The pharmacy chain is integrating pharmacist- and provider-facing tools to help them recommend cheaper alternatives.
A CVS store. Photo courtesy Wikimedia Commons user Miosotis jade. Image has been cropped for size.
CVS Health, the pharmacy giant currently trying to purchase insurance leader Aetna and potentially upend the healthcare industry, has recently introduced new data tools meant to help pharmacists and clinicians save their patients money.
The company’s new suite includes a pharmacist-facing tool that reviews a patient’s insurance benefits, prescription regimen, and drug history to look for ways to lower out-of-pocket costs by suggesting generics or alternatives. It can also determine whether it’d be cheaper overall for a patient with a recurring prescription to fill for 90 days rather than 30. Pharmacists have long worked to make such recommendations, but they typically haven’t had integrated tools to bring all the options to their attention.
The technology also applies on the physician side. Providers aligned with CVS Caremark—the company’s pharmacy benefits manager (PBM) arm—will be able to see recommendations during the prescribing process, with an interface that also scans for cost-effective alternatives based on a member’s coverage.
CVS hopes to cut down on the number of patients being prescribed drugs that aren’t covered by their benefits. According to a release from the company, “Early results show that prescribers accessing the real-time benefits information through their electronic health record switched their patient’s drug from a non-covered drug to a drug on formulary 85 percent of the time.”
The average savings for a treatment switch was $75 per drug, and when a covered drug was requested but had a lower cost alternative, prescribers elected to write a script for the cheaper one about 30% of the time.
Potential benefits could go beyond consumer savings. “Our direct experience is that patients who are confronted with high out-of-pocket costs at the pharmacy counter are less likely to pick up their prescriptions and are less likely to be adherent to their prescribed therapy,” Kevin Hourican, the company’s executive vice president of Retail Pharmacy, said in a statement.
CVS also said that Caremark was emphasizing expanded rebate programs to further lower costs.
The announcement comes at a time when the company is receiving a lot of attention—and criticism—for its attempted purchase of Aetna. Last month, the American Antitrust Institute (AAI) sent a letter to the Department of Justice requesting that they block the merger. The AAI fears that such vertical integration would be part of a larger restructuring of the healthcare industry, and would further a trend of consolidation in the PBM sphere. The Trump administration has expressed similar concerns about that industry trend.
Combining one of the country’s largest PBMs with one of its largest insurers would create “Stronger incentives to exclude rival PBMs and health insurers and to engage in anticompetitive coordination,” the group wrote, which would “harm competition and consumers at all levels.”
Perhaps spurred by their competitor’s massive move, Walmart (which is the second largest retail pharmacy in the country next to CVS) is reportedly in early talks to purchase insurer Humana. That transaction would give Walmart control of its own PBM, albeit a much smaller one than Caremark.