Addressing out-of-pocket costs for diabetes patients

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Rising costs are a burden for too many people living with diabetes today. Patients with a high-deductible health plan shoulder all of their medication costs while in the deductible phase of their insurance, which means they may be forced to make difficult decisions about whether they can afford their medications and fill their prescription.

Recent data reveal there is uncertainty on how to manage and predict the out-of-pocket costs associated with diabetes management. For example, nearly one-third of patients (32 percent) do not feel they have the resources needed to manage their own out-of-pocket costs. To address this challenge, CVS Health is working to eliminate member cost as a barrier to medication adherence.

Improving Medication Affordability and Adherence

Improving diabetes outcomes while reducing costs is a priority for CVS Health. We recently launched RxZERO to enable 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. The new 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.

“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. However, the new CVS Caremark solution expands affordable options to include the entire range of diabetes medications — improving affordability for the 95 percent of people with diabetes who are living with type 2 diabetes.”

— Troyen A. Brennan, M.D., M.P.H., is Executive Vice President and Chief Medical Officer of CVS Health

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.

A Comprehensive Approach to Diabetes Management

A person living with diabetes is required to take many tasks to manage their therapy annually. To make disease management affordable, accessible and local, CVS Health offers numerous programs to help people with diabetes effectively manage their condition and stay on track with their prescribed treatment plan.

We provide supportive care at our HealthHUB locations to complement the care that patients receive from their primary care physicians. Our HealthHUB model provides a first-of-its-kind community-based store that offers a broader range of health services, new product categories, digital and on-demand health tools and trusted advice. In these locations, people living with diabetes are able to receive the coordinated care and services they need all within our own four walls.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Streamlining Prescription Onboarding with Specialty Expedite

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As CVS Health looks to transform health care and contribute to a better, more efficient system, we are looking at ways to leverage and improve the use of technology to improve quality of care and patient outcomes.

This is especially important in specialty pharmacy and why we’ve introduced Specialty Expedite.Specialty Expedite is available exclusively for providers who use compatible electronic health record (EHR) systems including Epic Systems and others that participate in the Carequality Interoperability Framework. All data sharing and usage complies with applicable privacy laws. Patients receive real-time prescription status updates only after providing consent to CVS Specialty. Our connected capability transforms prescription onboarding for our CVS Specialty patients, on average shortening the specialty pharmacy onboarding process to as little as three days and ultimately helping to get patients started on appropriate therapy faster.

Getting Patients the Medications They Need Quickly and Efficiently

For patients with complex medical conditions requiring specialty medications, getting started on their prescriptions quickly and efficiently is crucial to their care. But the process has not always been that simple, with patients sometimes having to wait as long as several weeks to complete the manual onboarding and prior authorization process.

Specifically, the process to get started on a specialty medication often requires physician’s offices and insurers to fax appropriate patient records and/or required approvals before a prescription can be filled, which can be time consuming but is a critical step to ensure that patients are receiving the most appropriate medication.

In addition, across the health care system, the Federal government is looking at ways to help enable and improve health information technology (IT) systems and as part of that, officials have even called for health care to be a “fax free zone by 2020.”

How It Works

Specialty Expedite works by securely gathering appropriate patient information, including insurance, lab work and diagnosis codes via a doctor’s electronic health record (EHR) system instead of sharing through fax. The process also cuts down on paperwork and phone calls, resulting in fewer errors and more efficiencies.

In addition, patients also now have the option of receiving real-time status updates via email or text, so that they can stay informed on the status of their prescriptions and any prior authorization requirements. Patients are also able to choose how they want to get their specialty medications — at their local CVS Pharmacy or though specialty mail serviceWhere allowed by law. In-store pick up is currently not available in Oklahoma. Puerto Rico requires first-fill prescriptions to be transmitted directly to the dispensing specialty pharmacy. Products are dispensed by CVS Specialty and certain services are only accessed by calling CVS Specialty directly. Certain specialty medication may not qualify. Services are also available at Long’s Drugs locations. via Specialty Connect. Research shows that when patients have more flexibility and choice, they are able to start their therapies sooner and adherence and satisfaction improves.

