Improving Patient Access to Medications and Health Care: Evaluating CVS Health's New Payment Models and Competitor Prescription Savings Programs

Medication affordability, lack of insurance coverage, and access to health care remain some of the principal causes of nonadherence, unfavorable clinical outcomes, and increased ER visits and hospitalizations. Identifying and addressing barriers to medication access and routine health care is integral to reducing health burdens and direct and indirect costs for patients and the health care system. Many patients do not take medication as prescribed because of their inability to afford the medication.^1-3 Studies reveal that many patients who cannot afford medications employ cost-saving tactics such as skipping doses, only taking reduced doses, or postponing filling a prescription until they can afford it.^1-3

In a recent press release, the well-known retail pharmacy CVS announced its initiative to change how its pharmacies price prescription drugs and plans to simplify drug costs. The company announced its plan to base the costs of prescriptions on the “amount that it pays for a drug -- limiting the markup and service fee to customers.”^4-6 According to CVS Health, the new cost model aims to build patient confidence so consumers can obtain their medications at the best and most affordable prices.

The company announced the introduction of CVS CostVantage^TM and CVS Caremark TrueCost^TM to steer “aligned incentives and provide a more transparent and sustainable reimbursement model and launched the CVS Healthspire^TM brand for its health services segment that simplifies access to multi-payor capabilities, better aligns client service, and drives better outcomes and greater lifetime member value.”⁴

The mission of the CVS CostVantage is to “define the drug cost and related reimbursement with contracted pharmacy benefit managers (PBMs) and payors, using a transparent formula built on the cost of the drug, a set markup, and a fee that reflects the care and value of pharmacy services.” ⁵ To ensure an efficient modulation of the new incentive, CVS Health anticipates initiating CVS CostVantage with PBMs for their commercial payers in 2025.⁵

CVS Health also announced the CVD Caremark TrueCost model, which will launch in 2025. This model is designed to provide “client pricing reflecting the true net cost of prescription drugs, with visibility into administrative fees.”⁵ The retail chain indicates that efficient pricing will help patients, improve their confidence that they are obtaining their medications at optimal prices, and enable members of this novel model to access their national pharmacy network.⁵

Sources indicate that the newly announced CVS model will be analogous to the plan announced by Express Scripts in November 2023, which is comparable to the Mark Cuban Cost Plus Drugs model, which is a direct-to-consumer model that provides generic drugs at a cost marked up by 15% along with a $3 pharmacy fee.^7-8

Additionally, the CVS Healthspire brand for health services will be initiated sometime in December 2023 and progress throughout the new year. ⁵

Initiatives From Other Retail Chains and Companies to Assist Patients in Saving Money on Prescriptions

The retail chain Walgreens has a prescription savings club plan available via an individual subscription for $20/year and $35 for a family of 5. It provides discounts for over 8000 medications, and no insurance is required. GoodRx also offers a free plan, a paid individual plan for $9.99/month, and a family plan for $19.99/month. On November 30, 2023, Walgreens announced the launch of its novel Rx Savings Finder, described as an easy-to-use digital tool designed to help customers save money on prescription medications. The retail chain collaborated with a medication access and transparency technology company, RxSense, to devise this digital tool to enable patients to save money on medication by comparing prices on free third-party discount prescription cards and providing patients with a rapid and easy way to find lower prices on prescriptions filled at Walgreens.^9,10 Rick Gates, chief pharmacy officer at Walgreens, stated, “Inflation not only impacts our pockets but can have serious implications on health. Over one-third of Americans have avoided a prescription refill to reduce costs, and with over 131 million Americans taking at least one prescription medication, this is very concerning. That is why we have launched Walgreens Rx Savings Finder – to empower our customers with transparent prescription costs and help them save money on medications.”⁹

In January 2023, Amazon launched a generic medication subscription service, RxPass, available to Prime members. This program makes eligible generic drugs available for common conditions for a flat fee of $5 per month.¹⁰

In a recent study published in the Annals of Internal Medicine,11 researchers examined the cost savings of 20 commonly prescribed generic drugs. Then they compared their findings to the prices patients paid out of pocket for these drugs in 2020 with the prices advertised by discount pharmacy card programs from Amazon and GoodRx. The analysis included those with private health insurance, individuals with Medicare, and uninsured. Results revealed that at least 1 out of every 5 prescriptions were cheaper when dispensed via Amazon or GoodRx discount card programs compared to what patients paid out of pocket for the drugs.¹¹ In a statement, the lead author Pranav Patel, a research analyst, stated, “The takeaway really is that these discount card programs are potentially a tool to reduce the out-of-pocket burden for Americans.”¹¹

