Lowering costs while providing high-quality care shouldn’t require compromises. We have programs and tools to help you successfully manage costs while helping your members improve their health and well-being. Let’s get better – together.
We understand the impact that this pandemic is having on individuals and businesses in all sectors and are working to bring cost effective solutions to help combat the financial fallout that plan sponsors may be experiencing.
As businesses reopen doors and plan for the future, Evernorth Healthy Ways to WorkSM offers a diverse set of capabilities to help plans navigate what’s next, including solutions designed to provide cost savings and greater long-term value, while minimizing member disruptions. Our proprietary COVID-19 Risk Dashboard gives up-to-the-minute insight into each plan’s unique situation to make more informed decisions. We then work with plans to reach their business goals, from ensuring a safer jobsite and delivering whole-person care, to finding greater affordability for plans and members.
It’s no secret that care for the most complex and challenging disease states must be improved and costs must be better managed. Evernorth SafeGuardRx® – our first-to-market value-based platform – is proven to do both.
At the heart of SafeGuardRx is our unwavering belief that within the most expensive health care issues exist the greatest opportunities for improvement.
By enrolling in SafeGuardRx, you’re helping your members experience better medication adherence, higher therapy completion rates and greater compliance with clinical guidelines – all while mitigating financial risk.
Over time, SafeGuardRx unlocks increasingly greater clinical and financial value for plans and better outcomes for patients – providing peace of mind by reducing risk, cost and waste. For example, plans enrolled in SafeGuardRx experience lower overall trend than plans that aren't enrolled.
A fully optimized network strategy includes strategies for both 30- and 90-day supplies of medications. Plan sponsors can choose from a wide variety of retail anchors and home delivery options, based on their members’ current needs and preferences.
With our Optimized Network Efficiency (ONE) Method, we enhance your pharmacy benefit by recommending the best pharmacy network based on your goals for cost savings and member access. We negotiate with pharmaceutical manufacturers and retailers to drive competition and increase value, offering clients a comprehensive product portfolio to meet their savings goals. Through our unique mix of pharmacy network options, we offer maximum savings while providing members access to conveniently located pharmacies that help improve health outcomes.
An optimized pharmacy network includes:
- A more efficient mix of network size, savings and quality
- An option for members to fill 90-day supplies of maintenance medications for chronic or long-term conditions
- An option for members to fill 30-day supplies of acute medications like antibiotics
- Preferred and non‑preferred locations all within 5 miles of 98% of members
- Extra care for chronic and costly conditions from specialized pharmacists, member engagement tools and quality measurements
With ever-rising drug costs and members increasingly being diagnosed with chronic conditions, plan sponsors need guarantees for key disease states that are top trend drivers. That's where Health Connect 360SM can help.
A pay-for-service model will be harder to sustain in a world where, by 2030:1
80 million people will be diagnosed with more than three chronic conditions
U.S. health care spending is projected to exceed $5.5 trillion
1 in 5 Americans will be over the age of 65
Health Connect 360 is the first and only solution with guaranteed clinical outcomes, an ROI savings guarantee and a pay-for-performance feature. We work with you to identify meaningful clinical metrics, based on peer benchmarking and your plan’s past performance. Then, we agree on the targeted performance for which we’ll be accountable.
For one per-member-per-month fee, you get holistic benefit management that meets your clinical targets.
Leveraging our clinical capabilities, we deliver what each patient needs, based on their unique care plan. We tailor engagement tactics based on prior outreach – so there’s no more guessing, duplicate contacts or gaps in care. Our unprecedented level of personalized care delivers better clinical results – guaranteed.
Like all of us, patients and physicians are creatures of habit. Once a medication is prescribed and in-hand, it can be hard to make a change – even if a lower-cost option is available.
Using the unmatched analytical power of our patented MediCUBE® analytics platform, our academic detailing pharmacists pinpoint opportunities to reduce prescribing that adds cost but no clinical value. For example, a physician might write a prescription for tablets that cost $55 per 30-day supply, not knowing the same medication is available in capsule form for $2 per 30-day supply.
