CareSource taps Express Scripts for integrated PBM data platform

CareSource will implement a new integrated pharmacy benefits management approach called CareSource RxInnovations, managed by Cigna’s Express Scripts.

Dayton, Ohio-based CareSource, a nonprofit multi-state health plan serving government-sponsored programs, will let its current PBM contract with CVS Caremark expire at the end of 2019 and commence the new contract with Express Scripts on Jan. 1, 2020.

Last December, Express Scripts merged with Cigna, a global health service company, which offers health, pharmacy, dental, supplemental insurance and Medicare plans to individuals, families and businesses.

The shift aims to give the health plan more data-based insights, with information coming from various sources about its members, enabling wholistic care coordination.

The new RxInnovations program will be housed on “an integrated, industry-leading data platform driving real time opportunities to improve member health outcomes and lower costs,” CareSource executives said in an April 9 statement.

“We believe the current PBM model has significant room for improvement,” CareSource CEO Erhardt Preitauer said. “We saw an opportunity to reinvent the model with a focus on transparency, driving real value for stakeholders, building stronger partnerships with local pharmacies and controlling costs,” he said. “CareSource saw an opportunity to reinvent the model with a focus on transparency, driving real value for stakeholders, building stronger partnerships with local pharmacies and controlling costs.”

CareSource RxInnovations will provide full price transparency—validated by an independent third-party—giving CareSource’s Medicaid plans the ability to see where their pharmacy dollars are being spent, according to Preitauer. RxInnovations will also include a custom pharmacy network, ensuring members get access to their prescriptions and protecting independent pharmacies from “the volatility created by the traditional PBM model.”

The new model will also provide incentives to local pharmacists to support them in their critical role of educating patients against adverse drug events.

“This is the culmination of a year-long effort to address the major areas of opportunity in the current PBM model,” says Clayton Edwards, senior vice president of pharmacy at CareSource. “We want to create something that better serves members through the integration of all clinical data—medical, behavioral, social and pharmacy. This will allow us to provide holistic care coordination, while also meeting the needs of our other key stakeholders—the states in which we do business and our pharmacy partners.”

A Surescripts report issued last December says that pharmacy price transparency tools are taking off. “The market has responded to the benefits of Surescripts prescription price transparency tools in a remarkably short period of time, and this rapid growth is projected to continue,” the report said, citing a 40-fold increase in the number of prescribers using Surescript’s real-time prescription benefit in 2018.

“When healthcare professionals have price transparency tools at the point of care, they can make the best-informed prescription decisions for patients without interruption or rework,” Surescripts said.

Founded in 1989, CareSource is one of the nation’s largest Medicaid managed care plans, serving more than 1.9 million members across five states supported by a growing workforce of 3,800. CareSource said the new program will continue fueling job growth for the company.