Ever higher list prices for the medications Americans take to get and stay healthy are frequently in the news, but Express Scripts research has found that members are paying less at the pharmacy counter.
“In an era of inflation and rising health care costs, we’re proud to share that Express Scripts is fulfilling our mission to lower the cost of prescription drugs for the more than 100 million Americans we serve,” said Adam Kautzner, president of Express Scripts. “As highlighted by our 2022 data, we have continued to generate savings for consumers by combining our purchasing power with our innovative suite of cost-saving solutions.”
Express Scripts patients are paying less of the total cost of their medicines
Over the past five years, Express Scripts' year-over-year change in member cost sharing has remained relatively flat despite inflation increasing tenfold over that period.
About three in four Express Scripts members – 73% – spent less than $100 out of pocket for their medicines in 2022. On average, members paid $14.49 for a 30-day prescription.
This translates to pennies on the dollar when compared to average wholesale prices. For example, treatments for inflammatory conditions – which represented nearly 25% of total drug spend across Express Scripts’ commercial book of business in 2022 – had an average wholesale price of $494.30 for a one-month supply. Across Express Scripts, however, the average out of pocket was $43.28 – less than 10% of the total cost.
List price vs. average member out-of-pocket cost
Lowering the cost of diabetes care
For many people with diabetes, insulin and other medications are a necessity that carry an average wholesale price of $438.07 per month – almost $15 a day. “To provide patients with relief and predictability, we launched the Patient Assurance Program in 2020, capping member costs for diabetes medications at $25 for up to a 34-day supply,” Kautzner said. “That represents a significantly steeper discount than the majority of state government caps and is $10 less than the Medicare price cap.”
Our analysis shows that in 2022 alone, Express Scripts members saved $18 million for insulin at the pharmacy counter and became even more likely to use their medications as prescribed, increasing their adherence to treatment by 30%. As a result, their total diabetes-related cost share, including medical and pharmacy expenses, fell by 50%. “That adds up to more than $45 million in total patient savings for insulin prescriptions since 2020,” Kautzner said. “The results of this program – and our other actions to simplify access to the most clinically effective medicines for patients by implementing solutions that make prescriptions more affordable – speak for themselves.”
Ongoing commitment to consumer savings and transparency
In recent years, the Patient Assurance Program has expanded to some non-insulin diabetes treatments and cardiovascular therapies, including GLP-1s, DPP-4 inhibitors, GLP-1 agonists and SGLT2 inhibitors. Including those treatments, total patient savings for the program exceed $225 million.
In 2024, Express Scripts will build on our long-standing commitment to advancing transparency and affordability for members with the launch of two new digital tools. “Members will be able to evaluate their coverage in real time through our Check Coverage tool and track how much Express Scripts saved them on their medicines with our Digital Pharmacy Benefit Statement,” Kautzner said. “These initiatives will end surprises at the pharmacy counter and help consumers see the value of their pharmacy benefits at work.”