Express Scripts, CPESN making push to support independent pharmacies
Initially, efforts with CPESN will focus on enhanced care services for Medicare beneficiaries living with hypertension and diabetes.
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Express Scripts, the pharmacy benefits services business of The Cigna Group's Evernorth, has entered into a collaboration with CPESN USA, a network of pharmacy providers that delivers health services, to provide support to independent and community pharmacies.
Initially, efforts with CPESN (Community Pharmacy Enhanced Services Networks) will focus on enhanced care services for Medicare beneficiaries living with hypertension and diabetes, with plans to expand to additional capabilities and offerings.
It's estimated that diabetes affects roughly one in five Medicare beneficiaries aged 65 years and up, and 64% of people with Medicare fee-for-service report having a diagnosis of hypertension, according to internal data.
CPESN pharmacies will provide enhanced care, including coordination with other health providers to address care gaps, identification of at-risk people paired with pharmacist-led interventions, and informed medication management and optimization. CPESN has a network of more than 3,500 pharmacies in 44 states, and the company said it would add new options for care delivery within the Express Scripts retail pharmacy network.
WHAT'S THE IMPACT?
The collaboration is a result of guidance from the organization's Independent Pharmacy Advisory Committee, which includes 38 pharmacists from all regions of the U.S. and is led by former independent pharmacy owner Stephanie Smith Cooney, senior director of independent pharmacy affairs at Express Scripts.
All of this is the latest step in Express Scripts' IndependentRx Initiative, which seeks to strengthen pharmacists' role in delivering care. Last year, as part of the organization's push to expand access to care while supporting small businesses, Express Scripts invested millions to increase reimbursements for independent pharmacies that serve rural communities.
"Local pharmacies are the doorway to essential healthcare for many people, and independent pharmacies are critical to closing gaps in care for many communities," said Adam Kautzner, president of Evernorth Care Management and Express Scripts.
THE LARGER TREND
In December 2023, Express Scripts announced a new pharmacy network option that offers "cost plus" drug pricing for employers and health plans. Clients pay the estimated acquisition cost that the pharmacy pays for the medication, plus a small markup for pharmacy dispensing and service costs.
The "cost plus" model option covers all brand, specialty and generic medications on the client's formulary. Other models in the market offer pricing only on a select group of generics at a small group of pharmacies, Express Scripts said.
ON THE RECORD
"It is critical that independent pharmacy perspectives are heard and considered across the pharmacy services industry," said Cooney. "Our Independent Pharmacy Advisory Committee provides a forum for this dialogue, and has already produced impactful changes, including this collaboration with CPESN USA, which will elevate independent pharmacists' work and allow them to focus on providing people with the best care possible."
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
