Advisers working to help their clients’ employees reduce their prescription drug costs should take note of CVS Health’s new pricing initiative.
The pharmacy super-chain recently launched an e-prescribing program that provides real-time visibility to medication costs and lower-cost alternatives. Before prescribing a drug, physicians can review up to five therapeutically equivalent brand alternatives or generic medications on the patient’s health plan formulary. The doctor or the pharmacist can view patient-specific cost information for each drug based on an employee’s coverage terms and how much of the annual deductible has been met.
The initiative is part of the national drugstore chain’s ongoing effort to simplify and improve pharmacy benefits plan design and prior authorization requirements, according to Casey Leonetti, SVP of PBM innovation at CVS Health.
Lower cost alternatives
The stated purpose is to help doctors and health plan members find the most appropriate and lowest-cost therapy in the simplest and most efficient manner, although CVS also hopes to avoid disruption at the point of sale, where customers are often not aware of a drug’s cost or whether it requires prior authorization until they are at the pharmacy counter.
But doctors whose electronic medical record (EHR) systems are connected with the e-prescription program can now view all this information before they prescribe a medication. In most cases, Leonetti notes, a doctor will change a prescription to a lower-cost alternative, if one is available. Prior authorizations can be submitted electronically, she adds, and approvals are received within six seconds.
The CVS program includes a clinical database that maps therapeutic drug alternatives and codes them based on their formulary tier, and an adjudication engine that determines a patient’s out-of-pocket costs and prior-authorization status.
The technology and EHR connectivity that underpins the application is provided by the Surescripts electronic prescribing network, and the information is made available to health plan members through CVS’ Caremark prescription benefit management subsidiary, via its website and mobile app. The information is also available at CVS’ retail pharmacies.
The e-prescription will improve patient adherence, medical outcomes and customer satisfaction “by eliminating the friction that causes workflow interruption and prescription abandonment,” says Tom Skelton, CEO of Surescripts. “We are effectively taking the burden off the patient,” he says, “and arming providers with actionable patient intelligence, so they can have a conversation with their patient while they’re still in their office.”
Skelton cites research indicating that 10% of patients do not purchase prescribed medications because of cost, and 40% do not seek prior authorization when it is required. The CVS initiative is designed to help avoid sticker shock and poor patient adherence, he says, by providing the cost information and required authorizations at the point of care.
CVS’ proposed acquisition of Aetna for $68 billion will have no immediate bearing on the e-prescription program, whose development preceded the merger discussions, according to Leonetti. Since the initiative helps align benefit utilization with plan design, she maintains that it will benefit all payers, including Aetna and the employer community.
From an adviser perspective, the e-prescription initiative allows employers “to advance their plan design and utilization management approach to lowering drug costs,” she says. “This is the next step in helping to bend the cost curve.”
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