CVS to Show Real-time Medication Costs

CVS Health announced that members of its PBM, CVS Caremark, will begin receiving real-time visibility to member-specific medication costs at the point of prescribing and at the pharmacy. Members will also be pointed to available lower-cost therapeutic alternatives at those points.

According to CVS, pharmacists in CVS pharmacies will have the information integrated into their existing workflow, which they say will make it easy to engage Caremark members about lower-cost alternatives, based on a member’s specific formulary coverage. Beginning in early 2018, CVS pharmacists will also be able to view out-of-pocket costs for Caremark members, which will allow the pharmacist to help the member select the lowest-cost medication.

CVS pharmacists will also be able to request a prescription change from the prescriber with what CVS calls a “simple one-step process.”

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"Patients often do not find out that the medication they were prescribed is not covered or has higher than expected out-of-pocket costs until they go to the pharmacy to pick up their prescription, which can result in patients not filling a prescription, non-adherence and, ultimately, higher downstream health care costs," said Troyen A. Brennan, MD, Executive Vice President and Chief Medical Officer of CVS Health. "Making detailed, real-time benefit information available for our PBM members and their health care team, whether it's the doctor or the pharmacist, can help streamline the patient experience and improve health outcomes while also lowering costs for both the patient and the payer."

Prescribers will also see changes to their e-prescribing workflow. For Caremark members, prescribers will be able to see the cost of drug based on a patient’s coverage, including a patient’s remaining deductible (if applicable), as well as up to five alternative medications specific to a patient’s formulary coverage-all prior to prescribing a drug.

In addition to enhanced price visibility, prescribers will also have visibility to additional requirements, such as prior authorization or step therapy, which will allow them to immediately submit an electronic prior authorization request.

Traditional PBMs have come under scrutiny recently by some industry observers for their lack of transparency. This announcement addresses that issue to some degree.

All retail pharmacies in the Caremark network will have access to the list of formulary alternatives given to the prescriber. In early 2018, all Caremark members can use the Check Drug Cost tool to find lower-cost alternatives at caremark.com.

"Across the CVS Health enterprise, we are focused on providing patients with the most convenient access to affordable medications, and this innovation enables us to provide our PBM members and their health care providers with direct, easy access to real-time benefit information throughout the health care continuum whether they are at their physician's office or at the pharmacy," said Jonathan Roberts, Executive Vice President and Chief Operating Officer of CVS Health.

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The real-time benefit information is enabled through Surescripts, and is available to any provider using an EHR with real-time benefits and electronic prior authorization enabled.

According to CVS, many patients cite medication cost as a reason for non-adherence, but often do not have access to enough information about the use of formularies. The company also cited the extra time waste that manual prior authorization creates for both prescribers and pharmacists. Avoiding this, said CVS, can help to encourage medication compliance.

"No one else,” said Roberts, “provides this level of member-specific actionable drug benefit information across so many points of care, which can help simplify and streamline the process of getting a patient on the most appropriate and affordable therapy and increase member engagement and satisfaction with their care."