New Express Scripts Programs Aim to Boost Affordability, Transparency


Through Express Scripts’ new Copay Assurance plan, consumers will have lower out-of-pocket costs because of caps on prescription drugs: $5 for generics, $25 for preferred brand drugs, and $45 for preferred specialty brand drugs.

Express Scripts, the PBM of Evernorth, a subsidiary of The Cigna Group, is launching a new copay assistance program to increase access to affordable medicines. Other new programs aim to drive greater transparency and predictability, the company said.

Express Scripts’ new Copay Assurance plan ensures consumers pay less out-of-pocket by capping copays on prescription drugs at $5 for generics, $25 for preferred brand drugs, and $45 for preferred specialty brand drugs.

"A prescription drug doesn't work if it's priced out of reach. Reducing out-of-pocket costs for consumers is the single best thing we can do to improve the health of those we serve," said Adam Kautzner, Pharm.D., president of Express Scripts.

Adam Kautzner

Adam Kautzner

The new initiatives come at a time when PBMs are increasingly under fire by Congress and advocacy groups, which claim they are responsible for overall higher drug costs.

Express Scripts was first to deliver a $25 price cap on out-of-pocket costs for insulin and other diabetic treatments, according to Kautzner, which has saved consumers more than $45 million in two years.

“Our new Copay Assurance plan builds on this success and aggressively expands our efforts across medications to treat all diseases — providing millions more people with predictability and peace of mind at the pharmacy counter,” he said.

Express Scripts is also working with employer and health plan clients to offer consultative options to bring better affordability and predictability, the PBM said.

“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,” according to the organization.

Additionally, Express Scripts’ new ClearCareRx offers employer, health plan, and government employer clients “a fully transparent pricing option where clients pay exactly what Express Scripts pays for medication,” the PBM said.

Clients pay exactly what Express Scripts pays pharmacies for a prescription and they receive 100% of drug rebates that Express Scripts obtains by negotiating with pharmaceutical companies, according to the company.

Clients also “pay one simple fee to cover the administration of pharmacy benefits, PBM product services, reporting and analytics — and is 100% auditable, Express Scripts said.

The program also offers guarantees that keep Express Scripts accountable to clinical and financial performance measures, including improvements in drug performance, adherence, and overall patient outcomes.

"Expanding on our proven track record of driving transparency, ClearCareRx drives greater simplicity, with strategies to further reduce costs and improve health and pharmacy care. If we don't deliver on a client's goals, they pay less, guaranteed," Kautzner said.

Express Scripts is also further evolving its transparency to consumers and clients and enhancing its disclosure practices. Starting in 2024, prescriptions will include an “easy-to-understand” digital pharmacy benefits statement for consumers — sharing drug price information, out-of-pocket costs, and the value delivered by Express Scripts.

Beginning with the 2023 plan year, Express Scripts will provide clients enhanced financial and fee disclosure regarding their spread pricing arrangements for Form 5500 reporting and other plan administration functions.

The Form 5500 Series is a compliance, research, and disclosure tool for the U.S. Department of Labor (DOL), other federal agencies, Congress, as well as for plan participants and beneficiaries, and the private sector to assess employee benefit, tax, and economic trends and policies, according to the PBM.

“Express Scripts will provide the same level of increased disclosure to its non-ERISA clients to help support them in understanding the services Express Scripts provides," the company said.

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