Express Scripts is recognized for it’s leading edge solution which is powered by Agadia’s Doctor Portal and PAHub technologies…
“Express Scripts leading-edge solution, ExpressPAth, tackles the rising costs and complex clinical challenges of specialty medications. ExpressPAth provides a capability never before seen in the healthcare industry – managing 100% of a client’s drug costs regardless of whether the medications are covered under the patient’s pharmacy or medical insurance plan. Currently, more than 3 million Americans benefit from ExpressPAth. By first quarter 2014, every physician in the country will have access to ExpressPAth, impacting more than 100 million lives.
How it Works:
The ExpressPAth innovative platform draws upon terabytes of data and clinical results collected over the past 2 decades, and connects it with a real-time, user-friendly portal available to physicians and other prescribers via mobile devices (iPad) or desktops.
ExpressPath:
– Integrates leading technologies to enable real-time feedback on complex pharmacy benefit processing and clinical checks, to deliver safer, medically appropriate specialty drug care;
– Has custom behavioral modeling capabilities that succeed at the complex and sensitive task of helping prescribers and patients make better choices;
-Radically alters the reimbursement process, providing physicians with real-time approvals so they know exactly how much they’ll be reimbursed for a specific drug.
Business Purpose:
Specialty medications are commonly injected or infused drugs that treat complex and rare conditions, such as HIV and MS. They are incredibly expensive, with some therapies costing hundreds of thousands of dollars. Research estimates these drugs will make up 40% of all drug spend by 2018.
53% of specialty drug spend is billed under the pharmacy benefit where programs, like those traditionally operated by Express Scripts, help guarantee appropriate use, improved safety and reduced costs.
The remaining 47% is covered by major medical insurance where, until now, there is limited/no visibility or effective tools to manage costs. The result is an estimated $8 billion of unnecessary spending each year from lack of medication adherence, over-utilization and other inefficiencies.
How we did it:
To create ExpressPAth, we brought in critical vendor technologies and partners, such as Agadia, and enabled a series of new, industry-first capabilities to map complex procedures, rules and data, bridging them into mature and scalable in-house platforms. We then layered in our proprietary rules and services. In addition, Express Scripts created a new proprietary platform for specialty drug claims management. We also tapped into our behavioral models and leveraged the experience from our core practice to deliver intelligent guidance.
Results and Examples:
Express Scripts clients receive an average savings of 10-15% on specialty drug spend in the medical benefit with ExpressPAth:
– In 2012, ExpressPAth saved one small health plan client more than $350,000 in specialty drugs costs billed under the medical benefit.
– ExpressPAth saved a client $6,563 when it identified the correct dose of a drug claim for $10,400 under medical benefit system and re-priced claim for the proper amount of $3,837.
– ExpressPAth reviewed a prescription request for an IV antibiotic and determined that the requested prescription could have been lethal for the patient. A corrected prescription was obtained and approved.”
