Pharmacy benefit management giant Express Scripts unveiled several steps it's taking to boost transparency and mitigate high costs members may face.
The PBM said in an announcement that about 80% of its members pay less than $100 per year on their medications, but the remaining 20% are at times exposed to higher costs, a trend that's particularly true for people who may be in high-deductible plans.
For those patients, Express Scripts will now make sure they are charged the negotiated rate for a drug when they're in their deductible or have high coinsurance. In addition, Express Scripts said it will ensure that the patient does not end up paying more than the employer would at a negotiated rate.
Adam Kautzner, president of Evernorth Care Management and Express Scripts, told Fierce Healthcare that the initiatives announced Wednesday follow a series of changes made by the Express Scripts team with the goal of tackling affordability and transparency.
For instance, the company previously capped the cost of insulin through its Patient Assurance program and has launched the ClearNetwork model, which operates on a cost-plus framework.
"We plan to continue to expand," he said. "From our perspective, this is just the beginning."
In addition, the PBM said it will provide members with a personalized cost summary that gives them a more clear view into what their spending looks like and any discounts that were negotiated by Express Scripts. The report will cover their total annual drug costs, including list prices, negotiated savings including discounts and applicable rebates, what their plan paid and total savings.
Express Scripts will also be generating annual standardized reports for plan sponsors that disclose costs and pharmacy claim-level data, which will allow for further insights beyond those the PBM already provides, according to the announcement.
Kautzner said the PBM intends to make these steps standard operating procedure moving forward, creating a baseline for its efforts around transparency and affordability. The team will begin to work with employers throughout this year to roll out these options and then for new sales or contract renewals will include them as a standard.
Transparency in particular is a key concern for critics of the industry, which characterize PBMs as shadowy middlemen operating in an opaque manner. Kautzner said that given the bipartisan interest in reforms in this space, he's spent plenty of time on the Hill with policymakers, and these steps are an example they can bring to the conversation.
"I expect this will be favorably received," he said.