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CVS Health's real-time benefits program helps lower out-of-pocket costs

CVS Health has 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, or PBM, members between $120 to $130 per prescription fill.

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, the company said.

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 instances 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. This results in average out-of-pocket member savings of $130 per filled prescription, 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's 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 payers."

According to a recent national poll commissioned by CVS Health, 84% of Americans believe it would be helpful to have drug cost information up front, before they go to the pharmacy, and more than half 64% say they would use that information to find lower-cost alternatives instead of foregoing treatment altogether.

Members are also accessing information about drug costs and clinically appropriate alternatives based on their benefit within the Check Drug Cost tool on or via the Caremark mobile app. Members who are searching for their prescriptions using this tool are filling lower cost alternatives 20% of the time, when available. In these cases, the member cost was $120 lower per fill, compared to the original drug.

"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 of PBM Innovation, Casey Leonetti said. "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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