Helping You Get The Most out of Your Prescription Drug Benefits

May 02, 2024 at 01:00 AM EDT

SPONSORED CONTENT -- (StatePoint) The health care system can feel uncoordinated and costly. One in 10 U.S. adults ration medication because they can’t afford their prescriptions, according to the Centers for Disease Control and Prevention. In fact, the more a patient must pay at the counter, the more likely they are to abandon their treatment. Other Americans simply lack convenient access to primary care providers and pharmacies, and go undertreated as a result.

Pharmacy services companies exist to fill these gaps in care. Because these companies sit in the middle of the health care delivery system, they have the unique ability to spot and solve problems across the supply chain to drive affordability and deliver improved clinical outcomes.

“Every day at Express Scripts, we use our clinical expertise and patient-centered programs to help the more than 100 million Americans we serve keep their health on track,” says Adam Kautzner, president of Express Scripts, a leading pharmacy services company.

Before filling your next prescription, check out these insights from Express Scripts:

• Check your coverage: At a time of rising drug costs and access barriers, some pharmacy services companies are helping people take their medications as prescribed. Express Scripts, for example, was the first in the industry to cap the out-of-pocket costs of insulin and other diabetic treatments, saving people more than $45 million in two years.

“A prescription drug doesn’t work if it’s priced out of reach,” says Kautzner. “Reducing out-of-pocket costs is the single best thing we can do to improve the health of people we serve.”

• Tools to stay adherent: Half of all treatments fail because people don’t take medication as prescribed and nearly one-quarter of hospitalizations are due to medication non-adherence, according to the American Hospital Association. Further, chronic conditions, such as cancer, diabetes, and heart disease have been on the rise for more than two decades – today, 60% of U.S. adults have at least one chronic condition. One of the biggest – and costliest – challenges with managing the rise of chronic conditions is ensuring patients get on and stay on the medicines they need.

Express Scripts is helping patients better understand and manage their conditions through comprehensive disease management, including condition-specific coaching, tracking medication adherence, and digital tools.

“By taking medications as directed and working with their pharmacist, patients stay healthier longer and spend less on health care, requiring fewer emergency room visits, hospitalizations and medical tests,” says Stephanie Smith Cooney, PharmD, senior director of independent pharmacy affairs at Express Scripts.

• Understand your pharmacy benefits: Prescription drug coverage is the most frequently utilized benefit that employers and health plans offer. On average, a pharmacy benefit is used approximately 11 times a year. Unfortunately, pharmacy care benefits, like all healthcare benefits, can be confusing. That’s why pharmacy services companies are taking steps to give patients greater clarity. Starting this year, prescriptions from Express Scripts include an easy-to-understand digital pharmacy benefits statement with drug price information, out-of-pocket costs and the value delivered.

• Pharmacy access: Pharmacists often fill care gaps in their communities, particularly where there are shortages of physicians, such as in rural areas. One in five Americans live in rural areas, yet less than 10% of physicians practice in these communities. This means longer wait times to get an appointment and more difficulty accessing pharmacies.

A new effort called the IndependentRx Initiative, is working to expand pharmacy care services to widely include such care as smoking cessation support, behavioral health screenings, biometric screenings, routine vaccinations and the administration of life-saving naloxone. The Express Scripts program will also increase what it pays rural independent pharmacies to make sure their businesses can continue to serve their communities.

To learn more, visit evernorth.com/affordableforall.

Ensuring equitable access to affordable, quality pharmacy care and health services will not only improve health, but it will also help individuals, families and communities thrive.

Photo Credit: (c) Drazen Zigic / iStock via Getty Images Plus

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Helping You Get The Most out of Your Prescription Drug Benefits

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