A Path To Lower Drug Spend, Better Clinical Outcomes

Value-based health care programs employ an array of innovative strategies to help keep costs in check.
A clinician and his patient review notes on a tablet.

Sixty percent of Americans are living with a chronic health condition. Paired with a historic focus on the volume of care as opposed to its value, that means the United States spends nearly twice as much per person on medical care as other developed medical countries.

This is unsustainable. Fortunately, a growing number of value-based health care solutions are available to illuminate a better path.

These approaches, which unlock financial value for payers and enable better clinical outcomes for patients, are built around specific disease states, including inflammatory conditions, pulmonary disorders and cardiovascular issues. By deploying a mix of cost-containment strategies and condition-specific patient support, value-based approaches to pharmacy have the power to:

  • Lower prescription drug trend
  • Reduce downstream medical drug costs
  • Improve patient medication adherence
  • Drive higher therapy completion rates and greater compliance with clinical guidelines

Guiding patients to the right drug at the right price

Solutions that anticipate new drug approvals – rather than reacting to them – allow plans to benefit swiftly from cost-saving measures. This can be the case with new generics and biosimilars, which frequently offer equal clinic value at a lower cost than the brand drug or originator biologic product.

For example, a generic contraceptive came to market last year priced significantly lower than the innovator brand, NuvaRing®. Designating the generic as the preferred alternative enabled patients to save about $60 per prescription – a total of $720 per year.

Even some generics are priced beyond reason. The generic nonsteroidal anti-inflammatory drug ketoprofen carries a price tag 50 times higher than a generic competitor. Shifting utilization to the lower-cost generic provided significant savings to plans and patients while retaining clinical value.

Of course, patients sometimes have a medical need for the more costly medication. In those cases, a well-designed benefit provides a clear path for patients and their physicians to obtain the optimal treatment.

Adherence, healthy practices make medicine work harder

No medicine is effective when it’s not taken as directed. We’ve found that combining digital tools with one-on-one counseling from clinical experts helps patients stay on track, both with their medication regimes and lifestyle changes.

For example:

  • When patients with asthma and chronic obstructive pulmonary disease (COPD) enrolled in a pulmonary value-based solution that tracked use of their rescue inhalers and provided counseling from specialist pharmacists, patients experienced an 84% decrease in restricted breathing events and went 51% more days without using their rescue inhalers. This enhanced their health and reduced downstream medical costs.
  • When Express Scripts members enrolled in a lifestyle management solution provided as part of a value-based program used fitness trackers and connected scales, they recorded 8.2 billion steps and lost an average of 4% of their body weight in 2020 – improving their health and requiring less care for weight-related ailments.

Making the pharmacy benefit work harder

Value-based pharmacy solutions employ an array of innovative strategies that are helping keep costs in check during a time of financial uncertainty for so many. These solutions utilize an array of cost-containment strategies to maximize plan value, including exclusive savings, utilization management and discontinuation credits.

In 2020, plans enrolled in at least one Express Scripts SafeGuardRx® program:

  • Saved more than $6 billion.
  • Experienced median drug trend 5.6% lower than other plans.
  • Had lower median specialty drug trend. For example, plans not enrolled in Rare Conditions Care Value in 2020 experienced drug trend for rare conditions that was seven times higher than similar plans that enrolled in the program last year.

In 2020, despite a pandemic, value-based health care programs once again proved that by acting together, we can make progress in health care and positively impact millions of lives.