For years, plan sponsors have navigated the intricacies of traditional rebate guarantees in pharmacy benefits. While rebates were originally designed to lower overall drug spend, the process has grown increasingly complex as pharmaceutical companies invent new pricing strategies. This can make it increasingly challenging for some sponsors to accurately forecast budgets, manage pharmacy benefits efficiently, and confidently assess the value delivered by their pharmacy benefit management service partners. As market demand intensifies for greater clarity, there is a growing need for a more streamlined and transparent approach.
To address this need, Evernorth Health Services announced a new pharmacy benefit model to be launched by Express Scripts that will empower plan sponsors with greater transparency, streamlined administration, and long-term sustainability.
A simple, transparent fee
Express Scripts will develop and offer a new model where discounts negotiated with drug companies are available upfront to Americans buying their medications. This new approach seeks to eliminate the complex post-purchase rebate process by making the discounted price of the drug readily available and transparent from the start. This real-time visibility enables plan sponsors to conduct more accurate budgeting, forecasting, and strategic planning.
“Our clients have told us they need clarity and control in managing pharmacy benefits,” said Leslie Achter, senior vice president of account management, commercial division, at Express Scripts. “By offering alternatives to legacy rebate structures, we’re giving plan sponsors the tools to make better informed decisions as well as potentially increase value for their organizations.”
Express Scripts’ new model will replace complex rebate guarantees with a simple, transparent administrative fee that will be clearly stated in plan contracts and will not be based on the list price of the drug. “We will be compensated based on this fee, which is easily auditable to enhance visibility and help support our clients with their own transparency, compliance, and reporting obligations,” Achter said.
A strategic advantage: greater satisfaction and trust
Express Scripts’ new model will also help position plan sponsors at the forefront of the health care industry’s shift toward value-based care. The model aligns pharmacy reimbursement with clinical outcomes and service quality, which helps drive better health results while maintaining financial accountability. These performance-driven aspects foster innovation and trust, empowering plan sponsors to deliver meaningful, measurable value to their members. In addition, lower brand prices at the pharmacy counter are expected to contribute to higher satisfaction and improved medication adherence by members.
“All of these combined factors can contribute to better health outcomes and enhanced member satisfaction, which will strengthen the relationship between employers, unions, and the people they serve,” Achter said.
Ultimately, Express Scripts is focused on evolving pharmacy benefits to help plan sponsors deliver quality, cost-effective benefits for their members. Evernorth will continue to explore new ways to enhance pharmacy benefits and help plan sponsors successfully navigate the changing health care landscape.
