Express Scripts
ClearNetworkSM offers employers and health
plans a new option for simple, "cost-plus" pharmacy pricing for
brand, generic, and specialty medications.
ST.
LOUIS, Nov. 14, 2023 /PRNewswire/ -- Express
Scripts, the pharmacy benefits management (PBM) business of
Evernorth, a subsidiary of The Cigna Group (NYSE: CI), today
announced a new pharmacy network option, Express Scripts
ClearNetworkSM, for its clients – including employers,
government organizations, and health plans. It is designed for
clients seeking an option for cost-based pricing for prescription
drugs and pharmacy services and a seamless experience for their
employees and members. Through Express
Scripts ClearNetwork, clients pay a straight-forward
estimated acquisition cost for individual medications, in addition
to a small markup for pharmacy dispensing and service costs.
"We are constantly innovating to provide our clients with new
options that meet their needs and enable them to build custom
pharmacy benefits that best support their plans and members," said
Adam Kautzner, Pharm.D., President
of Express Scripts. "The Express Scripts ClearNetwork leverages our
scale, relationships, and deep understanding of the pharmaceutical
supply chain to create an easy-to-follow option for clients looking
to simplify what they pay for prescription drugs, while supporting
a seamless, convenient member experience."
Express Scripts ClearNetwork uses the lowest of several
established third-party industry benchmarks – including Predictive
Acquisition Cost, National Average Drug Acquisition Cost, and
Wholesale Acquisition Cost – to estimate the acquisition cost for
an individual drug. Then, pharmacy and administration costs are
added. First, a flat fee goes to the pharmacy to dispense
medications. Second, a fee of no more than 15 percent of the cost
of the drug is added. This fee is shared with participating
pharmacies to ensure a reasonable profit for them, and covers the
seamless management of claims and network services by Express
Scripts.
Available beginning in early 2024, Express Scripts ClearNetwork
will apply to all prescription drugs on a plan sponsor's list of
covered generic, branded and specialty medications. Express Scripts
is making this reimbursement model available to a broad network of
more than 65,000 retail pharmacies in its network to ensure
participating members will be able to conveniently access their
medications using their pharmacy benefit.
"This new model differs from other pricing options where Express
Scripts negotiates discounts with pharmacies to meet guaranteed
rates for clients," Kautzner added. "Express Scripts
ClearNetwork is a simple pricing option that reinforces the value
of our work to help consumers easily access the medications they
need, while also shining a light on the root cause of high drug
costs – drug manufacturers who set and raise prices."
Building on a Commitment to Transparency and
Affordability
This latest pharmacy pricing model builds on an existing suite
of transparent options offered by Express Scripts. Earlier this
year, Express Scripts announced several actions to drive greater
transparency and predictability, including ClearCareRx™ which
offers another transparent pricing option for clients.
Express Scripts also has a proven history of innovation and
industry-leading pharmacy service options to support the individual
needs of its clients and help members save on prescription drugs.
Programs like Copay Assurance Plan™ ,
SafeGuardRx®, Embarc Benefit
Protection®, and the Patient Assurance
Program® combined with effective negotiation and medical
management helped save consumers and clients more than $56 billion in 2022 alone.
About Evernorth Health Services
Evernorth Health Services creates pharmacy, care and benefits
solutions to improve health and increase vitality. We relentlessly
innovate to make the prediction, prevention and treatment of
illness and disease more accessible to millions of people.
Evernorth capabilities are powered by our businesses, including
Express Scripts, Express Scripts® Pharmacy, Accredo, eviCore and
MDLIVE, along with holistic Evernorth platforms and solutions that
move people and organizations forward. All Evernorth solutions are
serviced and provided by or through operating affiliates of
Evernorth Health, a wholly owned subsidiary of The Cigna Group
(NYSE: CI), or third-party partners. Learn more at
evernorth.com.
Contact:
Justine Sessions
860-810-6523
media@evernorth.com
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SOURCE Express Scripts