Navigating COVID-19

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The pandemic made a direct impact on specific drugs, classes and even the flu vaccine. It led to better adherence in critical categories and increased use of medications to treat mental health conditions.

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Supporting people with serious health conditions such as diabetes, heart disease, asthma, cancer and mental illness is important in any year.


Nearly 50% of Americans delayed medical treatment due to the pandemic

As COVID-19 swept through the nation, nearly 50% of Americans reported delaying medical treatment for themselves or a member of their household.2

Our data supports this, showing an across-the-board decline in the trend for new medication users, reflecting that people were not being diagnosed at the same rates as in 2019.

Still, many managed to take better care of themselves, increasing medication adherence in critical treatment categories. Taking advantage of technology. And making choices to stay home and stay safe, such as medication delivery and 90-day supplies, which meant fewer trips for refills.

2 Kaiser Family Foundation. KFF Health Tracking Poll. May 2020.

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Higher utilization of medications to treat chronic conditions

At the same time, our ongoing and advanced utilization management strategies helped to mitigate unnecessary hoarding and inappropriate usage we saw early in the pandemic.

Percent change in new medication users and drug utilization, 2020

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Higher adherence to medications for preventing heart attack and stroke

Percent change in adherence to medications by condition, 2019 and 2020

Spikes in specific drugs

By monitoring global drug trends, we were able to respond quickly for patients and clients when we saw rising international demand putting U.S. supply of critical medications at risk.

For example, we ordered significantly more albuterol, a critical treatment for asthma and COPD, and used by many with COVID-19, in December and March—before the U.S. went into quarantine. This enabled Express Scripts® Pharmacy to meet increased demand as more patients turned to home delivery to avoid the risk of contracting the virus at drugstores.

When we saw spikes in prescriptions for treating COVID-19 inappropriately with hydroxychloroquine, we worked to protect the supply for people who truly needed it to treat rheumatoid arthritis and lupus.

Increase in use of medications related to COVID-19 prevention/treatment, 2020 vs. 2019

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Actemra® (tocilizumab)

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Kevzara® (sarilumab)

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*Subsequently found to be ineffective in preventing or treating COVID-19

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fluvoxamine maleate
(Obsessive-compulsive disorder)

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Boosting the flu vaccine

More people got the flu shot this season and earlier—driven by increased promotion by public health authorities and concerns of the danger of getting flu and COVID-19.

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Flu vaccinations paid under the pharmacy benefit increased more than 50% August through December, 2020 vs. same period, 2019.

Flu vaccinations paid under the pharmacy benefit, per 100,000


Keeping mental 
health top of mind

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As we previously reported, prescriptions for anti-anxiety medications increased sharply from mid-February to mid-March.3


3 Express Scripts America’s State of Mind Report, April 2020.

By April 2020, almost 50% of U.S. adults surveyed reported that worry and stress over COVID-19 affected their mental health.4 By June, 75% of employers surveyed cited mental health as a top concern.5

4 Kaiser Family Foundation. KFF Health Tracking Poll. April 2020.
5 McKinsey & Company. National Annual Employer Survey. June 2020.

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Utilization of antidepressant medications increased nearly 8% in 2020 vs. 2019


Nearly one-third of people taking antidepressants in 2020 were “new”
users (no use in past 180 days)

We responded by adding solutions to address the increasing need for mental health services:

  • Added digital tools, including cognitive behavioral therapy, for treating mild depression, anxiety and insomnia to the Evernorth Digital Health Formulary. And provided free access to these tools during late Spring and early Summer.
  • Launched Evernorth inMyndSM, featuring industry-first predictive models for identifying people at risk of progression of depression, anxiety and insomnia, and connecting people to digital solutions and other helpful plan resources.

A girl looks out the window on a laptop thinking about her mental health