Providing Real-Time Benefits to Bring Savings to Patients

Consumers are concerned about rising drug prices, and many, especially those in high-deductible health plans, may decide not to fill a prescription if it is too expensive. This trend can have a major impact on patient health and also lead to higher downstream medical costs due to avoidable complications or even hospitalizations.

At CVS Health, we are helping to address the high cost of prescription drugs by increasing drug pricing transparency for patients, prescribers and pharmacists. For example, CVS Health’s real-time benefits program is helping patients with CVS Caremark pharmacy benefit management (PBM) coverage access the lowest cost and most clinically appropriate drug. Launched in late 2017, the program is already resulting in savings and lower out-of-pocket costs for patients.

Expanding Visibility into Patients’ Drug Costs

Real-time benefits gives prescribers visibility into member-specific formulary and plan design information via their electronic health record (EHR) at the point-of-prescribing. For example, when prescribers write electronic prescriptions for their patients, they will now see the cost of the drug they are prescribing and have the opportunity to switch to a different, lower-cost option. Specifically, the information includes member-specific out-of-pocket costs for a selected drug, along with up to five lowest-cost, clinically appropriate therapeutic alternatives based on the patient’s formulary. 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. In addition, patients with CVS Caremark coverage may access information on lower-cost alternatives within the Check Drug Cost tool through their online member portal and the CVS Caremark digital app.

Results Show Real-Time Benefits Save Patients Money

Within the first few months since launch, we are seeing high adoption of real-time benefits, which is ultimately helping patients access more affordable drug options and can help improve medication adherence.

Prescribers are using real-time benefit information for patients covered by CVS Caremark approximately 280,000 times per week with the following results:

  • If the selected medication is not covered by the patient’s benefit, prescribers are switching to a covered medication 85 percent of the time.
  • If the initial medication is covered, but there is a lower-cost alternative available, prescribers are switching the member’s medication up to 40 percent of the time, resulting in a difference in out-of-pocket cost to the patient of approximately $75-$100 per prescription.

Patients are also using the online Check Drug Cost tool to find lower cost drug options.

  • Specifically, they are initiating more than 250,000 searches each month.
  • This results in potential savings opportunities approximately 20 percent of the time at an average of $80 in savings per prescription.

Identifying Potential Savings at the Pharmacy Counter

Rising drug prices are a major issue for our CVS Pharmacy customers as well, and we are doing a number of things to help patients afford their prescriptions. For example, the Rx Savings Finder tool, our new digital savings and discount program, will help our pharmacists quickly identify if there are any available savings opportunities for individual patients at the pharmacy counter. This tool is expected to produce an average of $420 in additional annual savings for the patient.

In support of greater drug pricing transparency, our enterprise capabilities together help make it easier for patients and their health care providers to understand what drugs are covered by their insurance, the out-of-pocket cost to the patient for the drug and if there are other preferred drugs the patient can fill at a lower cost as well as identify other potential savings opportunities.  These capabilities are enabling more informed prescription decision-making, improving access to affordable therapies and helping avoid delays in patients starting or staying on their therapies, all of which can improve health outcomes.

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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