring that allows Express Scripts diabetes pharmacists to track and analyze blood glucose readings to provide proactive and meaningful patient interventions.
• The Mango Health mobile platform, powered by Express Scripts, which combines personalized messaging and reminders, innovative technology, gamification features and incentive rewards to promote adherence and adoption of better behaviors that can lead to improved health.

These advanced capabilities joined the other components of this comprehensive program that also leverages a novel quality-based pharmacy network of more than 10,000 pharmacies nationwide, and whole-patient clinical consulting and care from Express Scripts diabetes specialist pharmacists.

The SafeGuardRx Platform

Using data and technology in innovative ways to facilitate the most appropriate and effective treatments, provide high-touch clinical support for patients, and apply value-based payment strategies, SafeGuardRx delivers better medication adherence, higher therapy completion rates, greater compliance with clinical guidelines and substantially reduced wasteful healthcare spending. In addition to diabetes, the condition-specific SafeGuardRx solutions address some of the costliest therapy classes for payers, including cancer, hepatitis C, high blood cholesterol, inflammatory conditions, multiple sclerosis, pulmonary conditions and rare diseases.

When we created our Diabetes Care Value program in 2016, we took on a tough challenge to deliver greater affordability and greater outcomes for patients. By remaining diligent and continuing to innovate around value-based payment programs for prescription drugs, Express Scripts is turning theory into practice bringing patients the access to the clinical care they deserve, while reducing cost, waste and inefficiencies for payers.