Helping patients with complex medical conditions get the specialty medication they need more quickly and efficiently through technology and solutions such as Specialty Expedite is one more way we are helping people on their path to better health.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Addressing Rising Drug Prices

Addressing Rising Drug Prices
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Rising drug prices hurt patients and lead to negative and costly outcomes throughout our health care system. For example, data show that 40 percent of patients do not pick up their prescriptions when out-of-pocket costs per prescription exceed $200.CVS Health Internal Analysis. Completed December 2015, Retail RxDw; Analysis Timeframe of 1/1/15 – 12/28/15 When patients don’t take their medications as prescribed, the cost to our health care system is approximately $290 billion.https://www.nehi.net/writable/publication_files/file/pa_issue_brief_final.pdf

At CVS Health, we recognize that one of the most important things we can do is to help people afford and take their medications. That’s why we’re working to improve transparency and pioneering solutions to help patients get the right medicine at the lowest possible cost.

Providing Information across Multiple Points of Care

Information about how much a drug costs is not always readily available. According to a poll sponsored by CVS Health, more than half (57 percent) of patients do not know how much a drug will cost them, and nearly as many (54 percent) believe it would be helpful to have information about the cost before they fill their prescriptions.

CVS Health is working to expand visibility into drug cost information across multiple points of care.

  • At the physician’s office: Our real-time benefits technology – used by 100,000 prescribers nationwide – enables visibility into what a patient will pay for a specific drug under their benefits plan and presents up to five lower-cost, clinically appropriate alternatives for consideration by the prescriber.
  • At the pharmacy counter: Our more than 30,000 retail pharmacists use the Rx Savings Finder tool to search for potential savings opportunities.
  • For CVS Caremark members: About 230,000 times per month, CVS Caremark members search the Check Drug Cost tool to find lower-cost, clinically appropriate alternatives to more expensive medications.

Helping Control Costs While Promoting Better Health

As a Pharmacy Benefit Manager (PBM), we use every tool at our disposal to bring down drug prices. For example, we encourage the use of lower-cost, clinically appropriate generic alternatives, which data show can lead to a 3-percent decrease in overall mortality.https://www.ncbi.nlm.nih.gov/pubmed/2522238. We offer evidence-based guidelines to help prescribers connect patients to the most cost-effective medicines, resulting in more than $2.9 billion in savings.CVS Health White Paper. Current and New Approaches to Making Drugs More Affordable. Published August 2018 We also provide point-of-sale rebates and zero-dollar copay drug list options to clients, helping to deliver savings directly to patients at the pharmacy counter.

Keeping Costs Down for Patients, Employers and Government Programs

Our PBM strategies rein in costs across the health care system and also increase access to affordable medications for patients. While brand manufacturers have increased prices on average 9.2 percent annually from 2008 to 2016,https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05147 we have worked to stabilize drug costs for our clients and patients. In fact, CVS Health kept drug price growth to just 0.2 percent in 2017.

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.

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Moriarty Addresses Prescription Drug Affordability at Roll Call Live

Moriarty Addresses Prescription Drug Affordability at Roll Call Live
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In the midst of a very important discussion around prescription drug pricing in Washington, DC, CVS Health sponsored an event with CQ Roll Call titled “Empowering Patients as Partners in Health Care” to focus on the issue and the consumer experience in health care today. At the event, policymakers and health care policy experts discussed the progress being made to make the health care system work better and identified areas where more solutions are needed. Tom Moriarty, Chief Policy and External Affairs Officer, and General Counsel for CVS Health, addressed the affordability of prescription drugs – one of the most critical issues impacting patients today.

Moriarty emphasized how high drug prices can have an adverse effect on patients’ health. For example, when medications are above $200 in out-of-pocket costs per prescription, more than 40 percent of patients do not pick up their prescriptions. To ensure patients can afford their medicines and take them as directed, Moriarty outlined the importance of the pharmacy benefit management (PBM) tools and solutions CVS Health is pioneering to improve medication adherence and reduce patients’ out-of-pocket costs. He also highlighted policy ideas that can increase market competition and provide the transparency that consumers, providers and pharmacists need to get the most effective drug at the lowest cost.

