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CVS Health: Real-time benefits program reduces drug costs

CVS Health on Wednesday released new data showing that the company's real-time benefits program, powered by its proprietary engine, Script Intelligence, can save CVS Caremark pharmacy benefit management (PBM) members between $120-$130 per prescription fill.

CVS also found that when provided with access to member-specific pharmacy benefit and formulary information at the point-of-prescribing, prescribers are often switching a member to a lower cost covered drug when available.

Prescribers using CVS Health's real-time benefits information are switching to a covered drug 75% of the time, when the originally prescribed drug is not on the member's formulary. In situations where the original drug is covered, but a lower cost alternative is available, prescribers are switching patients to a clinically-appropriate alternative 40% of the time, resulting in average out-of-pocket member savings of $130 per filled prescription, the company said.

When prescribers, pharmacists or CVS Caremark members search for a specific drug, the database provides up to five lower-cost clinically appropriate brand drug alternatives or therapeutically equivalent generics that are specific to the member's formulary and pharmacy benefit plan. Prescribers, pharmacists and members can see what the member's out-of-pocket expense is at that moment in time and identify clinically-appropriate less expensive alternative drugs specific to the member's plan.

Through real-time benefits, prescribers can also see if a drug requires a prior authorization and complete it electronically, directly in the e-prescribing workflow. More than half of electronic PA decisions are returned in as little as six seconds. This can improve the prescriber and member experience and can also result in fewer claims rejections at the pharmacy, helping get more affordable drugs to the member faster, according to the company.

"As prescription drug prices continue to rise and enrollment in high deductible health plans grows, many patients are shouldering higher pharmacy costs or abandoning their prescriptions altogether, which can negatively impact overall health outcomes," CVS Health chief medical officer Troyen Brennan, said. "These proven, statistically significant savings from real-time benefits underscore the utility and public health implications of providing drug cost transparency, which is making it easier for members to afford and adhere to their medications while lowering overall costs for both members and payors."

"At CVS Health, our real-time benefits information is facilitated by our unique database and powered by our proprietary engine, Script Intelligence. This database gives us the differentiated ability to therapeutically map drug alternatives based on the member's individual coverage and benefit status in a way no other PBM in the market is doing today," CVS Health senior vice president PBM Innovation Casey Leonetti said, in a statement. "Wherever a member chooses to interact with CVS Health, we can help provide greater drug cost transparency and access to the lowest cost prescription drugs."
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