The cost of managing a chronic condition has gotten too high
You’ve taken steps to keep your members healthy and to protect them from rising drug costs. Still, the high price tag for life-saving therapies has grown into a serious problem that continues to have a real impact on people’s lives, health and wellbeing.
Together, we’ve moved a step closer to solving the medication affordability issue
This will help us eliminate the tragic and expensive medical consequences of patient medication rationing.
The cost of rationing
On Jan. 1, 2022, we expanded our market-proven foundation to make more medications accessible in two of the most expensive non-specialty conditions for plan sponsors: diabetes and cardiovascular disease.
54%
increase in RX drug cost from 2006-2016 for total patient out‑of‑pocket spending1
1 in 10
are concerned about the cost of prescription drugs2
~70%
are concerned about the cost of prescription drugs3
A Step Closer.
Express Scripts Patient Assurance® program
A simple pathway to more affordable, predictable medicine costs
How does this work for my plan?
In order to provide members with immediate access to this predictable $25 out-of-pocket cost per 34-day fill of included prescriptions, even prior to their deductible being satisfied, plans will need to provide first-dollar coverage for participating products. If your current member cost share for participating products is less than $75, there will be no additional cost to your plan or your members. If your current member cost share is more than $75, your plan will need to agree to lower the member’s cost share for participating products to $75 or below to participate in the program.
If you have questions about how this specifically applies to your plan, please contact your account representative.
Increasing benefit usage and improving affordability
When medication is affordable without copay coupons, your members are more likely to use their benefits at the start of the plan year and continue throughout —providing plans with greater visibility into prescription spend, better formulary compliance and increased total health care savings from improved adherence
Making it simple for patients
When a member fills a prescription for a participating product in the Patient Assurance program, they automatically only pay the capped copay amount at the point-of-sale, making this a simple experience without any extra steps. It all happens seamlessly whether your member chooses Express Scripts® Pharmacy or any current in-network retail pharmacies.
Committed to helping people live healthier lives
The Patient Assurance program was our industry-first approach to delivering a new level of relief and predictability when paying for prescription medications. Now, with a market-proven foundation, we can address additional areas exposed to high out-of-pocket medication costs.
10M lives
offered seamless, affordable access to diabetes medication since the inception of our Patient Assurance program, with more than 240,000 patients benefiting immediately.
Up to 66%
reduction in out of-of-pocket costs per 34-day fill for many members via this program. While significant, this is especially critical to those who are experiencing financial difficulty.
Together, we’re moving a step closer to healthier living with the Patient Assurance program.
While the Patient Assurance program is currently focused on improving affordability and access for your members, we believe that through this program’s continued expansion we can address broader chronic conditions where members may be exposed to higher out-of-pocket medication costs.
Sources
- Kaiser Family Foundation, 2006 – 2016
- Centers for Disease Control and Prevention
- 2020 Medication Access Report https://www.covermymeds.com/main/medication-access-report/