Innovative Solutions to Address Rising Drug Costs

The status quo of rising drug prices is not acceptable. Moriarty highlighted how CVS Health is implementing solutions to mitigate the effects of manufacturer-driven price increases. We are:

  • Pioneering the use of point-of-sale rebates and started by offering them to our CVS Health colleagues. As a result, we’ve seen adherence improvements of four to six percent. Additionally, we offer point-of-sale rebates to our clients – making this benefit available to 10 million people covered by CVS Caremark plans.

  • Utilizing preventive drug lists for colleagues to make medications for common chronic conditions, including diabetes, hypertension and asthma, available at a zero-dollar copay. Data show that this can lead to better adherence and provide medical cost savings and productivity gains.

  • Expanding visibility into prescription drug costs – starting at the doctor’s office and culminating at the pharmacy counter. At the doctors’ office, we provide real-time benefits to ensure prescribers have information on patients’ covered benefits and what patients will pay out-of-pocket under their plan for a specific drug. At the pharmacy counter, our retail pharmacists are using the Rx Savings Finder to help members save, in some instances, an average of $420 per year.

Rebates are Discounts that Help Lower Costs for Patients and the Government

There has been a lot of discussion about the role of rebates in the drug pricing system, which are discounts used to reduce costs for patients and government programs. Moriarty debunked the myth that drug companies increase prices as a result of having to pay rebates, pointing to the fact that there is no correlation between manufacturer-driven price increases and these rebates and discounts. In fact, list price is increasing faster for drugs with little competition than it is for medications with competition and substantial rebates and discounts.

Despite the fact that brand drug manufacturers increased list prices by an average of 9.2 percent annually between 2008 and 2016,QuintilesIMS Institute, Medicines Use and Spending in the U.S. (May 2017). https://structurecms-staging-psyclone.netdna-ssl.com/client_assets/dwonk/media/attachments/590c/6aa0/6970/2d2d/4182/0000/590c6aa069702d2d41820000.pdf?1493985952 CVS Caremark has been able to keep drug price growth nearly flat at 0.2 percent by negotiating rebates and discounts and encouraging the use of lower cost, clinically appropriate medicines.

Policy Solutions to Lower Drug Costs for Patients

PBMs are very effective at lowering drug prices when there is competition, but there is still a substantial number of products that face limited to no competition. In addition, due to the increased enrollment in high-deductible health plans, the deep discounts being driven by PBMs are not being seen at the pharmacy counter by patients when they are in their deductible phase. To address these challenges, Moriarty presented four patient-centric solutions:

  • Medicare should drive the adoption of real-time benefits to give patients and their physicians visibility into lower costs and offer an option for a point-of-sale rebate Part D plan.

  • For plans associated with health savings accounts, policymakers can take immediate action to change Internal Revenue Service (IRS) rules to allow those plans to provide first-dollar coverage for drugs outside of the deductible, even for maintenance medications intended to treat an existing chronic condition.

  • By prohibiting pay-for-delay agreements and passing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act to stop Risk Evaluation and Mitigation Strategy (REMs) abuse, we can curb anti-competitive practices and help bring lower cost, clinically equivalent generic medications to market more quickly.

  • Lastly, we must accelerate the pathway to bringing biosimilar drugs to market. Biosimilar drugs have the potential to save the health system $54 billion dollars over ten years, but our country is far behind in accessing these medicines. In Europe, 53 biosimilar medicines have been approved. In contrast, only seven are on the market in the U.S. today.

CVS Health will continue to innovate and use every tool at our disposal to bring down the costs of drugs while also advocating for effective policies that increase access to affordable medications.

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.

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A New Approach to Pricing of Pharmacy Benefit Management Services

A New Approach to Pricing of Pharmacy Benefit Management Services
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Across our CVS Health enterprise, we are transforming the way we deliver care to help more people on their path to better health. As part of this, our pharmacy benefit management (PBM) company, CVS Caremark, today introduced the new Guaranteed Net Cost pricing model, which will help redefine the industry by offering drug cost predictability and pricing simplicity for our clients.

