Express Scripts and the Statin Class: a Powerful Proof Statement

In the summer of 2005, major changes were brewing in the statin therapy class. Zocor, the first high-potency cholesterol-lowering agent, was scheduled to lose patent protection in mid-2006, offering a lower-cost alternative to brand statins. As a result, Express Scripts recommended that plan sponsors encourage members on cholesterol-lowering drugs to switch from brands to Zocor or the low-potency statins already on the market where clinically appropriate.

Nearly all of our plan sponsors agreed with our recommended strategy, but we still faced a significant challenge. We needed members to move actively toward less-expensive options. To that end, we applied findings from social psychology and cognitive linguistics to develop member-specific messaging. This approach allowed us to successfully educate millions of members on lower-cost alternative drugs through a variety of channels, including mail, phone, IVR, and web.

The result was the largest intentional market-share shift in the history of pharmacy, as members moved toward generics and lower-cost brands. As a result, our plan sponsors and members saved more than $126 million in 2006 alone from reduced ingredient costs and copayment reductions, while member satisfaction remained above 95 percent. To date, we’ve saved plan sponsors and members more than $600 million.

Our statin initiative was far more successful than we’d anticipated. Throughout 2007, Express Scripts thoroughly analyzed all relevant data to determine why. We knew the formulary change played a role, providing a financial incentive for members to shift from a non-formulary medication to a generic or formulary brand. But we were interested in understanding how our member communications helped drive the market-share shift.

The majority of our plan sponsors took part in our comprehensive member communications campaign, but a subset chose not to participate. This created a natural experiment where we could isolate the effects of communications on market-share movement. Express Scripts’ independent research group controlled for differences in plan design, co-payment, and the use of clinical programs such as Step Therapy, creating an “apples to apples” comparison in which the only difference between the groups was whether patients were exposed to our comprehensive communications campaign.

The results were impressive. Rather than offering just an incremental increase, comprehensive communications had a multiplicative effect on the market-share shift associated with the formulary change. For patients using retail, the communications doubled the effect of formulary removal alone. Patients using Home Delivery engage with Express Scripts more frequently (more phone calls and web visits). Among these patients, comprehensive communications tripled the market-share shift.

These findings are remarkable because they demonstrate the power of getting members on board when driving to lowest net cost. In addition, the experience convinced us that tremendous opportunity remains “locked up” at the member level and that we are capable of helping plan sponsors unlock that potential.

We have since institutionalized the capabilities developed in our statin initiative. This approach allows us to provide consistent, comprehensive messaging for all savings opportunities across all communications channels as we move forward in the evolution of aligned pharmacy benefits management.

About Bob Nease
Bob Nease is Chief Scientist and Vice President of marketing at Express Scripts. He works to advance the understanding of consumer behavior at the PBM, closely following emerging science around human behavior, translating findings to testable hypotheses, and developing tools to help clients enable better health and value in the pharmacy benefit.