Prescribing physicians and pharmacists will have access to individual-specific data on drug costs and alternatives in real-time with the new program.
Troyen A. Brennan, MD, MPH
CVS Health announced that CVS Caremark, the company’s pharmacy benefits manager (PBM), will now provide real-time insight into medication costs and alternative therapies at the time of prescription and at the pharmacy.
This new visibility, provided through Surescripts, will be individual-specific, with lower-cost alternatives providing a way to “eliminate potential dispensing delays, improve patient outcomes through increased medication adherence and lower costs for members and payors,” according to the company.
Medication costs often impact the patient’s ability to decide whether or not to fill a prescription, and research has shown that patients tend to feel as though they do not have an adequate amount of information regarding the drugs available to them within their plans.
An estimated $300 billion cost to the US health care system is caused by non-adherence to treatment each year, and it is an issue faced by nearly every specialty.
"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," Troyen A. Brennan, MD, MPH, the 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."
CVS Caremark will now also provide specific benefit information to prescribers, interwoven into the already established e-prescription workflow. According to the PBM, physicians will be able to see drug costs based on a given patient’s coverage — including deductibles when appropriate – as well as up to 5 “clinically appropriate branded alternatives” or generics that are medically equivalent and within the patient’s coverage. This information will be available to physicians before anything is prescribed.
Physicians will also be granted visibility of prerequisite therapies, allowing them to submit a prior authorization request with more immediacy. According to CVS Health, 80% of physicians stated that manual prior authorization requests can delay the start of therapy due to the extra work and time they require.
Additionally, all pharmacists within the CVS Caremark network will have the same access to view other clinically appropriate alternatives. The PBM also announced that beginning in 2018, CVS Caremark members will be able to locate lower-cost alternatives with its Check Drug Cost tool on its website, caremark.com.
Pharmacists within the network, while able to notify patients about these substitutes, will be able to request a prescription change to a lower-cost alternative in a single-step process. There will also be visibility of associated out-of-pocket costs for patients available to pharmacists beginning in 2018.
"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 in a statement. "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."
For physicians, the change is impactful - but whether or not it will be beneficial remains to be seen. For Zachary Bloomgarden, MD, MACE, clinical professor of medicine at the Icahn School of Medicine at Mount Sinai, the impact depends on what is meant by "alternatives."
"For example, if sulfonylureas are proposed as alternatives to SGLT2 inhibitors, certainly the acquisition price will be lower - but the current evidence from a large variety of studies suggests the latter to be associated with as much as a 50% reduction in heart failure and in mortality, as well as substantial reduction in deterioration of renal function," Bloomgarden said. "The differences in outcomes should be part of the picture presented to the patient, and if it is not then it is unlikely that these presentations of "alternatives" will result in improvement in health outcomes."
For Christian Ruff, MD, MPH, of the TIMI study group and the Cardiovascular Division at Brigham and Women's Hosptial, the benefit is all there, not starting at the pharmacy for the patient, but for the physician at the time of prescription. For Ruff, being able to tailor medicines that work for the patient can go a long way to helping with medication adherence.
"Now when we prescribe a medication we are unsure of what the specifics of the insurance coverage or pricing will be for that specific patient with their specific plan," he said. "Frequently, we prescribe medications only to find out from the patient that the copay was too expensive or that the drug was not approved unless we filled out a prior authorization. Many times the patient will just not pick up the mediation and not tell us and we find out at their next visit months later. Now the health care provider will get real-time information about cost and need for prior authorization. This will allow us to prescribe a medication that the patient can afford and will be able to pick up from the pharmacy. Medications only work if patients take them and this may go a long way in helping to make that happen."