CVS Health is rolling out a tool to alert its 30,000 pharmacists to cheaper drug options when they fill patients' prescriptions.
If the software flags a less expensive therapeutic equivalent, the pharmacist will tell the patient and seek permission to ask their doctor to make the switch. It is also being made available directly to CVS Caremark consumers through an app.
Pharmacy benefit management, the business of negotiating drug prices on behalf of insurers and employers, has come under intense scrutiny for its role in drug pricing.
The Trump administration has highlighted consolidation in the pharmacy benefit management industry as a major concern. Two of the industry's biggest players are on the cusp of major mergers that are undergoing federal antitrust scrutiny -- including CVS, which is buying health insurer Aetna for $69 billion.
Providing information on out-of-pocket costs and cheaper alternatives to pharmacists, doctors and consumers will help save money, CVS says, and is necessary because each insurance plan may vary widely in how it covers drugs and shifts costs to patients.
Kevin Hourican, executive vice president of retail pharmacy for CVS Pharmacy, cited the example of a patient who comes in to the pharmacy with a prescription for a generic cholesterol medication, atorvastatin. In that patient's health plan, the atorvastatin might cost $50, and the pharmacist could be alerted to a different generic statin, simvastatin that might only be $5 under that patient's plan. In another patient's plan, however, the situation might be reversed -- with the atorvastatin preferred and cheaper -- all due to how the insurance plans have built their list of covered drugs.
"Before this tool was developed, they [pharmacists] would not know which was least expensive for that given customer's plan," Hourican said. Pharmacists would have had to run claims through the system manually to find a cheaper option.
Pharmacists will also be able to easily check whether a 90-day prescription could be cheaper than three 30-day fills and look for other cost-savings, including coupons.
Doctors are beginning to be able to access patient-specific drug pricing information through electronic health records when they're writing a prescription. CVS says doctors are receptive to the information, although the capability is being used by fewer than 10,000 of them.
In early results, if the drug the doctor is prescribing isn't covered by the person's health plan, the practitioner switches to a covered drug 85 percent of the time when prompted. When the prescribed drug is covered by the patient's plan, but there is a lower-cost therapeutic alternative available, doctors switch to the drug that is cheaper for the patient only 30 percent of the time. Patients who switched to a lower-cost drug are saving $75, on average.
Giving doctors greater transparency about how much drugs will cost their patients is important because high costs can deter people from taking their medicine. But this cost information is incomplete — it won't necessarily reflect the overall cost of the drugs to the health care system, Walid Gellad, co-director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh pointed out.
Doctors may find the information useful if it helps their patients afford and adhere to medication regimens -- or they might find it adds to their administrative burden, and they may object to having their clinical decisions questioned by pharmacists.
"I think the problem is there's more and more of this interruption in the clinic -- at the point of prescribing, at the point of everything. Eventually, there's a limit to how much clinicians can take, to the point where they're actually trying to get away from the electronic medical record and talk to the patient," Gellad said.