Why EGWP Is the Best Option for Employers and Retirees

Providing prescription benefits to retirees in an affordable and sustainable way can be complex and challenging for employers. The maze of government regulatory requirements can make offering a Medicare Part D-compliant prescription plan seem difficult to balance. Express Scripts’ approach in partnering with employers to provide retiree prescription drug coverage enables employers to provide continuity of benefits to their members while effectively managing costs and keeping them safe. Express Scripts focuses on three main areas for success.

Keeping It Seamless

Employers’ most common goal is to maintain a seamless transition for their members when they age from active to retiree status. At Express Scripts, we partner with employers to simplify an otherwise complex process in mirroring the active plan as closely as Medicare allows, in order to implement an Employer Group Waiver Plan (EGWP). This helps employers to continue to provide the same level of coverage and copays to their retiree members, keeping their out-of-pocket drug costs the same as what they have become accustomed to under the active benefit. Additionally, members are assisted through the transition phase and on an ongoing basis by highly trained Medicare Patient Care Advocates that have insight to Centers for Medicare and Medicaid Services (CMS) guidelines and member benefit design.

Managing Spend and Containing Cost

On average, members within a retiree population typically fill four times more prescriptions than active members. Employers often feel like they have little control over drug spend and programs they can implement because of the need to adhere to a variety of government regulations. These complex dynamics add to the challenge of effectively managing costs to allow for longevity of employer group benefits.

With that in mind, Express Scripts leverages flexibility within the EGWP model to help employers collect federal subsidies as well as manage utilization and drug spend.  Our Market Strategist team works to closely align current benefit design and clinical programs - in addition to making recommendations based on successes within our book of business and EGWP market trends - keeping member experience top of mind. Our goal is to help identify optimal subsidies and savings opportunities while ensuring minimal member disruption.

On average, Express Scripts EGWP clients experience subsidies of approximately $1,460 per member per year, a 191% increase from subsidies received while in the Retiree Drug Subsidy (RDS) program.

Safeguarding Patients

At Express Scripts, we are continuously working to ensure drug safety is a priority for all of our patient populations. Over the last few years, we have made great strides in bringing EGWP-compatible solutions to market including the Advanced Opioid Management program geared toward avoiding over-utilization and opioid addiction, as well as HealthConnect 360, a personalized healthcare platform that ensures better health outcomes through enhanced clinical metrics and care coordination.

Having these programs in place as retirees transition into an EGWP greatly minimizes the likelihood of them sliding into poor practices such as not taking medications due to lack of sufficient coverage or taking multiple overlapping therapies or pain medications without appropriate safety measures and limits.

Partnership is key in aligning benefit designs and creating a smooth transition for members and plan sponsors alike. Our proven approach has resulted in strong retention rates year-over-year, which is attributed to our industry expertise and strong customer focus.