You’ve taken steps to keep your members healthy and to protect them from rising drug costs. Still, the high price tag for life-saving therapies has grown into a serious problem that continues to have a real impact on people’s lives, health and wellbeing.
Together, we’ve moved a step closer to solving the medication affordability issue and eliminating the tragic and expensive medical consequences of patient medication rationing. Beginning Jan. 1, 2022, we’re expanding our market-proven foundation to make more medications accessible in two of the most expensive non-specialty conditions for plan sponsors: diabetes and cardiovascular disease.
costs up 54%
2006-2016 for total patient
1 in 10 adults ration
because of the cost2
Nearly 70% of patients
had to make personal or
financial sacrifices to be able
to afford medications3
A simple pathway to more affordable, predictable medicine costs
We worked to build a program to ensure more value goes toward cost reduction at the point-of-sale, so your members have predictable out-of-pocket costs throughout the year and pay no more than $25 per 34-day Rx on participating products.
When a member fills a prescription for a participating product in the Patient Assurance program, they pay the reduced out-of-pocket amount at the point-of-sale for both the Express Scripts® Pharmacy and in-network retail pharmacies.
By removing cost as an access barrier to medication, members are 30% less likely to abandon their therapy, which can help plans contain the total cost of care for patients living with chronic conditions.
Together, we can change the medication affordability story and make a meaningful difference for your members.
How does this work for my plan?
In order to provide members with immediate access to this predictable $25 out-of-pocket cost per 34-day fill of included prescriptions, even prior to their deductible being satisfied, plans will need to provide first-dollar coverage for participating products. If your current member cost share for participating products is less than $75, there will be no additional cost to your plan or your members. If your current member cost share is more than $75, your plan will need to agree to lower the member’s cost share for participating products to $75 or below to participate in the program.
If you have questions about how this specifically applies to your plan, please contact your account representative.
Patient access and affordability
When medication is affordable without copay coupons, your members are more likely to use their benefits at the start of the plan year and continue throughout – providing plans with greater visibility into prescription spend, better formulary compliance and increased total health care savings from improved adherence.
We made it simple
When a member fills a prescription for a participating product in the Patient Assurance program, they automatically only pay the capped copay amount at the point-of-sale, making this a simple experience without any extra steps. It all happens seamlessly whether your member chooses Express Scripts® Pharmacy or any current in-network retail pharmacies.
The Patient Assurance program was our industry-first approach to delivering a new level of relief and predictability when paying for prescription medications. Now, with a market-proven foundation, we can address additional areas exposed to high out-of-pocket medication costs.
Since its inception, our Patient Assurance program has helped offer seamless, affordable access to diabetes medication for 10 million lives, with more than 240,000 patients benefitting immediately.
This program will reduce out-of-pocket costs by up to 66% per 34-day fill for many members. While significant, this is especially critical to those who are experiencing financial difficulty.
While the Patient Assurance program is currently focused on improving affordability and access for your members, we believe that through this program’s continued expansion we can address broader chronic conditions where members may be exposed to higher out-of-pocket medication costs.