This high-touch physician outreach works. Our academic detailing pharmacists proactively identify opportunities and address issues before they turn into expensive prescribing patterns – keeping your plan on track to meet your cost and clinical goals.
Patients need their specialty medications, and plans need better affordability.
In partnership with SaveOnSP on the first non-essential health benefits copay assistance solution, we’ve driven significant savings by targeting high-cost, high-volume drugs. SaveOnSP utilizes plan-design changes to identify select drugs as non-essential health benefits, enabling maximum savings and reducing plan and member costs.
In 2020, enrolled plan sponsors saw a negative first-year trend of -7.2%, compared to 9.6% trend for our book of business. And, impacted patients realized zero out-of-pocket costs.
As manufacturer programs and regulations change, this aggressive solution adapts, delivering lower specialty plan cost and enhanced patient support. This means you can offer a richer pharmacy benefit while controlling specialty spend, to create budget headroom for future needs.
Managing costs and driving out waste are critical needs, with the U.S. wasting nearly $1 trillion annually on unnecessary health care spending, with no added benefit.
In 2018, our industry-leading National Preferred Formulary provided payers and their members access to 3,886 medications, while saving $3.2 billion by directing members to lower-cost medications.
As drug pricing strategies continue to evolve, we find new ways to help our clients control their costs. Our National Preferred Flex Formulary creates a pathway to cover lower list-price products, helps deliver lower member out-of-pocket costs, and reduces reliance on brand rebates. Like the National Preferred Formulary, the Flex formulary follows our clinical-first decision process for all new therapies.
Proper management of specialty drugs in the medical benefit is key to ensuring plans aren't overpaying. We offer plan sponsors a suite of medical management tools and solutions that drive and guarantee cross-benefit savings and trend visibility.
Whether you need a robust, hands-free solution or a software system that allows you to self-manage prior authorizations in both the pharmacy and medical benefit, we can provide the technology, experience and resources to address your plan-specific medical management needs.
Beyond utilization management, Express Scripts has a medical claims processing system with claims management and editing capabilities. Our advanced reimbursement management solutions will help you manage not-otherwise-classified (NOC) codes, waste management and appropriate infusion services.
Our suite of medical drug services can help you improve visibility and savings with your medical drug benefit.
Achieving the lowest possible drug costs requires management of pharmacy and medical drug spend. But for drugs typically managed within the medical benefit, you may struggle to develop a holistic, proactive approach to negotiate rebates and manage medical Rx contracting on your own. This creates administrative burden without adding any financial value.
Express Scripts MedRx ManagementSM is the medical rebate and contracting strategy you need to bring total drug spend under control.
By 2024, the cost of gene therapies is expected to reach more than $16 billion in the United States. While this number is astonishing, the curative and life-changing benefits of these therapies is priceless. And today’s health care financing system isn’t designed to achieve this balance, which leaves clients with a terribly difficult decision around coverage. It also makes protection for the “million-dollar lightning strike” as vital as any other financial protection a business can buy.
Evernorth Embarc Benefit Protection℠ brings together the health services, medical benefit management and specialty pharmacy expertise of eviCore, Accredo, CuraScript SD, and Express Scripts to make breakthrough medicines more affordable and ensure access for those who need it.
Our clients, who collectively provide health coverage for millions of Americans, will be better protected against the high prices associated with new potentially curative therapies. Our goal is to provide coverage to as many people as possible, as soon as possible, promoting access to life-altering, but high-cost gene therapy drugs.
The coming boom in specialty generics presents a sizable opportunity for client savings. We can help with strategies to shift market share to these lower-cost alternatives while ensuring patient adherence.
Giving physicians visibility into your plan design means better prescribing patterns, improved formulary compliance and higher medication adherence. ScriptVisionSM is a suite of data-driven capabilities designed to remove barriers to care and empower physicians to make better clinical and cost-effective decisions – in real time.