Evernorth
More Than RxSM Services
Expanding access, affordability and speed of care with enhanced pharmacy services.
Care shortages leave millions without easy access to care
The impact of geography on health disparities
While almost 20 percent of the U.S. population lives in rural areas, less than 10 percent of U.S. physicians practice in these communities.1 For many, getting access to a primary care doctor when they need a prescription just isn’t easy, living in areas of the country with inadequate health care where hospitals, doctors and other health care providers are not easily accessible.
Physicians’ offices and urgent care clinics may be too far away from members’ homes with wait times that vary considerably depending on the number of people already in line to be seen.
These shortages of care can arise in both rural and urban areas due to geographic and economic limitations, and lead to disproportionate gaps in care for the people in these communities. When patients cannot easily access care, not only does it impact their health, but it also increases the potential for future costly medical claims.
1. https://www.aha.org/system/files/2019-02/rural report 2019.pdf
For many living in rural areas, access to care may be challenging to find
days is the average wait time for a physician appointment in 20222
Americans live 60 minutes or more from a hospital with trauma care3
states have at least one county without access to hospitals, primary care physicians and other health care providers4
Evernorth MoreThanRx
With a long history of launching solutions that close gaps in care, our goal has always been to provide members with opportunities that enable them to achieve their full health potential regardless of social, economic or environmental circumstances. MoreThanRx is a suite of solutions that opens new doors of access to patients through partnerships with retail pharmacies across the nation.
With over 65,000 pharmacies across the country employing over 300,000 pharmacists, pharmacist care has untapped potential that plan sponsors can leverage.
By using our size and scale to negotiate deeper discounts for our plan sponsors and billing through the pharmacy benefit, basic care products and services are delivered conveniently and quickly to pharmacies nationwide for communities in need—all for a fraction of the cost of visiting a doctor’s office.
Bringing access to basic care closer to home
We deliver convenient consultative and medical services at the pharmacy counter and through home delivery, billed under the pharmacy benefit to lower the cost of care. Pharmacists in our network can test for common disease and illness, immediately prescribe and fill the medication, and provide medication counseling often all in one visit.
Our suite of health care solutions includes:
COMING SOON
Direct to Patient Prescribing assists plan sponsors in making healthcare more convenient for members by expanding access to prescription treatment of COVID-19, seasonal flu, oral contraceptives, smoking cessation treatments and more at their local pharmacy.
Expanding access to pharmacist-prescribed medications lowers health care costs for members who typically visit a hospital, urgent care or primary care physician. Pharmacists can assess symptoms and treat COVID-19 and flu with medications such as Paxlovid™ and Tamiflu®.
Furthermore, increased accessibility to prescribed smoking cessation products assists smokers in achieving their efforts to quit, while more readily available contraceptives empower patients to manage their reproductive health.
The Pharmacy Vaccination Program makes our existing relationships with retail pharmacies work for plan sponsors and their members. Offering vaccines at a member’s familiar pharmacy or at a client’s worksite via an Evernorth On-Site Flu Vaccine clinic, leads to higher vaccination rates, healthier outcomes and decreased employee absenteeism.
Plan sponsors can choose their coverage, which can be all available vaccines or specific ones.
COVID-19, flu, tetanus/diphtheria/pertussis, hepatitis, HPV, meningitis, pneumonia, shingles/zoster
Travel vaccines (rabies, typhoid, yellow fever, etc.)
Childhood vaccines (measles, mumps, rubella [MMR], etc.)
Up to $70 savings when members get their shot at a pharmacy vs. a doctor’s office
Access to a wide range of clinically-approved pharmacist-administered lab tests enrich the plan and reduce member out-of-pocket costs.
Covered Pharmacist-Administered Tests
Flu
Strep
UTI
Pink eye
And more
COMING SOON
Over-the-counter supplements, care products, and at-home test kits offered through the pharmacy benefit.
