Helping Patients Maximize Prescription Benefits and Save Money | CVS Health

Helping Patients Maximize Prescription Benefits and Save Money

The percentage of Americans enrolled in high deductible health plans has grown significantly in recent years – from four percent in 2006 to 28 percent in 2016. At the same time, drug prices have continued to rise, resulting in many Americans shouldering higher costs for their prescription drugs.  

While CVS Health has made significant progress in mitigating the impact of high list prices set by pharmaceutical manufacturers, for too many Americans, annual out-of-pocket (OOP) drug costs are still significant. To fight back on rising drug costs, CVS Health launched the most comprehensive program in the industry designed to save patients money on their medications. By helping patients realize savings at the pharmacy, the initiative helps consumers access and stay on the medications they need to maintain their health.

Reducing Costs at the Pharmacy Counter

CVS Pharmacy Rx Savings Finder is a new savings and discount capability available at all CVS Pharmacy locations. The integrated tool helps the company’s 30,000 retail pharmacists quickly and seamlessly evaluate individual prescription savings opportunities right at the pharmacy counter. In fact, pharmacy teams can review a patient’s prescription regimen, medication history and insurance plan at the pharmacy counter to determine the best way to save money on OOP costs.

The new capability will help pharmacists navigate in a step-by-step process to ensure that patients receive the lowest cost option:

  1. First, if the prescribed medication is on the patient’s formulary and is the lowest cost option available.
  2. Second, if there are lower-cost options covered under the patient’s pharmacy benefit – such as a generic medication or therapeutic alternative with equivalent efficacy of treatment.
  3. Third, if the patient may be able to save money by filling a 90-day prescription rather than a 30-day prescription.
  4. Finally, if neither a generic nor a lower-cost alternative is available, other potential savings options for eligible or uninsured patients where allowed by applicable laws and regulation.Prescriptions submitted for reimbursement to Medicare, Medicaid or other federal or state programs are not eligible.


Increasing Cost Transparency and Using Pharmacy Benefit Management Solutions

Other components of the company’s comprehensive savings approach help keep prescription medications affordable for patients. These include:

  • The recently launched real-time benefits program helps bring greater drug price transparency to physicians and CVS Caremark pharmacy benefit management (PBM) members at the point-of-prescribing. Early results show that the majority of prescribers accessing patients’ real-time benefits information have switched their patients’ drug when it is not covered and they frequently switch from a drug that is covered under the member’s plan to a less expensive option.
  • The Point of Sale (POS) rebate offering allows the value of negotiated rebates on branded drugs to be passed on directly to patients when they fill their prescriptions – and the savings from this program can be significant. In 2013, CVS Health led the industry with the introduction of POS rebates to clients, and today nearly 10 million members are covered by and able to benefit from the program.
  • CVS Caremark also offers clients the ability to adopt preventive drug lists, which make medications for many common, chronic conditions available at a $0 copay to the member. Use of this option, coupled with higher utilization of generic drugs, dropped members’ overall prescription cost share by nearly one percent in 2017.

Mitigating Impact of High Drug Costs

Our core PBM strategies – leveraging market competition, maximizing the use of low-cost generics and other formulary management, and effectively negotiating discounts and rebates – continue to be an important part of reducing drug trend, the measure of growth in prescription spending per member per month, for our payor clients and keeping drugs more affordable for PBM members.

Our latest Drug Trend Report shows that great progress is being made. For example:

  • In 2017, our strategies helped protect clients from drug manufacturer price increases of almost 10 percent, keeping cost growth per unit nearly flat and trend to the lowest level in five years.
  • For chronic conditions such as diabetes, high blood pressure and high cholesterol, our plan designs connected patients to lower-cost options that ultimately helped improve adherence to medications by as much as 1.8 percentage points.
  • Forty-two percent of CVS Caremark clients had negative trend, meaning they spent less in 2017 on prescription drugs than in 2016.
  • Nearly 90 percent of our PBM plan members spent less than $300 out-of-pocket for their prescription medicines last year.   

CVS Health is taking a leadership role in developing programs and initiatives to help consumers save money on their overall prescription drug costs and stay adherent to the medicines they need. And while this initiative signals progress, the company remains committed to doing even more across the enterprise to help patients on their path to better health.

Read the white paper to learn more about our efforts to address rising prescription drug prices.

For more information on how CVS Health is working to expand access to more affordable and effective health care, check out our Cost of Care information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.