Express Scripts creates value pricing model for RA drugs
- Express Scripts is tackling high drug costs with another of its SafeGuardRx Solutions value programs, with a stated aim to control the costs of inflammatory disease for patient through formulary management, patient support and refunds. The latest program will go into effect on January 1, 2017.
- A month of drugs for inflammatory conditions costs on average $3000+, but up to a third of patients stop taking the drugs within 90 days, meaning that the patient still pays but gets little benefit. The program from the PBM will provide refunds to plan-sponsors when a patient discontinues a drug that is on the preferred formulary list, refunding as much as $6,000 is the drug is discontinued within the first 90 days of use.
- The program also includes indication-based pricing that will allow smaller, niche drugs that only have one or two indications to better compete with large blockbusters like Humira that have a laundry list of anti-inflammatory indications, by separating drugs by the smaller indications instead of lumping them together.
With the debate regarding healthcare costs raging on, pharmacy benefit manager (PBM) Express Scripts is moving toward a value-based pricing model for anti-inflammatory medications -- one of the best-selling category of drugs -- that is used to treat conditions like rheumatoid arthritis, psoriasis and Crohn's disease.
According to Express Scripts, around 10 million Americans live with an inflammatory condition, and in 2015, the drugs took up almost 10% of U.S. pharmacy spending, the most in any therapy class. AbbVie's Humira (adalimumab) brought in more than $14 billion in 2015 and is just one of many blockbusters in the category.
The Inflammatory Care program is just the latest installment in Express Scripts' SafeGuardRx Solutions series, which have so far included Care Value Programs for diabetes, hepatitis, cholesterol, and oncology, and an ‘Inflation Protection Program’ that aims to protect plans from ‘excessive’ year-over-year price increases.
"More precise approach to formulary management will enable Express Scripts to leverage the additional competition to make this therapy class more affordable for participating plans," said Express Scripts Chief Innovation Officer Glen Stettin.
The SafeGuardRx Solutions, and other approaches, such as Express Scripts favoring certain insulins, but excluding higher-priced alternatives on its national formularies, are just a few examples of the PBM flexing its pricing muscle to take advantage of the competitive dynamics of the market place.
- Express Scripts Blog
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