Since 2017, the Express Scripts Diabetes Care Value Program has been dedicated to supporting individuals managing diabetes and those at risk, aiming to improve their health outcomes and alleviate the financial burden associated with this condition for both patients and plan sponsors. In 2022, we broadened the program, introducing innovative tools and resources designed to enhance the prevention and management of this complex, chronic disease.
The urgency of addressing the escalating diabetes epidemic, which impacts over 38.4 million Americans, remains critical. This condition poses significant challenges and costs for employers and plan sponsors. Comprehensive solutions utilizing the latest digital technologies are essential to meet the unique needs of each patient, fostering adherence and achieving better health results.
The Express Scripts Diabetes Care Value program incorporates coverage for continuous glucose monitors (CGMs) within the pharmacy benefit. CGM integration offers increased convenience and delivers crucial clinical insights into a patient’s glucose levels. Fluctuations in blood sugar can cause both immediate and long-term health complications. When clinically suitable, CGMs can assist individuals in reaching their health objectives while lowering overall healthcare expenses.
The Diabetes Care Value program effectively combines traditional pharmaceutical approaches with a suite of tools and resources from Evernorth’s health services to empower patients in understanding and managing their diabetes more effectively. Beyond CGM coverage under the pharmacy benefit, the expanded program includes the following components to facilitate and streamline adoption:
- Predictive analytics: Proactive identification of eligible members and outreach to their healthcare providers to facilitate informed decisions regarding the potential advantages and utilization of CGMs.
- SmartPA: Simplifying prior authorizations to ensure timely access to appropriate CGM therapy for members when prescribed.
- Specialized pharmacist support: Dedicated pharmacist guidance for members utilizing CGMs, aimed at promoting initial adoption and sustained adherence.
Participating plans also qualify for program discounts on CGM devices and discontinuation credits for select preferred products.
Alongside access to affordable diabetes treatments, tools like CGMs are integral to a more holistic approach to diabetes management. They empower members and enable plan sponsors to proactively manage this intricate and costly disease.
Moreover, given the interconnected nature of chronic conditions, this comprehensive strategy contributes to improved outcomes across a range of health challenges. For instance, in 2023, the Express Scripts Diabetes Care Value program, as a component of our value-based SafeGuardRx platform, facilitated an 18.2% increase in statin therapy initiation among enrolled patients at risk of heart disease and stroke. If all plans achieved comparable increases in statin utilization, it is projected that over 21,500 heart attacks could be averted over the next decade.1
The Express Scripts Diabetes Care Value program also features a preferred quality pharmacy network designed to reduce costs and enhance adherence, the National Preferred Formulary or utilization management tools to optimize the use of cost-effective diabetes medications, and reimbursement opportunities for instances of therapy discontinuation. Furthermore, we offer specialized support through the Diabetes Therapeutic Resource Center®.
Originally published on 8/31/22 and updated on 11/22/24.
