Nearly 90% of the U.S. population lives within five miles of a pharmacy, making local pharmacies among the most accessible health care resources in the country. In rural communities, pharmacies are often the first – and sometimes only – health care contact for residents. These pharmacies provide not just medications, but also chronic disease management, vaccinations, screenings, and point-of-care testing.
To lead the industry to a new era of pharmacy benefits, Evernorth Health Services announced a new, transparent rebate-free pharmacy benefit model for Express Scripts. In addition to these efforts, Evernorth is also working to modernize pharmacy reimbursement and introduce new performance-based payments that help ensure fair compensation for local pharmacies, which act as central players in community health.
Under the new model, pharmacies participating in the Express Scripts network – including more than 20,000 independent pharmacies – will be reimbursed based on their cost to procure medications.
To further support access to care in underserved communities, the new model will also provide higher dispensing fees to pharmacies in these areas so they can continue to provide critical services to one of the country’s most vulnerable populations.
In addition to the new reimbursement structure, the model will offer opportunities for pharmacies to earn additional payments by meeting high clinical quality standards and providing expanded services, such as 24-hour access, health screenings, and rural outreach. This value-driven approach rewards pharmacies for their contributions to patient health and further supports their role as essential resources for community care.
“Community pharmacies are the backbone of health care in neighborhoods across America,” said Adam Stacy, senior vice president of enterprise network strategy and solutions at Evernorth. “By modernizing reimbursement and recognizing pharmacies for the clinical care they provide, we’re empowering these trusted local partners to do even more for the people they serve. This new model is about ensuring rural and independent pharmacies remain viable, vibrant centers of health in their communities.”
The new Express Scripts reimbursement model is expected to launch in 2027.