We sat down with CVS Caremark President Derica Rice to learn more about the company’s innovative new PBM pricing model and how it will deliver value to the health care system.

Why is CVS Health introducing the Guaranteed Net Cost pricing model?

The pharmaceutical market continues to be highly dynamic and managing costs effectively can be challenging for payors, patients and the entire health care system. PBM strategies such as preferred formulary placement and drug exclusions have helped create, and keep up, the pressure on pharmaceutical manufacturers and have been successful in keeping drug prices in check.

However, as the marketplace has continued to change at a rapid pace, it is clear that the PBM model must also evolve to continue to deliver value to the health care system, while also optimizing the quality of care. And, the time is right for change.

We believe the Guaranteed Net Cost pricing model will better serve our payor clients by providing them cost predictability and to help them clearly see the net cost of their pharmacy benefit, ultimately enabling them to select their PBM provider based on who can deliver lowest net cost. This also helps plan sponsors continue to provide an affordable benefit.

How is this new model different than what is currently in the market?

While current pricing models offer discounts and rebates, they do not provide net cost predictability, and the variability between PBMs can make it difficult for plan sponsors and PBM consultants to draw direct comparisons.

Our new model more closely aligns PBM incentives with plan sponsors’ objectives by focusing on a simple concept – net cost per drug claim. It simplifies the financial arrangements underlying PBM contracts by guaranteeing the average net spend, after discounts and rebates, per prescription for each distribution channel. Overall this model will help provide our clients more predictability related to their drug spend and eliminates the need for clients and consultants to project drug price inflation, shifts in drug mix and the total value of rebates.

In addition, under this new model, we will also pass through 100 percent of the rebates to clients. Clients also continue to have the option to implement point-of-sale rebates for their members, as CVS Health does for its own employees. In turn, this can help to lower out-of-pocket costs for consumers.

How will Guaranteed Net Cost change the PBM industry?

At CVS Health, we are working to help redefine the PBM industry in a way that better serves payors, patients and the entire health care system by helping to lower prescription drug costs and maximize payor cost savings.

We believe guaranteeing the net cost is in the best interest of the client, and we are confident clients and consultants will also see it that way. We think this model is the right choice for any PBM that wants to demonstrate the value of its cost-control strategies and alignment with clients’ objectives. As such, we believe that other PBMs will also want to adopt this model, which will help to collectively deliver even greater value to the entire health care system over time.

We are confident that this new model is the right thing to do and the right approach for the future and believe that payors, consultants and other PBMs will agree that a simpler approach to PBM pricing can deliver better drug cost predictability and ultimately, help better show the value of a PBM.

What’s next for CVS Caremark and the PBM industry?

By simplifying the way we contract with our clients, we can focus on maximizing the effective PBM tools we already employ to reduce costs for the client and the consumer, and direct our energies toward developing additional innovative tools and approaches.

We anticipate that PBMs will continue to play an invaluable role in the health care system in the coming years and are working with partners and stakeholders across the industry to continue to find new ways to help improve access to care and lower overall health care costs.

Learn more.

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.

12.05.18

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Proven Savings with Real-Time Prescription Benefits

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CVS Health’s real-time prescription benefits solution helps lower member out-of-pocket costs. Powered by our proprietary engine Script Intelligence™, we can offer actionable, up-to-the-minute, member-specific plan information across multiple points of care – at the doctor’s office, at the pharmacy and at the member’s fingertips – and provide visibility to lower cost, clinically appropriate brand and generic alternatives.

When members switch medications using real-time prescription benefits, they are saving an average of $120 to $130 per fill.

The solution also helps improve the member and provider experience by streamlining the prescribing process and getting more affordable medications to members faster.

For more of the actionable ideas, strategies and expertise we provide payors to help lower drug costs and improve health outcomes, visit CVS Health Payor Solutions

CVS Caremark | Drug Focus
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By the Numbers: The State of U.S. Health Care

By the Numbers: The State of U.S. Health Care
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With a presence in 10,000 communities nationwide, CVS Health is focused on bringing positive change to Americans’ health care. As part of this effort, we are committed to understanding how Americans perceive the current system and identifying potential solutions to their most pressing needs.

