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CVS PBM ends out-of-pocket costs for diabetes drugs

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WOONSOCKET, R.I. — CVS Health unveiled a new solution that eliminates out-of-pocket costs associated with all diabetes prescription medications, including insulin, for members of the company’s pharmacy benefit manager. Offered through the CVS Caremark PBM, RxZERO enables employers and health plan sponsors to leverage formulary and plan design approaches to offer all categories of diabetes medications at zero dollar out of pocket for their members without raising costs for the plan sponsor or increasing premiums or deductibles for all plan members.

“Eliminating out-of-pocket costs for diabetes medications ensures long-term affordability, improves adherence and, most importantly, puts patients on the path to better health,” said Dr. Troy Brennan, chief medical officer of CVS Health. “A person living with diabetes is required to take many tasks to manage their condition annually. Unfortunately, that can include making difficult decisions about whether they can afford their medications and fill their ­prescriptions.”

CVS Caremark analysis shows that members taking branded diabetes medications spend, on average, $467.24 out of pocket per year, with nearly 12% spending over $1,000 annually. The new RxZERO plan design enables plan sponsors to eliminate member out-of-pocket costs for the entire diabetes therapeutic area, including oral medications for type 2 diabetes, and fully adhere to American Diabetes Association standards.

“There are more than 30 million Americans living with diabetes, and far too many of them are struggling to manage their diabetes because of the high cost of diabetes prescription medications,” said Kelly Mueller, vice president of community impact for the American Diabetes Association. “The American Diabetes Association is committed to helping those living with diabetes thrive, and accessing the medications they need is critical. We are hopeful that by eliminating out-of-pocket costs for diabetes medications, CVS Health will remove one of the barriers many people face that prevent them from managing their diabetes successfully.”

“Traditionally, the focus of affordability for diabetes medications has been on insulin, which is the cornerstone of therapy for the 5% of people with diabetes who are living with type 1 diabetes,” said Brennan. “However, the new CVS Caremark solution expands affordable options to include the entire range of diabetes medications, improving affordability for the 95% of people with diabetes who are living with type 2 diabetes.”

CVS Health believes that eliminating out-of-pocket costs for diabetes drugs could be an important feature to all insurance plans, to help address the growing diabetes epidemic without increasing other costs, such as deductibles and premiums. CVS Caremark research demonstrates that by leveraging formulary and plan design approaches, plan sponsors can eliminate member out-of-pocket costs for all categories of diabetes medications without raising costs for the plan sponsor or increasing premiums or deductibles. The analysis demonstrates that the approach leads to savings for plan sponsors through improved adherence and a reduction in overall medical costs.

This solution, detailed in a CVS Health white paper, “A Prescription for Better Diabetes Management,” is part of CVS Health’s integrated approach to chronic care management and commitment to making care more affordable, local and easier to navigate. CVS Health also provides supportive care at its MinuteClinic and new HealthHUB store format, which features a broader range of health care services to help patients better manage chronic conditions and complement the care that patients receive from their primary care physicians.


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