Express Scripts Launches New Cost Plus Drug Model

Beginning in early 2024, Express Scripts will offer a new option similar to the Mark Cuban Cost Plus Drugs model. The pharmacy benefit manager aims to provide employers and plans a more simple pricing structure.

Called the Express Scripts ClearNetwork, the new option will use the lowest benchmark – Predictive Acquisition Cost, National Average Drug Acquisition Cost, or Wholesale Acquisition Cost – to estimate the acquisition cost for an individual drug. A flat pharmacy fee and a second fee of 15% is added. A spokesperson said the fees will be transparent to clients and pharmacies.

The option will apply to a plan sponsor’s list of covered generic, branded and specialty medications. This model is being offered to the 65,000 retail pharmacies in its network.

Adam Kautzner, Pharm.D.

“The Express Scripts ClearNetwork leverages our scale, relationships, and deep understanding of the pharmaceutical supply chain to create an easy-to-follow option for clients looking to simplify what they pay for prescription drugs, while supporting a seamless, convenient member experience,” Adam Kautzner, Pharm.D., president of Express Scripts, said in a press release.

This follows the company’s announcement earlier this year about the launch of ClearCareRx, which offers clients the option of a transparent economic model for prescription drug benefits. In this program, clients pay what Express Scripts pays pharmacies and also receive 100% of rebates negotiated with pharmaceutical companies. Clients pay a fee to cover the administration of pharmacy benefits, PBM product services, reporting and analytics. Built into this program are guarantee measures and financial targets.

This year, Express Scripts began providing clients enhanced financial and fee disclosure regarding their spread pricing arrangements. ClearCareRx is aligned with plan-specific targets, and includes a per member per month fee for the administration of pharmacy benefits, PBM product services, and reporting and analytics.

In addition, earlier this year, Express Scripts began offering what a Copay Assurance plan that caps copays for patients enrolled in the program on prescription drugs: no more than $5 for generics, $25 for preferred brand drugs, and $45 for preferred specialty brand drugs. These copays apply even before deductibles are met.

Also starting in 2024, prescriptions will include a pharmacy benefits statement for consumers — sharing drug price information and out-of-pocket costs. This benefit will be implemented across all 65,000 pharmacies in Express Scripts’ networks, including Accredo specialty pharmacy, and Express Scripts Pharmacy.

This story first appeared on Managed Healthcare Executive.