Express Scripts is Further Evolving its PBM Model

Cigna recently announced it is rebranding, which it said reflects its growing portfolio of businesses, into three distinct brands: The Cigna Group, the global health company; Cigna Healthcare, the health benefits provider; and Evernorth Health Services, the pharmacy, care and benefits solutions provider.

Evernorth Health Services includes a broad range of coordinated and point solution health services and capabilities, as well as those from partners across the health care system, in Pharmacy Benefits, Home Delivery Pharmacy, Specialty Pharmacy, Distribution and Care Delivery and Management Solutions, which are provided to health plans, employers, government organizations and health care providers.

Within Evernorth Health Services, Pharmacy Benefits and Home Delivery Pharmacy are foundational growth businesses and Specialty Pharmacy, Distribution, and Care Delivery and Management Solutions are accelerated growth businesses.

Express Scripts Pharmacy (Express Scripts) dispenses approximately 1.6 billion adjusted prescriptions annually to members of pharmacy plans managed by Express Scripts PBM. The company drives high-quality, cost-effective care through prescription drug utilization and cost management services.

Express Scripts dispenses drug claims via Express Scripts, Accredo, and its retail networks by integrating retail network pharmacy administration, benefit design consultation, drug utilization review, drug formulary management and pharmacy fulfillment services.

Express Scripts new solutions and capabilities will increase access to affordable medicines and drive greater transparency and predictability. Express Scripts is introducing a new and innovative solution, the Copay Assurance plan, which caps consumer out-of-pocket costs for prescription drugs under a client’s prescription drug benefit.

Additionally, Express Scripts is working with employer and health plan clients to offer consultative options to bring better affordability and predictability. This includes: adopting the broadest lists of preventive prescription drugs that are either fully covered or covered at a discount, lower premiums and deductibles, and increased Health Savings Account contributions for lower-income consumers based on IRS income requirements.

Express Scripts’ new ClearCareRx offers employer, health plan, and government employer clients the option of a transparent economic model by providing clear and predictable costs for prescription drug benefits

Also, Evernorth’s Accredo specialty pharmacy arm launched a new program that aims to assist members and plan sponsors in better managing the cost and complexity of therapies for rare conditions.

Accredo’s new offering, called Evernorth TRC Plus, builds on the company’s Therapeutic Resource Centers and will launch first for patients with hemophilia but expand to cover other conditions in the future. Hemophilia was chosen first because there is a mix of treatment options available, including a gene therapy, with costs that can vary widely.


Takeaway: Express Scripts is further aligning incentives across the pharmaceutical supply chain, consumers, and clients