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:
Pharmacists have been granted prescribing authority from the FDA, allowing them to prescribe PAXLOVIDTM to eligible patients testing positive for COVID-19. Within the Express Scripts PBM Oral Antiviral Therapeutics Program, plan sponsors can offer Direct to Patient Prescribing for PaxlovidTM as an add on option.
Direct to Patient Prescribing for PaxlovidTM includes:
Member access to participating pharmacies nationwide
$0 member copay for pharmacist visit and PaxlovidTM prescription
$60 Professional Service Fee: compensates pharmacists’ time to gather the necessary medical data for appropriate prescribing
Initial implementation and a discounted recurring annual fee thereafter dependent upon the plan life count
Member communications and templates for the plan to promote the benefit to members
When PaxlovidTM is prescribed and dispensed by a pharmacist, the savings are substantial, for both plans and patients. Based on analysis of health plan data, we project that plan sponsors can see up to a 50% decrease in plan spend when members see a pharmacist vs. a physician for a PaxlovidTM prescription.
COMING SOON
Additional Direct to Patient Prescribing medications, such as Oral Contraceptives, naloxone and Smoking Cessation prescriptions will be offered soon.
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 and at-home test kits enrich the plan and reduce member out-of-pocket costs.
Covered Pharmacist-Administered Tests
Flu
Strep
UTI
Pink eye
And more
Covered At-Home Test Kits
COVID-19
Pregnancy
Additional tests available at a future date
COMING SOON
Over-the-counter supplements and care products offered through the pharmacy benefit.
Contraceptives
Vitamins
Smoking cessation products
Opioid management products
Diabetes
Pain management
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.
COMING SOON
Counseling sessions that drive better health, wellness and financial outcomes through member education.
COMING SOON
Increasing member access to injectable medications, such as long-acting injectable antipsychotics (LAIAs), contraceptives, vitamin B12 and more, that must be administered by a health care professional.
Improving health equity and helping plans save
