Innovation from the middle out

I have been reflecting lately about two important labels: one is “innovator” and the other is “problem-solver.” Not all innovators are problem-solvers, but anyone who solves problems is innovating. At Express Scripts, we strive to be both. With patients and clients top of mind, we work to address challenges in the health care ecosystem that others can’t, don’t or simply won’t.

Pharmacy is the most used benefit in health care. The pharmaceutical pipeline is full of new drugs, and that - while positive – are straining the limits of our health care system. The FDA is under pressure to approve drugs at a break-neck pace, and many of our clients are trying to adapt and figure out how they and their members can sustainably afford the onslaught of new high-priced drugs. All these challenges create a need, and our opportunity, to bring more value to clients and patients alike.

At Express Scripts by Evernorth , this how we work with our clients each day. ?

We track trends shaping the market to help our clients stay a step ahead. We maintain a pulse on the pharmaceutical pipeline to help ensure our clients are prepared. For example, 2023 marked a turning point in what has been a long and complicated road to entry for biosimilars in the United States. As new biosimilars continue to become available, we’re conducting clinical reviews to ensure formulary decisions are guided first and foremost by safety and clinical efficacy. And, after clinical considerations, identify high-value therapies for our national formulary offerings that can help reduce costs.

We listen to our clients and their needs. Our account teams are on the front lines with our clients – identifying their greatest needs and either offering solutions we have in house or helping our product teams create a new solution. From addressing specific population issues to accelerating plan growth and retaining top talent, we’re helping clients accomplish their goals. ??

We look for new ways to simplify the experience. In 2023, we rolled out several new options to help simplify pharmacy benefits. For example, for members of clients enrolled in the Copay Assurance plan, out-of-pocket costs are capped at a simple $5 for generics, $25 for preferred brand drugs, and $45 for preferred specialty brand drugs. And for clients seeking to simplify what drugs cost, we introduced Express Scripts ClearNetwork to enable them to pay a straight-forward estimated acquisition cost for individual medications, in addition to a small markup for pharmacy dispensing and service costs.?

We identify barriers to care and help remove them. Even the best care won’t work if a patient can’t access it. That’s why we identify what is keeping patients from getting the care they need, and design solutions that meet them where they are. For example, one in five Americans live in rural areas, yet less than 10 percent of physicians practice in those locations – creating critical access gaps. We created the IndependentRx Initiative to help expand access to health care in rural communities through partnerships with independent pharmacies. By supporting the clinical expertise of pharmacists who want to do more for their patients, we are able to help remove geographic barriers, reduce total medical costs and improve vitality, community by community.

What we’re watching in 2024. As we look ahead to 2024, we’re already working closely with our clients to bring more value to their pharmacy benefit plans.

We expect the GLP-1 market to continue to evolve in 2024, as more data, simpler drug delivery in the form of a pill and potential new indications continue to drive more utilization. With the promise of this new class of drugs comes additional costs and complexity for health plans and employers grappling with how to provide sustainable coverage. We anticipate health plans and sponsors will take a more coordinated approach that balances the need for medications for patients who can benefit the most with lifestyle support that ensures long-term success. ?

Elsewhere, as the pharmacy landscape continues to change, independent pharmacists are increasingly well-positioned to help close gaps in care. As large chain pharmacies continue to grapple with closures, staffing shortages and walk outs, independent pharmacists not only continue to deliver convenient, high-quality pharmacy, but many are expanding their services to include certain routine, preventive, and chronic care services.

Lastly, now more than ever, patients are looking for straight-forward information to help them make better decisions about their own care and avoid surprises at the pharmacy counter. We think there’s an opportunity to help them see their pharmacy benefits at work – before and after picking up their medications.

As we head into the new year and health care continues to evolve, Express Scripts is in a unique position to spot and solve problems across the supply chain to improve the health of the people we serve.