Express Scripts to increase pay for independent rural pharmacies

Express Scripts will increase reimbursement for independent rural pharmacies, whose ranks have continued to dwindle over the past decade.

Express Scripts, the pharmacy benefit manager of insurer Cigna, plans to pay rural pharmacies that aren’t affiliated with a drug wholesaler more when they hit certain outcome-based metrics, such as ones related to drug adherence. The second-largest PBM by revenue will also pay independent pharmacies in both rural and urban areas for vaccinations, testing, nutrition counseling, behavioral health screening and other preventative and routine services, the company said Thursday.

The company did not detail how much it would boost reimbursement by but a spokesperson said about 1,000 independent rural pharmacies will be eligible for the pay boost.

“One in five Americans live in rural areas, yet less than 10% of physicians practice in those locations—creating critical access gaps. Independent pharmacists often can close those gaps as the front lines of care in their local communities,” Adam Kautzner, president of Express Scripts, said in a news release.

About 600 rural pharmacies closed from 2003 to 2021 as they struggled to manage low reimbursement rates, no payment mechanisms for certain services, delays in payments and competition from mail-order pharmacies, researchers from the University of Iowa’s RUPRI Center for Rural Health Policy Analysis. There were only 3,102 independent rural pharmacies as of the end of 2021, down 16.1% from 2003, according to an August policy brief from the center.

To try to stave off those closures and improve reimbursement rates, Express Scripts said it will form an independent pharmacy committee that will include pharmacy leaders across rural, urban and suburban communities.

Express Scripts’ rural healthcare initiative comes on the heels of the pharmacy benefit manager’s plans to offer employers, insurers and government programs a flat monthly fee for processing pharmacy claims. Pharmacy benefit managers have typically employed “spread pricing,” where PBMs charge payers more than they reimburse pharmacies and retain the difference. The spread pricing model has come under growing scrutiny, as lawmakers, regulators and researchers have tied it to rising drug costs.

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