Express Scripts 2011 Annual Report Download - page 12

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Express Scripts 2011 Annual Report
10
We offer education programs to members in managing clinical outcomes and the total healthcare costs associated
with certain conditions such as asthma, diabetes and cardiovascular disease. These programs are based on the premise that
better-informed patient and physician behavior can positively influence medical outcomes and reduce overall medical costs.
We identify patients who may benefit from these programs through claims data analysis or self-enrollment. Using the
advanced consumer marketing sciences and behavioral psychology of Consumerology®, we are able to encourage patients
to engage in more health-promoting behaviors that can have sustainable, life-changing benefits.
We offer a tiered approach to member education and wellness, ranging from information provided through our
Internet site, to educational mailings, to our intensive one-on-one registered nurse or pharmacist counseling. The programs
include providing patient profiles directly to their physicians, as well as measurements of the clinical, personal and
economic outcomes of the programs.
Rebate Programs. We develop, manage and administer programs that allow pharmaceutical manufacturers to
provide rebates and administrative fees based on utilization of their products by members of our clients’ benefit plans. The
rebate portion that the client receives varies in accordance with each client contract. Our rebates are determined based on
the characteristics of the formulary design and pharmacy benefit structure selected by the client. The amount of rebates
generated by these types of programs is a function of the particular product dispensed and the level of utilization that
occurs. Manufacturers participating in our rebate programs pay us administrative fees in connection with the services and
systems we provide through the rebate program.
Electronic Claims Processing and Drug Utilization Review. Our electronic claims processing system enables us to
implement sophisticated intervention programs to assist in managing prescription drug utilization. The system can alert the
pharmacist to generic substitution and therapeutic intervention opportunities, as well as formulary compliance issues, and
can also administer prior authorization and step-therapy protocol programs at the time a claim is submitted for processing.
Our claims processing system also creates a database of drug utilization information that can be accessed at the time the
prescription is dispensed, on a retrospective basis to analyze utilization trends and prescribing patterns for more intensive
management of the drug benefit, and on a prospective basis to help support pharmacists in drug therapy management
decisions.
Administration of a Group Purchasing Organization. We operate a group purchasing organization (―GPO‖) that
provides various administrative services to participants in the GPO. Services provided include coordination, negotiation and
management of contracts for group participants to purchase pharmaceuticals and related goods and services from
pharmaceutical manufacturers and suppliers, as well as providing strategic analysis and advice regarding pharmacy
procurement contracts for the purchase and sale of goods and services.
Consumer Health and Drug Information. We maintain a public website, www.DrugDigest.org, dedicated to
helping consumers make informed decisions about using medications. Much of the information on DrugDigest.org is
written by pharmacists – primarily doctors of pharmacy who are also affiliated with academic institutions. The information
on DrugDigest.org includes:
• a drug interaction checker
• a drug side effect comparison tool
• tools to check for less expensive generic and alternative drugs
• audible drug name pronunciations
• comparisons of different drugs used to treat the same health condition
• information on health conditions and treatments
• instructional videos showing administration of specific drug dosage forms
• monographs on drugs and dietary supplements
• photographs of pills and capsules
Many features of DrugDigest.org are also available in the limited-access member website at www.express-
scripts.com. The member website gives our clients’ members access to personalized current and, in many cases, previous
drug histories. Members can use the interactive tools from DrugDigest.org to check for drug interactions and find possible
side effects for all of the drugs they take.
To facilitate communications between members and physicians, health condition information from DrugDigest.org
has been compiled into ―For Your Doctor Visit,‖ which is available on the member website. Members follow a step-by-step
process to create a brief, customized packet of information they can share with their doctor. Discussing the completed
checklists gives both the member and the physician a better understanding of the member’s true health status. Information
on DrugDigest.org and www.express-scripts.com does not constitute part of this document.