A Wholehearted Solution: Cardiovascular Care ValueSM

Express Scripts’ new Cardiovascular Care ValueSM program expands on our SafeGuardRx® Cholesterol Care ValueSM program to holistically tackle the clinical and financial challenges of high cholesterol as well as other heart conditions.

When unproven PCSK9 inhibitors came to the market priced at $14,000 per patient per year, we launched the Cholesterol Care ValueSM program to ensure affordability and appropriate access. As a result, plan sponsors and members benefitted from this innovative value-based contracting strategy. Since then, and due in part to our efforts, costs went down for our clients, and two outcomes-based clinical research studies, one published in 2018 and one in 2019, confirmed PCSK9 inhibitors achieved proven positive outcomes with high patient adherence.

But there is more we can do. We wholeheartedly believe in this approach and are expanding it to help more members and drive more value for plan sponsors.

A Wholehearted Solution to One of America’s Costliest Conditions

The heart is a complex organ that can be affected in many ways, making cardiovascular disease alarmingly prevalent: it contributes to a startling 1 in 3 deaths in the U.S., according to the American Heart Association and, about 1 in every 6 healthcare dollars is spent on treating cardiovascular disease each year.

Cholesterol is not the only thing our patients have to worry about. In addition to managing the complexities of high cholesterol and PCSK9 inhibitor use, the newly expanded Cardiovascular Care Value program will tackle atrial fibrillation (AFib), which affects 2.7 million Americans.

AFib is an irregular heartbeat that can lead to blood clots, stroke, heart failure and other heart-related complications. Anticoagulants, blood thinning medications, are a major staple in the treatment of AFib, and in fact, the use of these medications can decrease these complications by 50%. These medications, while life-saving, can also increase the risk of bleeding, requiring additional care and oversight of patients who take them.

However, studies show only 16% of people with AFib are taking the recommended anticoagulants prior to a stroke. Our clinical experts have designed a program to help patients with AFib and their plan sponsors benefit from a more holistic solution.

The expanded Cardiovascular Care Value program takes a holistic approach to cardiovascular disease by:

  • Continuing to offer price predictability for your population’s use of PCSK9 inhibitor medications
  • Widening its focus to also tackle the clinical and financial challenges of atrial fibrillation (AFib), which can lead to blood clots, stroke, heart failure and other heart-related complications
  • Creating a proven, value-based pathway to drive down prescription and downstream medical costs for expensive cardiovascular conditions

Improving Heart Health at Lower Costs

Beginning January 1, 2020, through our Cardiovascular Care Value program, we’ll combat the devastating health and financial consequences of cardiovascular disease by:

  • Lowering costs through product discounts and cost caps for both PCSK9 inhibitors and select anticoagulants. With 50 million lives already covered in SafeGuardRx programs treating conditions like diabetes, oncology and multiple sclerosis, we are again using our size and scale to drive competition between manufacturers.
  • Improving adherence by identifying members who are nonadherent or are at risk of becoming nonadherent and reaching out to make sure they stay on a healthy path.
  • Ensuring therapy initiation by working with members who fail to fill their first anticoagulant prescriptions.
  • Optimizing patient care and safety with 24/7 support from our Cardiovascular Therapeutic Resource Center’s specialist clinicians.

What began as a program to tackle the high costs and uncertain side effects of cholesterol-lowering injectable medications has evolved. We’re widening our focus to address whole heart health, so we can have a broader impact across the entire cardiovascular disease category.

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