Express Scripts is launching an expanded value-based care program aimed at improving outcomes and mitigating the high costs for people with cardiovascular disease.
The nation’s largest pharmacy benefit manager (PBM) began with a program called Cholesterol Care Value, an offshoot of its broader SafeGuardRx initiative that took on the high cost of certain injectable cholesterol drugs called PCSK9 inhibitors.
The new Cardiovascular Care Value program takes that model and grows it to other heart conditions, such as atrial fibrillation. In the program, Express Scripts will offer discounts and cost caps for PCSK9 inhibitors and some anticoagulants.
In addition, it will use data analytics to identify members who are not adherent to their medications or are at risk for nonadherence, allowing for earlier intervention. Express Scripts will also reach out to members who fail to fill their first anticoagulant prescription, the PBM said.
As heart disease is widespread—the Centers for Disease Control and Prevention estimates one of every six healthcare dollars is spent on cardiovascular disease—health plans have been pushing for value-based solutions in this space, Harold Carter, senior director of product management at Express Scripts, told FierceHealthcare.
“This has been an area of, I think, continuous struggle for our plan sponsors,” Carter said.
Carter noted that there are 2.7 million Americans with atrial fibrillation alone, and ensuring those patients are taking their medications properly can reduce complications associated with their disease by 57%, and this includes risk of a blood clot, heart failure and stroke.
However, only 16% of afib patients are taking their anticoagulant medication appropriately prior to a stroke.
In addition to the cost management tools, health plans that sign on with Express Scripts’ Cardiovascular Care Value program will have the option of connecting their membership with the PBM’s group of providers that are specially trained in cardiovascular care and can assist with managing a patient’s disease and in educating them about their treatments.
Patients who are diagnosed with heart disease may have preconceived notions about their medications and the potential side effects, and these pharmacists can assist in navigating conversations about using anticoagulants and other cardiovascular drugs safely, Carter said.
The providers working in the Cardiovascular Therapeutic Resource center can offer “direct, outbound communication with those patients,” he said.