_compressed.jpg)
Member experience is a top priority for our customers, including Part D plan sponsors. We strive to provide a best-in-class service, including seamless access to medications, lower out-of-pocket costs and optionality for their beneficiaries.
Every year, the Center for Medicare & Medicaid Services (CMS) reviews Part D plans’ bids to ensure they are actuarially sound and comply with a wide range of Medicare rules and beneficiary protections — and Medicare beneficiaries are overwhelmingly satisfied with their prescription drug coverage. As the highest utilizers of prescription drugs, these older adults recognize the role that the program’s design plays in making prescription drugs more affordable and more accessible.
Varied pricing in a complex system
There are a number of reasons CMS pricing data can be varied. First, there is no spread pricing in Medicare. This means that reports on pricing can reflect the different individual prices charged by any pharmacy to a Part D plan. In rural areas where independent pharmacies have greater pricing power, for example, these pharmacies may charge higher than average prices and create significant variation. In addition, pharmaceutical manufacturers may also change their selling prices over time, creating further variation.
Affordability and access
To increase affordability, Medicare requires 100% pass through of rebates to Part D plan sponsors — those savings can be used by Part D plan sponsors to reduce premiums and lower out-of-pocket costs. Negotiating rebates on prescription drugs is one way PBMs work to bring down health care costs for health plans and their beneficiaries.
To improve access, PBMs, including CVS Caremark, must maintain a robust network of pharmacies to ensure greater access to medications for Medicare beneficiaries, in compliance with CMS and state adequacy requirements. With more than 65,000 pharmacies in network, of which more than 43% are independent pharmacies, our national pharmacy network continues to exceed industry benchmarks with regards to network pharmacy access by a significant margin.
At CVS Caremark, we know that greater affordability and access promote greater adherence to treatment plans, delivering enhanced health outcomes and higher cost savings for Plan D sponsors and their beneficiaries.
