Express Scripts just fired the next shot across the bow in its much-publicized quest to control prescription drug costs. Beginning 2016, ESI is launching the SafeGuardRx℠ program, marketed as a “collection of novel solutions that will transform the pharmacy benefit”. Specifically, the program is being positioned as a strategic imperative to shield ESI employers and health plans from the unsustainable trajectory of drug pricing and annual price increase practices.

There are four components to SafeGuardRx℠

  1. A new Oncology Care Value Program℠ targeting Lung Cancer, Prostate Cancer, and Renal Cell Carcinoma
  2. An “industry-first” Inflation Protection Program to control annual drug price increases
  3. Continued implementation of the current Cholesterol Care Value Program℠ (CCV)
  4. And finally a modified version of the ongoing Hepatitis Cure Value Program℠

The cumulative effectiveness of these efforts remains to be seen, but two things are immediately obvious:

First, the additional $2000 discount to clients who get Viekira Pak™ through the Accredo specialty pharmacy has the makings of an all-around winner since it promises to:

  • Reduce HCV cost of therapy by a minimum of 2.3% for ESI clients generating  significant pharmacy benefit savings given the high cost of HCV therapy
  • Increase Accredo profits by shifting HCV specialty pharmacy distribution from other specialty pharmacies
  • Incentivize ESI clients to minimize Sovaldi and Harvoni exceptions when Accredo is the specialty pharmacy

Complementing the more therapeutic area focused efforts, ESI’s Inflation Protection Program will have broad impact across all therapeutic areas. More importantly, this self-branded first in the industry program goes above and beyond garden variety price protection agreements by absorbing the financial risk when ESI contracted price protection manufacturer limits are higher than the guaranteed price increase caps to ESI clients. What this means:

 

  • Risk sharing could incentivize clients to switch to ESI thereby making it likely that other large PBMs will hear similar demands from their clients
  • Manufacturers with no price protection in their ESI contracts will be under pressure to provide them in the future, and those with existing price protection terms will be under pressure to lower their pricing caps
  • Manufacturers may have to look to a high WAC launch pricing strategy given that lifecycle price increases will be less effective in growing revenues

With This Missive, ESI continues to stand out as the key market maker when it comes to prescription drug pricing. Head over to Express Scripts since the entire thing is worth a read, and keep watching that space for it promises to be a harbinger of more game-changing trends in pharmacy benefit management.

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