Express Scripts Consultant News

Shortly after posting the blog entry immediately preceding this post entry we received the following email message from Express Scripts:

Express Scripts Logo
Consultant News:
What’s new? What’s now? What’s next?
Highlights from your Express Scripts Consultant Relations team to keep you informed
2020 | Volume 10
**9/1/2020 Enhancement** Migraine Care Value Program

Express Scripts’ SafeGuardRx programs undergo continuous development and feature expansion. The Migraine Care ValueSM (MCV) program enhancement is just one example of this. With the approval of new acute migraine products, MCV has evolved to provide support for clients and their patients who are candidates for these new therapies.

New program components, effective 9/1/2020:

  • Newly approved acute migraine products added: Reyvow, Nurtec, and Ubrelvy
  • Proactive physician education on acute migraine therapy options
  • A discount on preferred acute migraine products
  • In-network retail fills for preferred acute migraine products

What’s not changing:

  • Coaching on using an injectable migraine medication and proactive member outreach re: nonadherence
  • Early discontinuation reimbursement on preferred preventative CGRP-inhibitor medications
  • Exclusive Home Delivery for preventative CGRP-inhibitors
  • NPF and UM to drive members to the lowest net-cost medications and ensure proper access to CGRP inhibitors
Clients currently enrolled in MCV are being notified of the program’s enhancement by their account team. There is no need to re-enroll into the program; this will be an automatic update to the program.
**Reminder** Embarc Benefit ProtectionSM

Embarc Benefit Protection is the first solution of its kind to build a new pathway for payers to afford the coming wave of expensive, potentially curative gene therapy medications.

  • Embarc Benefit Protection fills a critical unmet need to protect payers, and is available to insurers, HMOs, TPAs, and self-funded employer plans through their medical carrier, so these potentially life-altering cures will not be out of reach for any patients* covered by a plan with the Embarc Benefit Protection solution.
  • Embarc is available through eviCore, an Express Scripts company, who will arrange affordable access to high-cost, breakthrough therapies through a carefully selected network of specialty care pharmacies, including Accredo specialty pharmacy, and CuraScript SD.

Key components of Embarc Benefit Protection

Embarc Benefit Protection will initially cover Luxturna®, the first FDA-approved prescription gene therapy for patients with inherited retinal disease, and Zolgensma®, a gene therapy for children younger than 2 years old with spinal muscular atrophy.

  • For $0.99 per member, per month, Embarc Benefit Protection creates member access to high-cost, potentially curative therapies, while ensuring cost predictability for payers.
  • Embarc Benefit Protection was initially available via eviCore contracting directly with health plans and is now also available directly to employers via eviCore, or via eviCore contracting directly with their health plan.
  • As new gene and cell therapies are approved by the FDA, we will continue to assess for future inclusion on an ongoing basis.

For a more detailed look at the solution and its benefits, please click here.

*With respect to Zolgensma, the solution applies only to children born after the Embarc Benefit Protection solution is implemented for their group health plan. Children born before the implementation date will have coverage under their medical plan. Plan deductible, co-insurance and co-pays will apply to the gene therapy product and related administration costs.

Our shared clients may have already received an update from us in early 2020. Additionally, Express Scripts account teams are meeting with these clients to explain the pathway for bringing this innovative solution to their plans. Some clients may receive an email with more information on Embarc Benefit Protection at the account team’s discretion.
Looking Ahead: Digital Health in the World of COVID-19

As you may recall in late 2019, we introduced the Express Scripts Digital Health Formulary and our first cohort that includes 15 clinically validated programs from leading digital health companies. As a reminder, the Digital Health Formulary is a clinically based platform of digital health options for our mutual clients. To be included on our Digital Health Formulary, a solution must demonstrate everything we know our clients expect:

  • Clinical effectiveness
  • Security and privacy compliance
  • Value and affordability
  • A great member experience

Digital Health has become more important than ever to both members and providers: delivering care in a safe and socially distant manner. But at the rate that new solutions hit the market, navigating this landscape can be overwhelming for plan sponsors.

We invite you to read this article for a look at insights we’ve gleaned in the first half of 2020.

Where appropriate, clients will be reintroduced to Digital Health Formulary at account team’s discretion.
For further information on the topics above, please reach out to your consultant relations director or send your inquiry here.
Express Scripts
One Express Way
St. Louis, MO 63121
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