New plan design from CVS Caremark eliminates member cost as a barrier to medication adherence without raising costs for benefits plan sponsors or increasing premiums or deductibles
WOONSOCKET, R.I. — CVS Health (NYSE: CVS) today announced a new solution eliminating member out-of-pocket costs associated with all diabetes prescription medications, including insulin. Offered through the company's pharmacy benefit manager (PBM), CVS Caremark, RxZERO enables employers and health plan sponsors to leverage formulary and plan design approaches to offer all categories of diabetes medications at zero dollar out of pocket for their members without raising costs for the plan sponsor or increasing premiums or deductibles for all plan members.
"Eliminating out-of-pocket costs for diabetes medications ensures long-term affordability, improves adherence, and most importantly, puts patients on the path to better health," said Troyen A. Brennen, MD, Chief Medical Officer, CVS Health. "A person living with diabetes is required to take many tasks to manage their condition annually. Unfortunately, that can include making difficult decisions about whether they can afford their medications and fill their prescriptions."
CVS Caremark analysis shows that members taking branded diabetes medications spend on average, $467.24 out-of-pocket per year, with nearly 12 percent spending over $1,000 annually. The new RxZERO plan design enables plan sponsors to eliminate member out of-pocket costs for the entire diabetes therapeutic area including oral medications for Type 2 diabetes and fully adhere to American Diabetes Association standards.
"There are more than 30 million Americans living with diabetes, and far too many of them are struggling to manage their diabetes because of the high cost of diabetes prescription medications," said Kelly Mueller, Vice President of Community Impact for the American Diabetes Association. "The American Diabetes Association is committed to helping those living with diabetes thrive, and accessing the medications they need is critical. We are hopeful that by eliminating out-of-pocket costs for diabetes medications, CVS Health will remove one of the barriers many people face that prevent them from managing their diabetes successfully."
"Traditionally, the focus of affordability for diabetes medications has been on insulin, which is the cornerstone of therapy for the five percent of people with diabetes who are living with type 1 diabetes," said Brennan. "RxZERO provides affordable options for the entire range of diabetes medications, improving affordability for the 95 percent of people with diabetes who are living with type 2 diabetes."
CVS Health believes that eliminating out-of-pocket costs for diabetes drugs could be an important feature to all health plan sponsors, to help address the growing diabetes epidemic without increasing other costs such as deductibles and premiums. CVS Caremark research demonstrates that by leveraging formulary and plan design approaches, plan sponsors can eliminate member out-of-pocket costs for all categories of diabetes medications without raising costs for the plan sponsor, or increasing premiums or deductibles. The analysis demonstrates the approach leads to savings for plan sponsors through improved adherence and a reduction in overall medical costs.
This solution, detailed in a CVS Health white paper, A Prescription for Better Diabetes Management, is part of CVS Health's integrated approach to chronic care management and commitment to making care more affordable, local and easier to navigate. CVS Health also provides supportive care at its MinuteClinic and new HealthHUB store format that features a broader range of health care services to help patients better manage chronic conditions and complement the care that patients receive from their primary care physicians.
About CVS Health
CVS Health is the nation's premier health innovation company helping people on their path to better health. Whether in one of its pharmacies or through its health services and plans, CVS Health is pioneering a bold new approach to total health by making quality care more affordable, accessible, simple and seamless. CVS Health is community-based and locally focused, engaging consumers with the care they need when and where they need it. The Company has approximately 9,900 retail locations, approximately 1,100 walk-in medical clinics, a leading pharmacy benefits manager with more than 102 million plan members, a dedicated senior pharmacy care business serving more than one million patients per year and expanding specialty pharmacy services. CVS Health also serves an estimated 38 million people through traditional, voluntary and consumer-directed health insurance products and related services, including rapidly expanding Medicare Advantage offerings and a leading standalone Medicare Part D prescription drug plan. The Company believes its innovative health care model increases access to quality care, delivers better health outcomes and lowers overall health care costs. Find more information about how CVS Health is shaping the future of health at https://www.cvshealth.com.