Managing Specialty

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Overview

Early adopters see significant impact to overall trend and care

As experts in managing specialty drug costs, Express Scripts and Accredo outperform other pharmacies with nearly 2% lower year-over-year trend. This means significant savings for clients even before they’ve adopted our most aggressive specialty solutions, which widen the trend gap and savings opportunity even further – all while delivering best-in-class clinical care – 6% higher adherence in certain therapy classes for patients using Accredo, compared to those using other pharmacies.

Offerings

Accredo
Unlock more savings and better clinical care

Working exclusively with Accredo, clients can deliver better clinical outcomes, drive patient engagement and generate savings.

500 500
Accredo pharmacists offer condition-focused clinical expertise and drug-specific knowledge
Interventions and clinical protocols

Because of our deep specialization, we have deployed more than 350 proprietary clinical protocols, which help predict potential patient issues and resolve them before they occur. For example, in 2018 we performed 3,000 hemophilia-specific patient and prescriber interventions to ensure patient safety, drug effectiveness and affordability. And, for patients with pulmonary arterial hypertension, another clinical protocol reduced gaps in care by 4.9%. 

Just as you expect an oncologist to have cancer-specific knowledge, our specialty-trained pharmacists, nurses and other health care experts match that expertise by practicing out of 15 specialty Therapeutic Resource Centers® (TRCs). Acting on data-driven insights, our clinicians provide critical care and education to patients and caregivers.

Nursing support

While most specialty pharmacies offer nursing services, not all have the wide range and types of nurses necessary to support patients throughout their journey. Accredo employs three types of condition-focused nurses, including field-based infusion nurses and nurses available 24/7 via phone, prepared to respond to emergency situations.

46K 46K
hours of nurse support for specialty patients living with cancer, inflammatory conditions, multiple sclerosis or other conditions in 2018
Patient and community engagement

We’re firm believers that the best patient support extends well beyond the pharmacy.  That’s why we go to great lengths to support the whole patient and the people around them.

We’re working every day with families, schools, physicians, foundations, advocacy groups and communities to ensure patients get the care and access to medication they deserve. Last year, our on-staff, field-based infusion nurses traveled more than 8.6 million miles to care for patients – equal to traveling to the moon and back 18 times!

96% 96%
or higher patient satisfaction rate for the past eight years

Our TRCs also include dedicated copay assistance coordination teams who assist in proactively identifying and enrolling patients in foundation or manufacturer assistance programs to help patients afford their medicationsIn 2018, we coordinated $670 million in copay assistance for patients.

At the forefront of innovation

The era of rare and gene therapies is here and the anticipated growth will be exponential and costly. With our knowledge, capabilities and cutting-edge solutions, Accredo is a market leader in handling the rare and gene therapies coming to market.

10-20 10-20
curative gene therapies expected to be FDA-approved each year by 2025

Our first-to-market Pay Over Time program is one example of unique cost-management solutions we’re developing to support these therapies. We’re excited to play an important role in advanced care that changes patient lives and will continue to lead by ensuring payers have access to innovative cost-management strategies.

Copay Assistance Solutions
Drive value for patients and plans

Copay assistance is key in patients being able to afford their medications, and research shows it positively impacts adherence – by as much as 9%.

Our first-to-market innovative copay solutions from Express Scripts help patients afford their medications, protect plan design preferences and achieve lower trend. In 2021, plans who enrolled in our copay solutions as a bundle (SaveonSP and Out of Pocket Protection) saw negative specialty trend of -3.3 percent. And, members on targeted SaveonSP medications achieved out-of-pocket costs as low as $0. 

Rare Conditions Solutions
Stay on top of breakthrough, life-saving therapies

Medications that address some of the rarest conditions offer great hope, but often come with high costs and alarming realities.

Alarming realities

Rare conditions afflict 30 million Americans, presenting critical challenges for patients and plan sponsors. The conditions share three key characteristics:

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Difficult to diagnose
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High mortality rate
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Extreme costs

Our Rare Conditions Care Value® program, part of our Evernorth SafeGuardRx® platform, offers critical clinical patient care while protecting plans from unexpected and staggering costs. An additional component of the program is a Second Opinion service to ensure proper diagnosis and treatment.

$2.3B $2.3B
saved through specialty-related SafeGuardRx solutions alone in 2019

It’s time to get your plan prepared for the future by:

  • Establishing a clinical foundation with Accredo

  • Participating in our expanding Rare Conditions Care Value program

  • Preparing for new and different cost management strategies

FamilyPath
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A life-changing solution from Evernorth. Helping to solve the problems others don’t, won’t, or can’t.
Nurturing the future of family

More and more organizations are considering family building and fertility coverage as a part of their comprehensive benefit package. We’re offering a solution to nurture the future of growing families that helps avoid unnecessary costs for both plan sponsors and their members. And unnecessary stress for hopeful parents.

130% 130%
increase in percent of companies adding or updating fertility benefits in 2019 vs. 2018.

Evernorth FamilyPathSM is a comprehensive solution that provides holistic care coordination across the health care system, and offers flexible benefit design options to fit a variety of different plan needs. It can be a complicated experience for members to get started on the right treatment, with the right doctor, or with the right adoption provider.

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Six million women are impacted by infertility in the U.S.
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Ten million couples will encounter difficulties having a baby by 2025
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57% of employees would change jobs for fertility coverage that includes IVF and egg freezing

That’s why FamilyPath simplifies the experience with dedicated fertility advisors, assistance in finding a provider or clinic, fertility treatment guidance, on-time medication support, lower out-of-pocket costs, and emotional wellbeing resources. We know when this combination works together, members and plans reap the benefits. Members with fertility coverage are more likely to rely on the right treatment paradigm, potentially resulting in 40% savings.

Embarc Benefit Protection
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A life-changing solution from Evernorth. Helping to solve the problems others don’t, won’t, or can’t.
Leading the way by connecting access, innovation and experience

Emerging gene and cell therapies can change, and even save, lives. But these medicines often come with a shocking price tag–one that can devastate a plan’s bottom line and be entirely out of reach for an individual patient. Payers and patients alike need a better answer for financial protection and affordable access.

Evernorth Embarc Benefit Protection℠ is the industry’s first solution to build a new pathway to pay for the coming wave of expensive, potentially curative therapies. Now, plans and employers have an option specifically built for one-time, potentially curative therapies. Embarc provides critical financial protection and predictability, while leveraging specialized pharmacy dispensing and distribution, and supporting patients on their therapy journey.