CVS Health recently partnered with Morning Consult to gauge how Americans view aspects of the health care system. Consistent with findings from our 2017 survey, more than half of Americans (59 percent) believe that the health care system does not work well for them. And while 87 percent are currently satisfied with their health plans, most say they would like their care to be less expensive, simplified and more innovative.

At CVS Health, we believe that by putting patients at the center of their health care, we have the ability to improve engagement and drive down costs. As we work to transform health care, we’ll continue to seek opportunities to reduce the complexity and cost burdens that Americans face today.

Addressing Rising Health Care Costs

The cost of care is cited as the primary reason Americans don’t believe the health care system is working well, with just 31 percent of Americans reporting that their health care is affordable. What’s more is that 41 percent of Americans rank the affordability of prescription drugs as their most pressing concern with the health care system – a seven percentage point increase from 2017. At CVS Health, we recognize that one of the most important things we can do is help people adhere to their medications, which improves overall health and lowers costs.

As a pharmacy benefit manager, we work diligently to negotiate discounts from drug manufacturers, and to deploy a variety of tools to ensure our members receive high-quality pharmacy care at the lowest possible cost. For example, drug price growth for our own clients was only 0.2 percent on a per capita basis in 2017, despite list price inflation of nearly 10 percent.

We have also deployed solutions to expand visibility into prescription drug costs to ensure patients are getting the most appropriate medicine at the lowest cost – starting at the point of prescribing and culminating at the pharmacy counter. Our real-time benefits program gives prescribers access to covered benefits and the price patients will pay out-of-pocket under their benefits plan for a specific drug, providing average savings of $120-$130 per filled prescription. In our 9,800 CVS Pharmacy locations nationwide, our Rx Savings Finder tool helps patients save $420 annually by enabling our pharmacists to review their prescription regimen, medication history and benefit plans to identify the lowest cost, clinically appropriate medication available.

Making Health Care Easier to Use

Navigating health care can be complex. Sixty-eight percent of Americans state that the current system is confusing or difficult. We believe that health care cannot be simplified with a one-size-fits-all approach. The integration of CVS Health and Aetna will enable us to make health care more personal and easier to use for patients. 

Through our combination of data and expertise, we can make an often complicated and confusing system more connected and simple. By fully integrating Aetna’s medical information and analytics with CVS Health’s community locations, we’ll have a strengthened ability to provide Americans with counseling and guidance they need to need to navigate their health care.

For example, when a patient living with a chronic disease comes to pick up their medications, we will be there with additional resources and counsel to help them better manage their overall health and well-being in a much more coordinated fashion.

Innovative Solutions for the Future Health Care System

When asked about the future health care system, 47 percent of Americans believe it is important to develop innovative health care solutions. By delivering the combined capabilities of CVS Health and Aetna, we have the ability to transform Americans’ health care experience and build healthier communities through a new health care model that is more patient-centric and less expensive.

For more information about CVS Health’s efforts to improve access to quality care across the nation, visit our Quality & Access 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.

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Promoting Competition to Reduce Drug Spending

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CVS Health Chief Policy and External Affairs Officer and General Counsel Tom Moriarty weighed in on a panel that examined the pharmaceutical supply chain.

Recently, I participated on a panel at The Brookings Institution on Fostering Competition in the Pharmaceutical Distribution Chain. The panel included:

  • Matthew Eyles, executive vice president, policy and regulatory affairs at America’s Health Insurance Plans;

  • B. Douglas Hoey, CEO of the National Community Pharmacists Association; and

  • Christine Simmon, senior vice president, policy & strategic alliances at the Association for Accessible Medicines, as well as executive director of the Biosimilars Council.  