In a recent publication by WebMD, the author highlighted the pros and cons of prescription savings programs. The benefits included cost savings, which can assist patients in getting medications, especially if costs are a barrier to obtaining medications, the ability to compare costs and find the best price, quick and easy to use, and free programs. The cons reported included limitations of some programs that do not allow use with insurance; some require paid memberships that are monthly or annual; the cost savings may go up and down depending on fluctuating drug prices from month to month, and some plans may share patient contact information, which may increase the incidence of marketing emails, calls, and text messages.¹²

Conclusion

A recent study conducted by the CDC discovered that more than 9 million adults in the US are not taking medications as prescribed due to the high costs of medications, and those without insurance coverage were more likely not to take medications as prescribed.¹ Sources indicate that discount savings programs offer a practical way to assist patients who are underinsured, uninsured, or have high deductibles to obtain medications at a lower price depending upon the drug, but there are pros and cons.¹¹ The impact of the novel CVS Health incentives remains to be seen. Still, any measures to make drug costs more affordable and increase patient access to health care are clearly steps in the right direction since an abundance of research has established that adherence to therapy and routine health care are integral components to improving clinical outcomes and reducing health and economic burdens. Making health care delivery more accessible and convenient may encourage more patients, especially the elderly patient population, to obtain routine health care, which could improve patient adherence and overall clinical outcomes.

References

1. Mykyta L, Cohen RA. Characteristics of adults aged 18–64 who did not take medication as prescribed to reduce costs: United States, 2021. NCHS Data Brief. 2023;(470). doi:10.15620/cdc:127680.
2. Doshi JA, Li P, Huo H, Pettit AR, Armstrong KA. Association of patient out-of-pocket costs with prescription abandonment and delay in fills of novel oral anticancer agents. J Clin Oncol. 36(5):476–82. 2018.
3. Stewart SJF, Moon Z, Horne R. Medication nonadherence: Health impact, prevalence, correlates and interventions. Psychol Health. Published online November 29, 2022.doi:10.1080/08870446.2022.2144923. Accessed December 5, 2023.
4. What to expect after CVS changes drug pricing formula. ABC News. December 5, 2023. Accessed December 5, 2023. https://abcnews.go.com/Health/expect-after-cvs-drug-pricing-formula/story?id=105391068
5. CVS Health highlights path to accelerating long-term growth through building a world of health around every consumer. News release. Nasdaq. December 5, 2023. Accessed December 6, 2023. https://www.nasdaq.com/press-release/cvs-health-highlights-path-to-accelerating-long-term-growth-through-building-a-world
6. CVS Health highlights path to accelerating long-term growth through building a world of health around every consumer. CVS Health. December 5, 2023. Accessed December 5, 2023. https://www.cvshealth.com/news/company-news/our-path-to-accelerating-long-term-growth.html
7. Express Scripts introduces new option to give clients maximum simplicity in drug pricing. Evernorth Health Services. News release. November 14, 2023. Accessed December 6, 2023. https://www.evernorth.com/articles/express-scripts-introduces-new-option-give-clients-maximum-simplicity-drug-pricing
8. CVS Becomes latest PBM to overhaul drug pricing formula. PhamrExec. December 6, 2023. Accessed December 6, 2023. https://www.pharmexec.com/view/cvs-becomes-latest-pbm-to-overhaul-drug-pricing-formula
9. Walgreens launches Rx savings finder to help patients save on prescription medications. News release. Walgreens Boost Alliance. November 30, 2023. Accessed December 8, 2023. https://www.walgreensbootsalliance.com/news-media/press-releases/2023/walgreens-launches-rx-savings-finder-help-patients-save-prescription
10. Walgreens, RxSense partner to give consumers prescription drug discounts. Mobile Health News. December 1, 2023. Accessed December 7, 2023. https://www.mobihealthnews.com/news/walgreens-rxsense-partner-give-consumers-prescription-drug-discounts
11. Patel PM, Len J, Shah S, Vaidya V. Cross-sectional analysis of out-of-pocket payments for commonly prescribed generic medications versus discount card pricing. Ann Intern Med. 2023;176(9):1282-1285. doi:10.7326/M23-0644
12. Ellis R. Prescription savings programs: Are they worth it? WebMD. November 21, 2023. Accessed December 7, 2023. https://www.webmd.com/health-insurance/prescription-savings-programs