Prescribers, patients can see cost, coverage information

WOONSOCKET, R.I. — CVS Health has announced that its pharmacy benefits manager (PBM), CVS Caremark, will begin providing real-time visibility to member-specific medication costs and available lower-cost therapeutic alternatives at the point of prescribing and at the pharmacy.

This enhanced visibility to the patient’s benefit across all points of care can help eliminate potential dispensing delays, improve patient outcomes through increased medication adherence and lower costs for members and payors.

“Patients often do not find out that the medication they were prescribed is not covered or has higher than expected out-of-pocket costs until they go to the pharmacy to pick up their prescription, which can result in patients not filling a prescription, non-adherence and, ultimately, higher downstream health care costs,” Dr. Troyen Brennan, executive vice president and chief medical officer of CVS Health said in a statement.

“Making detailed, real-time benefit information available for our PBM members and their health care team, whether it’s the doctor or the pharmacist, can help streamline the patient experience and improve health outcomes while also lowering costs for both the patient and the payor.”

Through visibility to “real-time benefits,” prescribers can see specific benefit information for patients supported by CVS Caremark integrated directly into their e-prescribing workflow. Even before they prescribe a drug, prescribers will be able to see the cost of the drug based on the patient’s coverage, including the patient’s remaining deductible, when applicable, and will be able to review up to five clinically appropriate branded alternatives or therapeutically equivalent generic medications specific to the patient’s formulary coverage.

Prescribers will also have visibility to requirements, such as prior authorization or step therapy, enabling them to immediately submit an electronic prior authorization request. In addition, pharmacists at all retail pharmacies within the CVS Caremark network will have visibility to the same list of clinically appropriate formulary alternatives provided to the prescriber, and beginning in early 2018, CVS Caremark members will be able to find lower-cost alternatives within the Check Drug Cost tool on Caremark.com.

At CVS Pharmacy, this information will be integrated directly into the pharmacist’s existing workflow, making it easy for them to engage CVS Caremark members about potentially lower-cost alternatives, based on the members’ specific formulary coverage. CVS pharmacists will also be able to easily request a prescription change from the prescriber – when needed – with a simple one-step process.

Beginning in early 2018, as part of the company’s ongoing, enterprisewide focus on helping patients save money, CVS pharmacists will also be able to see the associated out-of-pocket costs for CVS Caremark members. This will help ensure alignment with the member’s plan design and enable them to access the lowest cost medications within their benefit. For those members for whom drug cost is still a concern, the CVS pharmacist will also be able to share additional cost savings opportunities such as prescription discounts, when available.

“Across the CVS Health enterprise, we are focused on providing patients with the most convenient access to affordable medications, and this innovation enables us to provide our PBM members and their health care providers with direct, easy access to real-time benefit information – throughout the health care continuum – whether they are at their physician’s office or at the pharmacy,” Jonathan Roberts, executive vice president and chief operating officer of CVS Health said.

“No one else provides this level of member-specific actionable drug benefit information across so many points of care, which can help simplify and streamline the process of getting a patient on the most appropriate and affordable therapy and increase member engagement and satisfaction with their care.”

Medication cost can be a significant factor when a patient is deciding whether or not to fill a prescription. Yet, research shows that patients often feel they do not have adequate information about the use of formularies or the drugs covered by their plan.

In addition, when required, the manual prior authorization process to gain necessary approvals for a specific drug from both the insurer and prescriber can be time-consuming for prescribers, patients and pharmacists.

In fact, approximately 80 percent of physicians said manual prior authorization requests require extra work, rework and follow up, which can also delay the start of an important therapy or result in poor compliance. Altogether, this can result in medication non-adherence, which can lead to poor health outcomes and is estimated to cost the U.S. health care system nearly $300 billion each year.

Real-time benefit information is enabled through functionality from Surescripts and is available to any provider using an electronic health record system enabled with real-time benefits and electronic prior authorization.

Real-time benefits further build on CVS Health’s use of electronic health records, to support MinuteClinic nurse practitioners and CVS Specialty’s care management programs.