CVS Details New Pricing Transparency Solutions

March 9, 2018

In an effort to address the rising cost of prescription drugs, CVS Health recently detailed a program that provides drug cost transparency for prescribers, pharmacists, and patients, according to a press release.

Chief Policy and External Affairs Officer Tom Moriarty recently spoke to attendees at the AHIP National Policy Conference in Washington, DC. Mr Moriarty explained that while the current system works well for patients who have drug costs of $500 or less in a year, the system does not work well for the 5% of patients who need specialty drugs or biologics because of regulatory issues and legal issues that pharmaceutical companies have put into place.

“With more and more consumers in health plans with high deductibles, many are seeing the true cost of their medications for the first time, often at the pharmacy counter when they go to pick up their prescription,” Mr Moriarty said n a press release. “That is why we developed and introduced a system that provides true cost transparency by sharing member-specific drug cost information, formulary coverage and available lower-cost alternatives with doctors at the moment when they are writing the prescription.”

According to CVS, the program was launched in partnership with SureScripts.

“We launched real-time benefits in late 2017,” a CVS spokeswoman told First Report Managed Care. “The capability is enabled by CVS Health’s partnership with Surescripts, which allows CVS Health to connect to electronic health records (EHRs) and supports a secure, electronic transfer of information. Prescribers with access to real-time benefits is growing as Surescripts onboards additional major EHR vendors, and we expect it to increase exponentially over the next year.

Data from the program showed that a vast number of prescribers who used the real-time benefits capability, enabled through an EHR, switched their patients’ drug when it was not covered on their formulary or if a less expensive option was available. Further, the transparency solutions will allow the physician, pharmacist and patient to have a more meaningful dialogue about appropriate medications and their costs. This will better identify opportunities for lower out-of-pocket costs for patients.

The company said it will also continue to utilize its existing point-of-sale rebate offerings to combat these high drug prices—this program passes negotiated drug rebates directly to consumers when they purchase their prescriptions.

“Another way we help make prescription drugs more affordable for consumers is through point-of-sale rebates, which we have offered to our commercial clients since 2013,” Mr Moriarty said. “We currently cover nearly 12 million people under this option, by which the estimated value of negotiated rebates on branded drugs is passed along to the consumer when they get their prescription.”

According to CVS the increased transparency will allow pharmacists to adhere better with formularies, reducing costs for payers.   

“Our drug pricing transparency solutions, including real-time benefits and point of sale rebates, help support better formulary compliance by helping our PBM members access to the most clinically appropriate and cost-effective medication for their condition,” the CVS spokeswoman told First Report Managed Care. “As a result, this helps keep costs lower for both payers and their members.”

She continued, “In addition, our solutions also help promote better medication adherence – as high out-of-pocket costs can lead to situations where people abandon the prescription at the pharmacy counter or decide not to get a re-fill. As research shows, better medication adherence can help improve health outcomes by helping reduce the risk of disease-related complications, which can result in, for example, expensive ER visits or hospital admissions and lead to higher downstream medical costs for payers and patients.”

Julie Gould

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