Express Scripts Announced An Innovative HIV-Prevention Program

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Express Scripts has announced a new and innovative program to make HIV prevention more accessible to both patients and their employers.

Express Scripts Holding Company is a pharmacy benefit management organization. It’s the largest company of its kind in the United States of America. The company acts as a third-party administrator of prescription drug programs. Basically, the company works out the logistics of medications and healthcare between employers and employees, health plans and pharmacies, and so on. Or according to the American Pharmacists Association in a conversation with Quartz, “PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims.”


But what does this have to do with HIV prevention and treatment? According to Yahoo News, Express Scripts announced earlier Wednesday a new program, called the HIV Care Value program, to increase accessibility and simplicity to HIV prevention.

“By taking a single pill once a day, people with an elevated risk can prevent contracting HIV. Yet, with a list price of $24,000 a year, PrEP has been out of reach for many of the people who need it most,” said Candice Michaelson, Vice President of Value-Based Solutions in Express Scripts. “With our new program, we will help employers and health plans ensure that every eligible person has the resources and support needed to use PrEP effectively and prevent HIV transmission.”

The anti-retroviral drug Truvada, which is a combination of tenofovir and emtricitabine. / Image via Jeffrey Beall and Wikimedia Commons

The program hopes to make HIV treatment more accessible for an assortment of ways beyond a zero-dollar copay. As Yahoo News writes, the three elements to how the HIV Care Value program hopes to help employers and health plans support patients and citizens are below:

  1. “Cost Predictability:  To help employers and health plans continue to provide affordable, predictable health care coverage, Express Scripts will guarantee a maximum rate of growth of a plan’s spend on applicable HIV PrEP products, and will reimburse plans the amount that exceeds that trend guarantee dollar for dollar. This approach will help ease the strain plans will experience covering 100% of the cost for PrEP, and help prevent plans from having to shift costs to people in other ways.

  2. Patient Support:  Patients on PrEP therapy will have access to specially trained clinicians through Express Scripts’ Therapeutic Resource Center® who will help patients overcome the many unique obstacles to optimal medication adherence with PrEP.

  3. Increased Awareness:  Express Scripts will engage with providers to offer additional resources to help them educate their patients on HIV prevention. These efforts will help connect more at-risk people with PrEP therapy and other preventative measures while increasing awareness about the importance of medication adherence.”


Now, what makes this program innovative for the industry? This program is the health industry’s first value-based program to help prevent HIV transmission. According to the American Academy of Family Physicians (AAFP), “Value Based Payment (VBP) is a concept by which purchasers of health care (government, employers, and consumers) and payers (public and private) hold the health care delivery system at large (physicians and other providers, hospitals, etc.) accountable for both quality and cost of care.”

Here’s hoping that the program has a noticeable effect on the lives of U.S.A. citizens.

Sources: Yahoo News, Quartz, AAFP

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