Help members access the most cost-effective drug through clinical expertise

Prescription medicines are the most cost-effective part of our health care ecosystem, but they’re only clinically effective if patients can afford them. The amount that patients pay out-of-pocket has long been a point of contention in our health care system. Further underscoring this point, a recent CVS Health survey found that more than 70% of patients are concerned about the cost of their prescriptions.

The COVID-19 pandemic continues to create financial hardship in virtually every community. Recognizing this reality, solutions that help ensure that patients have access to prescriptions will be mission critical.

Clinical strategies to manage drug costs

Utilization management strategies are a cornerstone of our pharmacy benefit strategies. They enable appropriate use of medicines and help to mitigate the impact of high-cost drugs that do not demonstrate a clear clinical benefit.

We are closely monitoring trends in utilization, particularly high-cost specialty drugs, to stay ahead of the curve and ensure that patients can access clinically appropriate new therapies, while reducing wasteful spend.

We use innovative strategies to encourage the use of lower cost and clinically equivalent generic options when appropriate. Through these strategies, we continue to blunt the impact of price inflation, prioritize lower-cost generic options when clinically appropriate, and keep members’ out-of-pocket costs in check.

Prioritizing member savings and adherence

We also know that patients want to know whether their drug is covered, what it will cost out-of-pocket and have the ability to discuss with their provider. Just because a drug is expensive, doesn’t mean it’s the best option for every patient. That’s why we utilize patient-centric programs to make sure patients can access medicines that will create the best clinical outcome at the lowest possible cost.

Our approximately 100 million members, their prescribing physicians and pharmacists provides have immediate access to real-time prescription benefit information, including how much a drug will cost. With this information at hand, physicians and pharmacists can identify an alternative, clinically appropriate option, when possible.

We also offer a robust set of consumer-friendly tools to help members better understand how to access the most effective medicine at the lowest cost. With the digital tool Savings Advisor, members can view costs readily, enabling them to make more informed decisions about medicines choices.

10.07.20