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CVS Health Shows that Better Drug Cost Transparency Can Help Lower Out-of-Pocket Costs

CVS Health today released new data showing that the company's real-time benefits program, powered by its proprietary engine, Script Intelligence , can save CVS Caremark pharmacy benefit management (PBM) members between $120-$130 per prescription fill. The company found that, when provided with access to member-specific pharmacy benefit and formulary information at the point-of-prescribing, prescribers are often switching a member to a lower cost covered drug when available.

Published 6 years ago | About a 4 minute read

In fact, prescribers using CVS Health's real-time benefits information are switching to a covered drug 75 percent of the time, when the originally prescribed drug is not on the member's formulary. In instances where the original drug is covered, but a lower cost alternative is available, prescribers are switching patients to a clinically-appropriate alternative 40 percent of the time, resulting in average out-of-pocket member savings of $130 per filled prescription.

"As prescription drug prices continue to rise and enrollment in high deductible health plans grows, many patients are shouldering higher pharmacy costs or abandoning their prescriptions altogether, which can negatively impact overall health outcomes," said Troyen A. Brennan, M.D., Chief Medical Officer, CVS Health. "These proven, statistically significant savings from real-time benefits underscore the utility and public health implications of providing drug cost transparency, which is making it easier for members to afford and adhere to their medications while lowering overall costs for both members and payors."

Drug costs are often cited as a major barrier to medication adherence, and increasingly, Americans view drug cost transparency as a critical component to improving prescription affordability. According to a recent national poll commissioned by CVS Health, 84 percent of Americans believe it would be helpful to have drug cost information upfront, before they go to the pharmacy, and more than half 64 percent say they would use that information to find lower cost alternatives instead of foregoing treatment altogether¹.

In addition to prescribers using real-time benefits, members are also accessing information about drug costs and clinically appropriate alternatives based on their benefit within the Check Drug Cost tool on Caremark.com or via the Caremark mobile app. Members who are searching for their prescriptions using this tool are filling lower cost alternatives 20 percent of the time, when available. In these cases the member cost was $120 lower per fill, compared to the original drug.

"At CVS Health, our real-time benefits information is facilitated by our unique database and powered by our proprietary engine, Script Intelligence . This database gives us the differentiated ability to therapeutically map drug alternatives based on the member's individual coverage and benefit status in a way no other PBM in the market is doing today," said Casey Leonetti, Senior Vice President, PBM Innovation at CVS Health. "Wherever a member chooses to interact with CVS Health, we can help provide greater drug cost transparency and access to the lowest cost prescription drugs."

Script Intelligence, is a proprietary engine that powers a unique database of clinically-mapped drugs that differentiates the CVS Health real-time benefits solution in the market. When prescribers, pharmacists or CVS Caremark members search for a specific drug, the database provides up to five lower-cost clinically appropriate brand drug alternatives or therapeutically equivalent generics that are specific to the member's formulary and pharmacy benefit plan. As a result, prescribers, pharmacists and members can see what the member's out-of-pocket expense is at that moment in time and identify clinically-appropriate less expensive alternative drugs specific to the member's plan.

Through real-time benefits, prescribers can also see if a drug requires a prior authorization (PA) and complete it electronically, directly in the e-prescribing workflow. More than half of electronic PA decisions are returned in as little as six seconds. This can improve the prescriber and member experience and can also result in fewer claims rejections at the pharmacy, helping get more affordable drugs to the member faster.

Real-time benefits is integrated into the prescriber's workflow via electronic health record (EHR) systems. In addition, pharmacists at all retail pharmacies within the CVS Caremark network also have access to the list of clinically appropriate formulary alternatives provided to the prescriber. At CVS Pharmacy specifically, the list of formulary alternatives along with the cost information is embedded into the pharmacist's workflow. As a result, the CVS pharmacist is alerted prior to dispensing when a medication is not on a member's formulary, has the ability to see the member cost share associated with the prescribed medication, can view any available alternatives, and can quickly send an electronic prescription change request to the prescriber for a covered, lower-cost alternative.

¹The Morning Consult poll was conducted from July 23-25, 2018, among a national sample of 2,201 registered voters. The interviews were conducted online and the data were weighted to approximate a target sample of registered voters based on age, race/ethnicity, gender, educational attainment, and region. Results from the full survey have a margin of error of plus or minus 2 percentage points.