ST. LOUIS and BALTIMORE, May 31,
2018 /PRNewswire/ -- For any patient with a rare disease,
the journey to the right diagnosis and treatment can be long and
difficult. On average, it can take 7.6 years and seven different
doctors before a patient suffering from the symptoms of a rare
disease finally receives a correct diagnosis. Even then,
determining the best treatment and managing the complexities of any
rare disease can require expertise that many physicians lack given
the relatively small patient population affected by the condition.
Many times, a second opinion from an expert can help resolve
clinical questions and bring emotional reassurance to patients
struggling with the symptoms of a rare disease.
Express Scripts (NASDAQ: ESRX) today announced a new Rare
Conditions Care ValueSM (RCCV) program with the
introduction of a support service known as Second Opinion in
partnership with PinnacleCare® a private health
advisory firm that offers personalized guidance and expert case
review. Members whose plan enrolls in the RCCV program will have
free access to Second Opinion, a potentially life-altering service
that offers a second opinion from a top specialist in the field who
will provide an expert assessment of the diagnosis and
recommendations on the most effective treatment protocol.
The Second Opinion support service addresses the challenges that
patients with rare diseases face in securing a diagnosis and
treatment. In doing so, Second Opinion helps reduce the emotional,
physical and financial burden on patients and plan sponsors
associated with misdiagnosis, waste and inappropriate treatments,
which can cost millions of dollars and impact years of a patient's
life. Among patients who have used PinnacleCare services, nearly 77
percent of engagements have resulted in a change of diagnosis,
treatment or care, when working in coordination with a patient's
pharmacy benefit manager and medical benefit plan.
"The years spent going to different doctors, getting myriad
medical tests, managing paperwork and experimenting with numerous
treatments is an ordeal for patients and their health, as well as
for those who love and care for them," said Glen Stettin, M.D., senior vice president of
clinical, research and new solutions at Express Scripts. "Getting
to the right diagnosis and the right therapy is critically
important for the more than 30 million Americans currently with a
rare disease. Combining the benefits of PinnacleCare's Second
Opinion program with the expertise and care delivered by the
specialist pharmacists in our Accredo Specialty Pharmacy can make a
tremendous difference in the patient's quality of life and
substantially reduce wasteful spending."
Rare Conditions are not so Rare
The Rare Conditions
Care Value (RCCV) program is addressing rare diseases that have
recently seen significant increases in diagnosis and treatment
utilization, such as hemophilia, Huntington's disease, Gaucher's disease,
acromegaly, alpha-1 deficiency, hereditary angioedema and
idiopathic pulmonary fibrosis. Among these disease states alone,
the number of newly approved drugs that can treat the disease or
the symptoms associated with the disease will rise from 46 in 2014,
to 76 in 2020. These treatments can be very costly. For example,
hereditary angioedema, a potentially life-threatening genetic
condition occurring in as few as 1 in 50,000, can cost $2.2 million for one patient in a single
year.
With more than 7,000 different rare diseases identified by the
medical community so far, Americans living with a rare condition
are as common as people living with diabetes. Among Express
Scripts' commercial book of business, the proportion of clients
with at least one member who has one of the seven rare conditions
addressed by the RCCV program has grown from 29 percent in 2014, to
41 percent in 2017. Just as the prevalence of rare disease
has risen, so have the number of treatments available and the costs
of treatment. Consider:
- One-third of new FDA-approved drugs have an orphan designation.
- The price of rare-condition medications has increased 54
percent in the last four years alone, with some drugs costing as
much as one million dollars for a
single year's treatment.
- Patient out-of-pocket costs for these conditions have also
risen more than 41 percent since 2014 to an annual average of
$1,790 in 2017, not accounting for
manufacturer coupons or patient assistance programs, and may
continue to grow as additional therapies in the pipeline come to
market.
"Rare disease trends are growing on all fronts – more patients,
new drugs and higher costs," said Miles J.
Varn, M.D., chief medical officer of PinnacleCare. "In order
to provide affordable access to these newer therapies, we need to
make sure that the diagnosis is correct, and that the
pharmaceutical treatment plan is based upon expert best practices.
Working with Express Scripts, we'll help patients achieve better
health outcomes and ensure the care they receive is thoughtful and
cost effective."
Rare Conditions Care Value Program
In addition to the
Second Opinion service, the Rare Conditions Care Value program is
enhanced by personalized patient support from clinical pharmacists
and nurses specializing in the care of patients with rare disease
through the services offered by our Accredo specialty pharmacy.
This support includes one-to-one counseling and, when a drug
regimen so requires, in-home nursing services to help patients
better manage their disease and improve outcomes. The program also
helps clients prepare for and manage the high costs of
rare-condition treatments through a variety of cost-containment
tools and strategies.
The Rare Conditions Care Value program is part of Express
Scripts' SafeGuardRx® suite of solutions that offer affordable
access to medication classes that pose the largest budgetary threat
to payers, including inflammatory conditions, oncology, diabetes,
high cholesterol, multiple sclerosis, pulmonary conditions and
hepatitis C. Since 2015, Express Scripts has introduced 10
value-based programs that improve access to innovative drugs and
provide a pathway to the best care offered to all patients of
Accredo through specialist pharmacists at disease-specific
Therapeutic Resource Centers.
About Express Scripts
Express Scripts is leading the
way for tens of millions of people by aligning with plan sponsors,
taking bold action and delivering patient-centered care to make
better health more affordable and accessible.
Headquartered in St. Louis,
Express Scripts provides a full range of integrated pharmacy
benefit management services, including home delivery pharmacy care,
specialty pharmacy care and benefit management, benefit-design
consultation, drug utilization review, formulary management and
medical and drug data analysis, that guide patients and plans
toward better health by prioritizing care and increasing savings.
Our services drive down the cost of care for employer-funded,
Medicare, Medicaid and Public Exchange plans, and create the
headroom needed to keep patients' cost-share low, access broad, and
do more for those who are challenged by high out-of-pocket costs.
Express Scripts also distributes a full range of biopharmaceutical
products and offers innovative medical benefit management
services.
For more information, visit Lab.Express-Scripts.com or follow
@ExpressScripts on Twitter.
About PinnacleCare
PinnacleCare is a private health
advisory with a mission to ensure that all members realize their
highest expectations for their health and wellness. PinnacleCare's
personalized approach to health care is a unique combination of
exceptional medical resources, an unmatched range of services and
outstanding care allowing members efficient access to the finest
health care experiences, expert guidance through the complex
healthcare system by expert health advisors, and assurance in
leading the healthiest lives possible, at home and abroad.
www.PinnacleCare.com
Twitter: @PinnacleCare
Blog: www.PinnacleCare.com/blog
Media Contact:
Jennifer
Luddy
Express Scripts
jennifer_luddy@express-scripts.com
201-269-6402
George Cohen (for
PinnacleCare)
GCC, Inc.
George@gccpr.com
617-435-7208
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SOURCE Express Scripts