We discussed our reactions to a proposal focused on fostering competition in the generic drug marketplace, and I raised four points that are key to driving greater competition and better value in our health care system:

1. Generic Drugs Help Control Drug Spend

Although generic drugs account for the majority of drugs dispensed, they only account for a fraction of drug spending overall, helping to keep prices down for payors and consumers. Multiple data points from a variety of researchers and drug trend reports have supported this, including research from the U.S. Food and Drug Administration (FDA).https://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ucm129385.htm

We’ve also seen the positive impact of increasing generic drug utilization for our clients and members. In fact, our 2017 Drug Trend report showed that generic utilization was a moderating force on overall drug trend – the year-over-year measure of prescription drug spending.

2. Competition from Generics and Biosimilars is Key

An important way to continue driving down drug spending is to support reforms that promote competition via generic and biosimilar market entries. Currently, there is a considerable backlog of generic drug applications pending review and approval at the FDA. Clearing this backlog would allow thousands of generic drugs to enter markets in therapeutic categories where there is little to no competition, which will in turn help to drive down drug prices.

In addition, we need to also address the application pathway itself, as there were fewer generic manufacturers filing new generic applications last year. Creating a more efficient pathway will help incentivize generic manufacturers and speed entry to market.

Finally, biosimilars, which are commonly thought of as generic versions of biologic drugs, have great potential for bringing down costs of these often expensive, specialty therapies. Compared to other countries, the U.S. is lagging behind in bringing these drugs to market, but we see great potential and believe they can have a similar impact that they’ve had in global markets, such as Europe and Japan. That said, it is vital that we work to streamline the biosimilar approval pathway now, so we can better support competition in biologic markets going forward.

3. Generics and Driving Value for the System

Our health system needs to find ways to increase value for patients, like efforts to promote competition with generics and biosimilars. At CVS Health, we are exploring ways to ensure our clients are getting the highest possible value from drug spend relative to the outcomes the drugs deliver. This includes our strategic formulary approach that optimizes the use of clinically equivalent alternatives to branded drugs, and supporting policies that help drive market competition.

4. Pharmacists Play an Important Role

Our pharmacists engage with patients every day, and pharmacy care will become increasingly important as our system continues to move toward value-based care, with a greater focus on patient outcomes. In fact, studies have shown that pharmacist engagement improves medication adherence, which can lead to better health outcomes, fewer (often costly) adverse events and lower overall health care costs.

For more information on how CVS Health is working to ensure consumers have access to affordable medicines, visit our Rising Drug Prices information center. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.

 

CVS Health’s Tom Moriarty participated in a drug prices panel at The Brookings Institution.
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Promoting Access to More Affordable Medications

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With more than half of U.S. adults regularly taking at least one prescription medication, and a large number taking several,https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/ drug affordability continues to be top of mind for Americans. Generic drugs and biosimilar medicines, which can offer lower-cost and clinically equivalent alternatives to brand name prescription drugs and biologics, are one way patients can lower their drug costs. In fact, a recent CVS Health public opinion poll found that eighty-five percent of respondents report that switching to a generic saved them money and was also effective in treating their condition.

Addressing Rising Drug Prices: Streamlining the Generic Approvals Process

The U.S. Food and Drug Administration (FDA) has worked to improve competition in the marketplace for generic drugs by reducing the backlog of applications awaiting review at FDA, and most recently, releasing a set of statements as part of its Drug Competition Action Plan in support of increased generics in the marketplace. This three-step plan to boost the rate at which generic drug applications are reviewed, processed and approved includes to:https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm591184.htm

  • Reduce gaming from branded companies;
  • Resolve scientific and regulatory checks on drugs; and
  • Streamline the generic review process.

These strategies will work in tandem to curtail the multiple cycles of review that typical drug applications are subject to and in the process ease the backlog of thousands of generics pending approval. These efforts will build off of already strong progress last year. In November, for example, FDA saw the highest number of generics approved in a single month, and 2017, as a whole, brought significant decreases in the amount of time it takes to review and approve generics.

