Express Scripts by Evernorth Members Paid Less for Prescriptions in 2023 Despite Drug Price Increases

Rhea-AI Summary

Express Scripts, part of Evernorth under The Cigna Group (NYSE: CI), reported that members with employer-sponsored insurance saw a 1% decrease in out-of-pocket prescription costs in 2023, averaging $15.10 for a 30-day supply, despite a price increase for 60% of branded drugs. Their negotiations and innovative solutions contributed to these savings, even with rising consumer prices.

Four in five members spent less than $250 annually on medications. The Patient Assurance Program capped diabetes medication costs at $25 for a 34-day supply, leading to $92 million in savings. This highlights Express Scripts' efforts to manage drug prices and ensure affordability for patients.

Positive

• Members with employer-sponsored insurance saw a 1% decrease in out-of-pocket prescription costs in 2023.
• Average out-of-pocket cost was $15.10 for a 30-day supply.
• Express Scripts' innovative solutions and negotiations helped lower costs despite 60% of branded drugs seeing price increases.
• 81% of members spent less than $250 annually on medications.
• Patient Assurance Program saved $92 million on diabetes medications.

Negative

• 60% of branded drugs saw price increases in 2023.
• Rising consumer prices could impact overall cost management strategies.

Insights

Financial Analyst

Express Scripts' ability to mitigate rising drug prices for members with employer-sponsored insurance reflects a notable achievement in cost management. The 1% decrease in out-of-pocket costs, despite drug price increases, showcases the company's effective negotiation strategies with pharmaceutical manufacturers. This cost control can be particularly beneficial for retaining and attracting employer-sponsored plans, as lower costs can be a significant selling point for such contracts.

From an investor's perspective, this development is positive as it demonstrates the company's capability to manage expenses effectively and maintain customer satisfaction. The $92 million in savings on diabetes medications further exemplifies their impact on cost containment. Nevertheless, it's essential to monitor whether such strategies can be sustainably implemented without compromising service quality or profit margins in the long term.

Healthcare Policy Analyst

The reduction in out-of-pocket expenses for members, even amid rising pharmaceutical prices, underscores Express Scripts' role in advocating for affordable healthcare. Their innovative programs, such as the Patient Assurance Program, which caps costs for diabetes medications, align with broader healthcare policy objectives aimed at reducing the financial burden on patients.

This approach not only enhances access to essential medications but also positions Express Scripts favorably in the regulatory environment, potentially leading to supportive policies and partnerships. For stakeholders, this signifies a proactive stance towards addressing healthcare affordability challenges, which could strengthen the company's reputation and influence in the industry over time.

Members with employer-sponsored insurance saw about a 1% decrease in out-of-pocket costs for their prescription medicines last year, paying an average of $15.10 for a 30-day supply

ST. LOUIS, Mo., June 20, 2024  /PRNewswire/ -- Express Scripts, the pharmacy benefits services business of Evernorth, a subsidiary of The Cigna Group (NYSE: CI), today released research spotlighting that members with employer-provided coverage paid less at the pharmacy counter for prescription drugs in 2023 compared to the previous year. On average, members with employer-sponsored drug coverage paid $15.10 out-of-pocket for a 30-day prescription in 2023, a decrease of about 1% compared to 2022. While drug manufacturers raised prices for 60% of branded drugs in 2023, data confirm that Express Scripts lowered out of pocket costs for these members as a result of its negotiations with pharmaceutical manufacturers and innovative solutions, even as consumer prices for goods and services increased in the United States from 2022 to 2023.

"Express Scripts continues to bring down medication costs for patients," said Adam Kautzner, Pharm.D., president of Evernorth Care Management and Express Scripts. "Despite rising costs of prescription drugs and inflation, our commercial members' average cost share has increased by no more than 1.1% year over year since 2020."

On average, members with employer-sponsored drug coverage paid $15.10 out of pocket for a 30-day prescription in 2023. For the entirety of 2023, four in five Express Scripts members – 81% – spent less than $250 out of pocket for their medicines, or about $20 per month. Nearly two-thirds of members spent even less, even as the median annual list price for a new drug reached $300,000 last year, according to a Reuters analysis, up from $222,000 a year earlier.

Additionally, Express Scripts' innovative programs keep costs down for the millions of commercial customers it serves, including by:

• Capping out-of-pocket costs for people living with diabetes: Insulin and other medications that treat diabetes carry an average wholesale price of $438.07 per month – almost $15 a day. Over 11 million Express Scripts members living with diabetes can access participating insulin and other diabetes medications for $25 for up to a 34-day supply (or $75 for a 90-day supply) through the Patient Assurance Program.
• $92M in savings on diabetes medications: The Patient Assurance Program saved plans and patients $92 million in total last year for insulin and other diabetes medications.

Kautzner said, "Across disease areas, Express Scripts holds drug manufacturers accountable for their prices and uses generic and biosimilar competition to help ensure patients who need these medications can afford them at the pharmacy counter."

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.

Media Contact
Madeline Ziomek
(202) 615-1473
Madeline.ziomek@evernorth.com

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SOURCE Express Scripts

FAQ

What was the average out-of-pocket cost for Express Scripts members with employer-sponsored insurance in 2023?

The average out-of-pocket cost was $15.10 for a 30-day supply.

How much did Express Scripts members save on diabetes medications through the Patient Assurance Program?

The Patient Assurance Program saved $92 million on diabetes medications.

Despite drug price increases, how did Express Scripts manage to lower out-of-pocket costs for members?

Through negotiations with pharmaceutical manufacturers and innovative solutions.

What percentage of branded drugs saw price increases in 2023?

60% of branded drugs saw price increases.

What was the maximum annual out-of-pocket spending for the majority of Express Scripts members in 2023?

81% of members spent less than $250 annually on medications.