Express Scripts saved its plan sponsors $4.3 billion last year through its slate of SafeGuardRx value-based care programs, according to new data from the pharmacy benefit manager.
The 12 SafeGuardRx programs—including the newly launched HIV Care Value program—are offered across Express Scripts’ commercial membership, which includes 56 million members across about 2,000 plan sponsors.
The suite covers 10 chronic illnesses that pose cost management challenges for plan sponsors, growing to add new conditions since the initial launch in 2014.
“We’re always looking at where are we seeing cost or where are we seeing plan sponsors struggling to manage spend,” Candice Michaelson, vice president of product management, told FierceHealthcare.
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Michaelson said the programs are designed for plan sponsors to easily deploy even though they’re designed for complex conditions. The ease of use is especially valuable to the health plans, she said, as the supply chain for drugs and treatments—particularly costly ones—grows.
For example, the Market Events Protection Program avoided $41 million in price hikes for several drugs, while the Rare Conditions Care Value program, through its negotiated cap on some of the highest-priced drugs, saved clients an average of $250,000 for members that exceed the cap.
Here’s a look at the performance of some of the SafeGuardRx tools in 2019:
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Inflammatory disease: Drugs for inflammatory conditions are the costliest class for health plans, and through the Inflammatory Conditions Care Value Program, Express Scripts saved $254 million for plan sponsors. The program breaks down therapies by indication to decrease costs.
The program has also led to fewer members discontinuing treatment. Michaelson said that Express Scripts saw discontinuations decline by 13% in 2019.
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Diabetes: More than 80% of participants lost weight as part of the Diabetes Care Value Program, tracking more than 3.5 billion steps in 2019. Michaelson said members in the program lost about 209,000 pounds collectively.
The program also led to a boost in the number of high-risk patients taking statins, with 21.6% more members adding the therapy last year. Michaelson said that Express Scripts has also expanded the program for members with prediabetes.
Other conditions seeing positive results include multiple sclerosis, which reported an adherence rate of 84.9%. For this drug class, 25% of patients discontinue their therapies within 90 days.
“[The number of] patients that are struggling with chronic conditions continues to grow,” Michaelson said. “How do we start to make it easy for our patients? How do we continue to evolve?”