Increasing Accessibility of Biosimilar Products

Generics have helped save billions of dollars in drug costs, and biosimilars have similar potential – estimates say the U.S. could save up to $250 billion over ten years.http://lab.express-scripts.com/lab/insights/industry-updates/the-$250-billion-potential-of-biosimilars The full potential of the biosimilar market has not been realized yet, but FDA and CVS Health are working to change that. FDA has worked to help providers understand the valuable role of biosimilarshttps://blogs.fda.gov/fdavoice/index.php/2017/10/fda-taking-new-steps-to-better-inform-physicians-about-biosimilars-through-education-about-these-potentially-cost-saving-options/  in reducing costs for consumers, and as part of its Drug Competition Action Plan it hopes to increase the number of biosimilars on the market.  CVS Health has been successful in advocating for reimbursement policies that encourage the development of biosimilars, and we have also encouraged FDA to finalize industry guidance so biosimilar developers have a consistent approval process.

Helping Consumers Access Lower-Cost Alternatives

We are encouraged by FDA’s progress and commitment, and will continue to work toward ensuring all Americans have access to affordable medicines. For instance, our pharmacy benefit management strategies work to create multiple avenues that connect our members to lower-cost, clinically equivalent options, including encouraging the use of generic medicines through our formulary strategy. Additionally, our strategic partnership with Epic increases the visibility of patients’ drug benefits at the point of prescribing, including information about clinically effective options at the lowest out-of-pocket cost for the patient, to facilitate better prescription-related decision-making for patients and their care teams.

For more information on how CVS Health is working to ensure consumers have access to affordable medicines, check out our Rising Drug Prices information center. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.

CVS Health is working to promote more affordable medications for patients
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Prescription Drug Pricing: The Experts Weigh In

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“It’s a simple truth: patients lose access when they can’t afford their medications,” explained CVS Health Chief Health Strategy Officer and General Counsel Tom Moriarty in his opening remarks at the November 2016 POLITICO Pro Healthcare Briefing. Moriarty noted that prices of new and existing drugs are rising at rates that exceed inflation, and posed the following questions:

  • How do we ensure patients have access to the right medication?

  • How can we be sure that the health care system is not bearing unnecessary price increases?

  • How do we create a framework to re-accelerate bringing innovations to the prescription drug market?

These questions set the tone for the subsequent “Politics and Prices: What's Next for Drug Costs?” panel discussion. Sponsored by CVS Health and convened by POLITICO in Washington, D.C., the event featured four experts who gathered to talk about the current state of prescription drug costs in the United States, and how the results of the 2016 election may affect policies and pricing going forward.

Drug Pricing Discussions Will Continue in Washington and the States

The panelists agreed that while prescription drug pricing will remain a concern for the new administration, it is likely to be overshadowed, at least initially, by discussions about the future of the Affordable Care Act. Some panelists stated that the expected reauthorization of the Prescription Drug User Fee Act, and other related laws, could serve as a vehicle for some drug pricing provisions to make their way through the Capitol Hill.  And with drug costs straining state budgets, panelists suggested that the potential for action around drug pricing at the state level will remain high.  

Value is Personal

As “values-based” reimbursement gains traction and more payors opt to offer high-deductible health plans, patients are bearing an increasing share of the cost of prescription drugs. But when discussing “value,” the experts cautioned, it’s important to remember that perceived value is highly personal. Will this drug extend a cancer patient’s life by one year or one month? What are the side effects and corresponding quality of life related to a particular treatment? A further complication is that not all patients receive the same benefit from the same drug. Patients and prescribers need comprehensive information to weigh the financial burden against a treatment’s potential benefits.

Price Transparency Can Help

The experts stressed that it’s important for providers, insurers and patients to understand how drugs are priced relative to their effectiveness. For example, tools that give doctors cost information at the point of prescribing can facilitate a conversation that helps patients decide whether a particular therapy is right for them. In this scenario, a patient who cannot afford the physician’s suggested medication might opt for a less-expensive alternative, rather than being faced with sticker shock at the pharmacy and leaving with nothing. The panelists also called for additional focus on manufacturers’ claims regarding research and development and marketing costs to understand the true cost of developing and advertising a drug.

For more information about the issues related to prescription medication costs, visit our Rising Drug Prices Information Center

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