Archived Content

Driving Innovation In the Health Care Marketplace:

A CEO Report

Express Scripts, Inc.

For many American workers, health benefits are a major driver of job satisfaction and workplace loyalty. The pharmacy benefit is the most used — 11 times per year on average — so it’s easy to see why the pharmacy benefit is rich with opportunities to improve lives and make health care more affordable. 

Express Scripts helps businesses, health plans, unions and public programs maintain a robust pharmacy benefit for working families, seniors and the disabled by providing access to prescription drugs in the most cost-effective way possible. Our competitive, market-based model has expanded choices, reduced costs and improved outcomes. 

When you boil down the complex nature of health care and benefits, it comes down to decisions. Only through improvements in decisionmaking can we make the kind of positive impact our country needs. 

Our innovation in three specific areas — behavioral science, clinical specialization and actionable data — has driven out pharmacy waste, controlled costs for clients, and helped people live better. We bring these together in a unique approach called Health Decision Science. 

  • Bridging the gap between what patients want to do and actually do is best achieved by creating an environment where the optimal choice is the easiest. Applying behavioral science to health care has increased adherence, controlled client costs, and made delivery of medication safer and more convenient. 
  • Our Therapeutic Resource Centers focus on specific diseases, and our pharmacists have a level of understanding that rivals or surpasses many physicians. An oncologist may see a few hundred patients each year, while our oncology pharmacists engage with thousands. That expertise can mean life or death for some patients with particularly rare diseases. 
  • “Big data” is everywhere, but actionable data is what truly matters. We process more than 1 billion prescriptions yearly, generating extraordinary amounts of data. We take what we learn, add unique insight and create models that predict patient behavior. We then determine the most appropriate intervention to help ensure that patients make good health decisions. 

Innovative solutions from pharmacy benefit managers like Express Scripts are expected to reduce the cost of health care by more than $1 trillion over the next decade. It’s a huge number, but it’s necessarily ambitious. When we make the use of prescription drugs safer and more affordable, we sustain an important benefit, help businesses control costs and improve the lives of patients. 

Companies

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BRT companies provide health coverage to more than 40 million Americans. We help American workers and their families remain healthy, receive quality treatment when necessary and achieve better health outcomes. The private-sector innovations in the insurance marketplace that enable us to provide these services to our employees and their families serve as models for public programs — but additional reforms are necessary.

This report highlights the innovations we have made and the public policy changes we believe would drive value by promoting health and improving outcomes.

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