Cost is a barrier to nonadherence, that's a no-brainer. While medication adherence can be classified as intentional (e.g., concern about a side effect, distrust of medication) or nonintentional (e.g., forgetting to take a medication, disease impedance), the cost can be thrown under both categories. Patients may not be able to pay for the medication, and intentionally not buy it, but they may want it, though regarding cost-of-living immediacy (e.g., rent, gas, food) it can quickly fall towards the bottom of priorities.
CVS recognizes this issue, and wants to make it easier to be transparent with patients on getting the best drug for the cost to the patient. At least that is what they are announcing with their new programs to help patients save money. The recently rolled out "CVS Pharmacy Rx Savings Finder" is to be used by pharmacists to help evaluate patients' medications, identify cost saving opportunities, and reduce out-of-pocket expenditures.1
This works through a process where several factors are evaluated:
- Is the prescribed medication on the patient's formulary, and lowest cost agent available?
- Are available lower-cost medications covered, such as a generic or therapeutic alternative?
- Can money be saved with a 90-day supply versus a 30-day supply?
- What other cost-saving measures can be applied if nothing else works?
CVS is also looking to expand services to providers using their PBM by allowing them to see costs at the point-of-prescribing, to alert them of how much the dug may cost, and if there are better options. I am unsure how large this rollout will be, and if it is built into a user interface readily accessible to providers to make it easy to use. My biggest gripe over the years, and comments by providers I've talked to, has usually been that they just don't know how much the drug they are prescribing will cost. The other issue being tackled includes rebates at the point of sale through negotiated contracts with pharma, and other organizations. These will hopefully reduce costs for patients as well.
In a statement, Thomas Moriarty, Chief Policy and External Affairs Officer at CVS said, "Today's consumers are faced with higher prescription drug prices than ever before, and many of them are now paying for a larger share of their prescription drug costs out of their own pockets at the pharmacy counter, due to growth in high deductible health plans. Until now, patients haven't had the appropriate tools available to them to help them manage these costs. To address this, CVS Health is giving expanded tools to patients, prescribers, and pharmacists so they can evaluate prescription drug coverage in real time and identify lower cost alternatives. We are committed to finding the right drug at the lowest possible cost for patients to ensure they are able to access, and stay on the medications they need. That's our promise."2
But the picture is more complex. Take for the instance, a recent research letter published in the Journal of the American Medical Association this past March. Looking through the reimbursement data from CVS and comparing to the national average retail price, they looked to see what claims costs were like for patients co-pays.3 Their results demonstrated that there were substantial differences in retail price and co-pays for patients, with the 9.5 million claims evaluated showing 2.2. million had overpayments for generic drugs. Couple this issue with the so-called 'gag clauses' that limit pharmacist discussion of drug prices with patients, and you can see the concern that has arisen regarding cost transparency for patients in the past few years.
At the end of the day, it was inevitable for CVS to take this upon themselves to avoid concerns that they are marking up drug costs beyond reasonable amounts, and causing drug-related nonadherence issues among their customers. Now their process seems reasonable, but there may be a few gray areas. In the case of their last option, where they look for alternative cost-saving measures, will they enlist companies like GoodRx or Blink Health or other drug coupon/cost saving companies? Would they look into pharmaceutical discount programs for patients that meet the cut-off? These are questions that remain unanswered at this time, though I think this is a step in the right direction.
- Helping Patients Maximize Prescription Benefits and Save Money. CVS Health website. https://cvshealth.com/thought-leadership/helping-patients-maximize-prescription-benefits-and-save-money. Created April 11, 2018. Accessed April 24, 2018.
- CVS Health Fights Back on High Cost Drugs by Launching Industry's Most Comprehensive Approach to Saving Patients Money [news release]. Woonsocket, RI. CVS News Room. April 11, 2018. https://cvshealth.com/newsroom/press-releases/cvs-health-fights-back-high-cost-drugs-launching-industrys-most-0. Accessed April 24, 2018.
- Van nuys K, Joyce G, Ribero R, Goldman DP. Frequency and Magnitude of Co-payments Exceeding Prescription Drug Costs. JAMA. 2018;319(10):1045-1047.