Greater Rx Price Transparency at the Point of Care

Casey Leonetti, Senior Vice President of PBM Innovation recently participated in a panel at HIMSS 2018, one of the largest annual health information and technology conferences. The panel, Bringing Prescription Price Transparency to the Point of Care brought together industry experts to discuss price transparency challenges and solutions.

Moderated by Dr. Pat Salber of The Doctor Weighs In, the panel opened with some startling facts.

Did you know…

  • Medication cost can be a significant factor when a patient is deciding whether or not to fill a prescription.
  • In addition, approximately 80 percent of physicians said manual prior authorization requests require extra work, rework and follow up, which can also delay the start of an important therapy or result in poor compliance.

Ms. Leonetti discussed this as the impetus for launching CVS Health’s real-time benefit capability, which provides visibility to member-specific medication costs and available lower-cost therapeutic alternatives at the point-of-prescribing and at the pharmacy. Specifically,

  • Prescribers are able to see specific benefit information for CVS Caremark PBM members integrated directly into their e-prescribing workflow, and even before they prescribe a drug, prescribers can also see the cost of the drug based on the patient’s coverage, factoring in the their remaining deductible.
  • In addition, the prescriber is able to review up to five clinically appropriate branded alternatives or therapeutically equivalent generic medications specific to the patient’s formulary coverage.
  • Prescribers also have visibility to requirements, such as prior authorization or step therapy, enabling them to immediately submit an electronic prior authorization request and in most cases, receive a near real-time decision.
  • Pharmacists at all retail pharmacies within the CVS Caremark network have visibility to the same list of clinically appropriate formulary alternatives provided to the prescriber.
  • And, CVS Caremark members are also able to find lower-cost alternatives within the Check Drug Cost tool on, including visibility to their remaining deductible.

Altogether, this type of transparency helps eliminate disruptive situations where the patient arrives at the pharmacy counter and is unable to fill a prescription because, for example, it is not covered on the formulary or requires additional approvals. It also helps ensure that the patient doesn’t abandon the prescription because of cost. In addition, real-time benefits help ensure that the member is accessing the most clinically effective and affordable medication, which can help keep costs low for the entire health care system.

The other panelists, including representatives from Surescripts and Aprima, also provided their perspectives on greater prescription price transparency at the point-of-care.

For more information about how CVS Health is working to ensure patients have access to affordable health care, visit our Cost of Care information center and the CVS Health Impact Dashboard. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.