- Addiction and substance abuse
- At-home testing/acute infection testing
- Chronic disease testing & management
- Diabetes management
- Family planning & contraceptive care
- Pain management
- Smoking cessation
- Vitamins
- Other acute therapeutics
A comprehensive approach to improving health for patients who need it most, the quality and disease management (QDM) program helps improve performance on quality measures for Medicaid, Medicare, and commercial plans through member engagement, chronic conditions support via regular touchpoints and timely interventions, and more.
The QDM program offers three components:
- Comprehensive medication reviews which look at a member’s entire medication profile through real-time interactive encounters between a pharmacist and member to detect any conflicts, duplications or cost-saving opportunities
- Quality measures support that focuses on HEDIS and CMS star measures to help ensure covered Medicaid and Medicare beneficiaries receive high quality care that helps improve adherence and close gaps in care
- Chronic condition support connects members to the exact support and tools they need to manage their conditions, with a focus on high-priority diseases – asthma, COPD, coronary artery disease, depression, diabetes, dyslipidemia, heart failure, hypertension, osteoarthritis and rheumatoid arthritis.
Plan sponsors can setup the criteria for member qualifications into programs based on the number of chronic diseases they have and medications they take, and can enroll into each component individually or as a whole, based on desired member health outcomes.
Reach out to your Express Scripts representative to learn more.
Enhancing the safety of patients taking prescription opioids through a holistic program. Meaningful impact and influence across the care continuum includes prescriber education, safer fentanyl utilization initiatives at the pharmacy, mental health support for patients, and more.
New for 2024: addition of over-the-counter NARCAN® Nasal Spray to the program.
Counseling sessions that drive better health, wellness and financial outcomes through member education.
For Americans living with conditions that require medication administration via injection, failure to take medications as prescribed can have major effects on their health and quality of life. In most states, pharmacists can administer injections for patients such as long-acting antipsychotics (LAIAs), antibiotics, contraceptives, hormones, vitamin B12 and more.
By increasing access options to medication administration services at members’ local pharmacies, we are bridging gaps in care, educating members on the importance of adherence and reducing future costly medical claims.
The Enhanced Fraud, Waste and Abuse program helps sponsors identify members and prescribers with unusual or excessive utilization patterns.
Analysis: Identifies prescriber and/or member outliers, patterns and potential abuse using advanced analytics and data mining
Investigation: Completes full investigation of identified outliers, including prescription verification and prescriber outreach
Consultation: Reviews actionable investigative reports and collaborates with plan sponsors regarding intervention opportunities
Implementation: Member level lock-in at pharmacy and/or prescriber level if necessary. Prescriber NPI blocks initiated by client if necessary.
Express Scripts’ Medicare Drug Management Program (DMP) is a delegated service that supports Medicare plans in meeting the Centers for Medicare & Medicaid Services' (CMS) Part D Drug Management Program requirements based on the Comprehensive Addiction and Recovery Act (CARA) regulations. The DMP will engage in case management for such beneficiaries through contact with prescribers, pharmacies, and members to determine at-risk status.
DMP reviews “Potentially at-risk beneficiaries” (PARBs) with utilization of frequently abused drugs (FADs) such as opioids and benzodiazepines that meet the Overutilization Monitoring System’s (OMS) distinct criteria for potential abuse.
Case Management outreach elicits clinical feedback necessary to determine if additional interventions are necessary to prevent abuse, diversion, and overutilization while maintaining access as medically necessary.
The annual letter campaign includes educating members on opioid risk factors, educational resources and services, as well as plan contact information for directing members to their plan for coverage of nonpharmacological therapies, devices and alternatives to opioids.
Improving health equity and helping plans save
IndependentRx Initiative
The MoreThanRx suite of products and services is just one of the ways we’re fulfilling our IndependentRx Initiative commitment to expand rural health care access through partnerships with independent pharmacies across the U.S. Offering MoreThanRx products and services in independent pharmacies increases access to certain routine, preventive and chronic care services — driving new business growth opportunities for pharmacy owners and providing convenient care options for consumers.
The IndependentRx initiative also recently created and convened an Independent Pharmacy Advisory Committee, which includes independent pharmacy owners from across the country. They meet to discuss how Evernorth and Express Scripts can and should work to enable an expanded role for pharmacists in the health care system.
