According to a study published in the New England Journal of Medicine, medication non-adherence in the United States contributes up to nearly $300 billion in healthcare costs for the United States annually. Another study in the Annals of Internal Medicine cites 20-30% of prescriptions in the U.S. aren’t filled, primarily due to their cost.
For more than 35 years, it has been Express Scripts’ mission to make prescription medication more affordable and predictable for members. When prescription medication is more affordable, members are more likely to be adherent to their treatment plan, avoid downstream medical costs and – most importantly – achieve healthier outcomes.
That’s why Express Scripts plans include “lesser of” logic when processing a prescription claim. This helps members pay the lowest price available when picking up their medication at the pharmacy, whether that price is their co-payment or the pharmacy’s price for the medication. The key to lesser of logic? It doesn’t require members to take any action or price shop.
Innovative partnerships furthers pharmacy savings and affordable medications
As the health care landscape continues to evolve, we constantly look to build deep, innovative partnerships to ensure we’re always advancing this mission to deliver even greater value to clients and members.
Express Scripts recently expanded our collaboration with GoodRx to integrate their pricing into the pharmacy benefit for generic medications to allow customers to automatically access lower prices, if available, on their medications and apply it to their deductible.
In most cases, the best prescription medication price comes from our negotiated price within the benefit, but there are instances where cash discount pricing is lower, particularly for members in High Deductible Health Plans where the member is responsible for the full cost of the medication until they meet their deductible. By integrating access to GoodRx discount program into the benefit, we help ensure members don’t miss out on potential cost savings – again, without any action on their part.
Increased pharmacy health and safety measures within the benefit
Critical to our partnership with GoodRx is the ability to keep visibility of claims within the pharmacy benefit. First, this ensures that any out-of-pocket costs contribute to a member’s deductible, which doesn’t happen when an individual uses third party discount programs. Second and most importantly, any Express Scripts members’ prescription undergoes thousands of health and safety checks for things like drug interactions and allergic reactions to ensure each member gets the right medication at the right time.
For example, when a commonly filled prescription like sildenafil, which has dozens of potential adverse drug interactions, is purchased independently by a consumer outside of their insurance benefit, these additional health and safety checks are not completed. Whereas when sildenafil is purchased through Price Assure, our system will flag the potential drug interaction risk and Express Scripts’ team of clinicians can intervene as appropriate.
Through our open approach to form unique collaborations across the health care ecosystem, we can deliver an even more affordable, simple and predictable experience that gives members peace of mind.