ST. LOUIS, Nov. 18, 2010 /PRNewswire/ -- Express Scripts, Inc. (Nasdaq: ESRX), today announced the formation of Express Scripts Specialty Benefit Services, the industry's most comprehensive specialty benefits organization. Express Scripts now delivers plan sponsors a first-in-the-industry offering that enhances patient care across the pharmacy-medical spectrum, and guarantees savings on the specialty medical drug spend.
The new organization expands the company's long-standing commitment to enhancing patient care and reducing wasteful expenses associated with chronic, high-maintenance health conditions and specialty medications.
Express Scripts is the first PBM to bring together the three functional areas needed to comprehensively manage specialty benefits: 1) pharmacy benefit management, 2) specialty pharmacy and distribution and 3) medical benefit management. The vital third component – medical benefit management – is delivered through the company's long-standing subsidiary, Care Continuum™.
By integrating core PBM and pharmacy services with expanded capabilities through Care Continuum, Express Scripts offers an unprecedented solution to specialty patient care and trend management across both pharmacy and medical benefits.
"Our creation of the first specialty benefits organization is very timely, as the national healthcare reform discussion centers around three critical areas: access, quality and cost," said Steven Miller, MD, chief medical officer of Express Scripts. "Express Scripts is responding to rising market demand for comprehensive specialty benefit services spanning both pharmacy and medical benefits. As a result, we are using evidenced-based methods to enhance patient safety and clinical care, while eliminating wasteful healthcare expenses."
Specialty drugs are used to treat chronic, complex conditions, such as cancer and pulmonary arterial hypertension. As noted in the Express Scripts 2009 Drug Trend Report, the pharmacy and medical costs for specialty drugs are expected to increase from 24% of national drug spend in 2009 to 40% by 2014. To control this upward climb of specialty spend and to help patients achieve positive health outcomes, Express Scripts Specialty Benefit Services encourages the use of the right therapy at the right time in the appropriate quantity, regardless of whether a patient receives the drug through the pharmacy or medical benefit.
Based on data from the MarketScan® Commercial Claims and Encounters Database, more than 55% of total specialty drug spend occurs within the medical benefit, as many of these drugs are administered in a doctor's office, clinic, ambulatory infusion site, hospital or by a home health agency.
Matt Totterdale, who heads Express Scripts Specialty Benefit Services, summarized the advantages that the new organization provides. "Traditionally, specialty drugs billed through the medical benefit have not received the same robust clinical and trend management programs as in the pharmacy benefit," he said. "By combining PBM, specialty pharmacy, and now medical benefit management, Express Scripts Specialty Benefit Services helps plan sponsors manage utilization, site of care and claims for medications billed under the medical benefit. Our comprehensive approach makes the use of specialty medications safer and more affordable."
By applying proven tools for specialty drug utilization, trend and claims adjudication, Express Scripts Specialty Benefit Services can forecast, guarantee and deliver measurable savings for plan sponsors. In its preliminary 2010 rollout, the program has already saved Express Scripts clients $8 million.
"We are proud to make this offering available to all of our clients, after having expanded our capabilities in several strategic areas," noted Totterdale. "And because of our unique medical benefit management expertise, Express Scripts is willing to guarantee savings on specialty medical drug spend."
About Specialty Medications
The Academy of Managed Care Pharmacy (AMCP) defines specialty medications as high-cost medications that are usually prescribed for people with complex or chronic medical conditions, such as multiple sclerosis, hemophilia, hepatitis and rheumatoid arthritis. These medications typically exhibit one or more of the following characteristics: drugs that are injected or infused, however some may be taken by mouth; drugs that have unique monitoring, storage or shipment requirements; drugs that require additional education and support from a health care professional; and drugs that are usually not available at retail pharmacies.
About Express Scripts
Express Scripts, Inc., one of the largest pharmacy benefit management companies in North America, is leading the way toward creating better health and value for patients through Consumerology®, the advanced application of the behavioral sciences to healthcare. This approach is helping millions of members realize greater healthcare outcomes and lowering cost by assisting in influencing their behavior. Headquartered in St. Louis, Express Scripts provides integrated PBM services including network-pharmacy claims processing, home delivery services, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services. More information can be found at http://www.express-scripts.com/pressroom/ and http://www.consumerology.com/.
SOURCE Express Scripts, Inc.