A new analysis from Express Scripts reveals that value-based programs are keeping costs down while also improving care and outcomes for patients.
The goal is to combine reimbursement strategies with clinical initiatives to help insurance plans and patients to get the best value out of high-cost therapy treatments and drugs.
The financial value to payers comes from guarantees, better pricing on medications and costs and waste avoided as a result of clinical initiatives, says Harold Carter, Pharm.D., senior director of product development at Express Scripts. In 2018, plans that participated in its value-based SafeGuardRx programs saved more than $2.4 billion and saw lower growth rates in drug spending among the costliest therapy classes compared to health plans that did not jump into the program.
For example, members buying the drug Praluent saved an average of $319 per script through a point-of-sale rebate, according to the study.
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Similarly, for medications for inflammatory conditions, patient year-over-year spending in the category was nearly flat for members enrolled in the value-based programs, compared with an average 7.3% increase in plans not enrolled.
"There is a desire from payers to tie value to what they are paying for medications, but there is no one-stop solution for all medications, and the industry as a whole has struggled to implement this on a large scale," Carter said.
Express Scripts also reported a 19% increase in 2018 in the use of guideline-recommended statin therapy for people with diabetes and increased consumer engagement with the Mango Health app, where the average user logged in 14 times per week to record positive health behaviors, such as taking medication. The value-based care programs also reduced rescue inhaler use by 72% in 2018 through the use of remote monitoring by pulmonary specialist pharmacists.
In addition, medication adherence for people who filled a prescription at a member pharmacy was 6% higher in 2018 than at retail pharmacies in general.
Carter says there are many positives to value-based care when it is done correctly. It can lead to improved patient outcomes, as Express Scripts saw in a measurable way in its study, and can improve cost control for payers.
Plus, such programs offer valued insights into cost and clinical effectiveness. In the fifth year of SafeGuardRx, Express Scripts has been able to leverage key insights to enhance existing programs and bring forward new solutions for other challenging therapy classes.
"As we go forward, we will continue to develop and implement reimbursement strategies and programs that are as innovative as the newest, breakthrough treatments that come to market, so plans can afford those treatments for their members and keep their benefit affordable and sustainable," Carter said.