Patients with complex health conditions such as cancer or multiple sclerosis can spend $6,000 to $100,000 per year on "specialty" prescriptions, which aren't covered by traditional prescription drug plans but by more complex and unmanaged medical insurance plans.
St. Louis-based Express Scripts wants to take a bite out of those astronomical costs by combining its pharmacy knowledge with extensive data it collects from its patients to find the best medications for each patient and the lowest possible prices.
What's more, its ExpressPath platform can manage 100% of a client's drug costs regardless of whether the medications are covered under the patient's pharmacy or medical insurance plan, a feature not previously available in the healthcare industry.
Physicians connect to the platform through a portal that can be accessed via mobile device or desktop and can determine how much a prescription will cost before the purchase.
"Physicians are able to see all the other conditions and prescriptions on this patient," explains Gary Wimberly, senior vice president and CIO at Express Scripts. "[The system is] able to interact with them [to determine] the right medication and the right channel -- whether through a clinic, home infusion or specialty mail-order pharmacy. It optimizes both the care for the patient and the medication."
"It gives our providers unlimited access to getting authorization requests," even at night and on weekends, says Melinda Pollard, manager of pharmacy operations.
"We're attacking $8 billion a year in wasted specialty [spending]," Wimberly says. "If we get true adoption, we can drive $8 billion a year out of the healthcare system."
Launched in 2012, ExpressPath already has more than 3 million patients through its member organizations. Those patients receive an average savings of 10% to 15% on specialty drugs through ExpressPath, and approval times have been reduced from as long as 72 hours to as little 12 hours.