Express Scripts

To Prevent the Costs of Misdiagnoses and Mismanaged Care

It is common, and even encouraged by many physicians, to seek a second opinion when a patient is diagnosed with a rare condition. Payers and patients may be overpaying if a provider’s treatment recommendation for a patient is incorrect. Rare conditions are so unique that patients may wait nearly eight years for an accurate diagnosis and see an average of seven physicians during that time.1 Getting a second opinion from expert medical specialists helps patients quickly get the accurate information and appropriate care they deserve.

Nearly 30% of conditions are misdiagnosed.2

$750B is wasted due to unnecessary services and inefficiencies in healthcare3

Second Opinion service provides validation that treatment recommendations are cost-effective and clinically appropriate. Express Scripts is offering this optional service through an exclusive partnership with PinnacleCare®, an unbiased, independent healthcare company.

PinnacleCare health advisors connect patients with top specialists who can provide expert opinions for the treatment of rare conditions. They can help prevent inappropriate procedures, treatments and drug regimens that could result in poor health outcomes for patients and unnecessary and costly expenses for payers.

77% of PinnacleCare engagements result in a more appropriate change in diagnosis, treatment, surgery and/or treating physician4
9 out of 10 members accept the new recommendation and report a 99% overall satisfaction rate4

Any plan enrolled in the Rare Conditions Care ValueSM program can enroll in the Second Opinion service as an additional option.

Second Opinion Service

Avoid Costly Misdiagnoses

Drives better patient outcomes and lowers overall plan costs by reducing unnecessary and inappropriate treatment plans

Gain Objective Health Reviews

Gives patients and families access to Centers of Excellence and expert evaluations to ensure accurate diagnosis and appropriate care for rare conditions

Sign up for Second Opinion service
Talk with your Express Scripts account team to learn more about the value it can bring to your plan and patients.