The pilot will examine the impact of rewarding pharmacies that fill prescriptions for Express Scripts members and demonstrate a positive improvement on individual members’ medication adherence for conditions such as diabetes, hypertension, and asthma.
“Pharmacists are one of the most trusted of all healthcare professionals and their frequent interactions with our members present enormous opportunities to positively impact patient health,” Amy Bricker, president, Supply Chain, Express Scripts said in a statement.
“We have supported quality-based retail network for Medicare plans for several years now, and this new pilot will draw from that experience, as well as our strong relationships with the pharmacies in our networks, to test the impact of this innovative, value-driven network for commercial plan sponsors.”
The pilot program will launch in fall 2018 and focus on the unique needs of each participating client’s patient population. The pilot metrics are recognized by the Pharmacy Quality Alliance (PQA) and participating pharmacies will be able to track their own performance and identify gaps in care via a web portal.
Leveraging actionable data and clinical experience, Express Scripts will work collaboratively with each pharmacy participating in the quality network pilot program to provide them with the necessary tools to measure and guide their performance. Retailers will compete against each other in the network pilot, thus incentivizing them to continuously improve their performance through relative assessment, rather than predefined benchmarks.
For this pilot, participating plan sponsors, such as employers and health plans, will have the ability to select the four therapy classes where they would like to see an improvement in medication adherence — for example, diabetes, cholesterol, hypertension or asthma — that will be used to measure each pharmacy’s performance.
Highlighting the unique needs of a plan sponsor’s member population leads to more meaningful improvements in medication adherence and outcomes.
“We have the ability to work across the pharmacy value chain and to develop new solutions that improve the health of our members — solutions that held the growth rate in drug spending to just 1.5% in 2017 and delivered $32 billion in savings,” said Bricker. “Through this pilot program, we will work collaboratively with our clients and our network partners to test and learn how to make a quality network program successful for all involved.”
“Express Scripts is committed to simplifying and improving the pharmacy experience for our more than 80 million patients. Our nation spent more than $3.3 trillion on healthcare in 2016 and it is critical that we generate better value for that spending.” “Improved medication adherence and aligning incentives is just one way Express Scripts is working to improve health care. Our industry-leading clinical programs and specialized pharmacy care are providing solutions – not available anywhere else in the market – to patients managing complex conditions. Through better data sharing and integrated care, Express Scripts is helping our members and clients manage their healthcare, avoid downstream costs, and lead fuller, richer lives,” Bricker added.