Express Scripts program caps drug costs for diabetes

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ST. LOUIS — Express Scripts has unveiled a program designed to rein in drug spending for diabetes patients.

The pharmacy benefit manager on Wednesday launched the Diabetes Care Value Program, which the company said improves pharmacy care and controls plan costs for people with diabetes.

Under the program, Express Scripts guarantees per-patient spending caps in which participating plans, on average, will experience an increase in the 2017 diabetes drug spend of about half of what the industry is projecting for U.S. commercial payers. The PBM, citing its “2015 Drug Trend Report”, said U.S. diabetes prescription drug spending rose 14% in 2015 and, for plans not participating in the Diabetes Care Value Program, those expenditures stand climb another 18% for 2016 and 17.7% for 2017.

Express Scripts Diabetes Care Value Program_Rx photo“Diabetes is wreaking havoc on patients, and it is also a runaway driver of cost for payers,” Glen Stettin, senior vice president and chief innovation officer at Express Scripts, said in a statement. “Our Diabetes Care Value Program helps our clients and diabetes patients prevail over the cost and care challenges created by this terrible disease.”

In its “The Lab” blog this spring, Express Script had said it planned to create the Diabetes Care Value Program to add to its SafeGuardRx suite of pharmacy solutions, which include programs for oncology, hepatitis and cholesterol, as well as an inflation protection for branded drug pricing. The Diabetes Care Value Program is slated be implemented March 1, 2017.

“We plan to increase medication adherence, broaden insulin options for patients and bend down the cost curve of what is currently the costliest class of traditional prescription drugs,” Stettin noted. “As we have done with our other SafeGuardRx solutions, Express Scripts will assume financial risk for drug spending in excess of the caps to protect our clients from skyrocketing costs and budget uncertainty.”

Express Scripts said the Diabetes Care Value Program has a network of preferred pharmacies delivering on a set of quality metrics, including high medication adherence levels for diabetes patients. Members of participating plans can get 90-day supplies of diabetes maintenance drugs from more than 10,000 pharmacies nationwide, including via mail delivery from the Express Scripts Pharmacy, at all Walgreens pharmacies and at more than 1,200 independent retail pharmacies. All patients enrolled in the program, regardless of which network pharmacy they select, also can access clinical counseling from the diabetes pharmacists in the Express Scripts Diabetes Therapeutic Resource Center.

“As an independent pharmacy benefit manager, we have the flexibility to work with any and all pharmacies to achieve our clients’ specific care, cost and geographic access objectives,” Stettin stated. “With our emphasis on achieving quality metrics, this new diabetes pharmacy network ensures our retail partners are aligned and focused on providing the care that people with diabetes need.”

The Diabetes Care Value Program is expected to raise the average medication adherence rate for enrolled patients by 5%, in turn reducing related health complications and care costs. Express Scripts reported that $4,690 per diabetes patient is spent each year on medical expenses that could have been avoided if patients had taken their diabetes medications as prescribed.

“Nearly nine of 10 people with diabetes also have high blood pressure or high cholesterol, and one out of every four is currently taking an antidepressant,” Stettin added. “Our Diabetes Care Value Program surrounds each person with the specialized knowledge and support needed to manage increasingly complex therapies that treat diabetes and related conditions.”

Also on Wednesday, Express Scripts announced that its 2017 National Preferred Formulary will include multiple preferred basal insulins. Pending market entry later this year for the nation’s first follow-on insulin, Basaglar (insulin glargine), the PBM said it plans to add Basaglar as a preferred product for the formulary, alongside the originator product Lantus (insulin glargine).



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