Keeping prescription medications affordable for CVS Caremark members

Today’s pharmaceutical pipeline is rich with innovative therapies — some of which may treat conditions with few or no treatment options to date. However, medications need to be accessible for those who have been prescribed them. 

Cost can be a considerable factor in accessing prescription medications. While generics have made many prescription medications more affordable, cost is still a barrier for many patients — particularly for brand-name medications. 

Between 2019 and 2023, wholesale acquisition costs (WACs), also known as pharmaceutical manufacturers’ list prices, grew with a compounded annual growth rate (CAGR) of 7.6%. They are expected to continue growing between 6% and 9% from 2024 to 2028. And many new therapies are coming to market with five- and six-figure prices for a year’s supply. In fact, from 2020 to 2021, the proportion of drugs priced at $150,000 for one year or more was 47% across all new drug launches.

For PBMs, this means taking a multi-faceted approach to help ensure coverage for the medications that plan members need at an affordable price.

As the PBM for ~90M Americans, CVS Caremark offers prescription drug plan coverage options that align to clients’ goals and support lower out of-pocket costs for their members. There are several ways that CVS Caremark has supplemented traditional methods, such as rebates from drug manufacturers, to help drive down costs. Four examples are:

• Response to hyperinflation — CVS Caremark identifies hyperinflated drugs that can be removed from the formulary, while ensuring that members have access to clinically appropriate alternatives.^*

• Real-Time Benefits — Providers are the navigators of plan members' health care. With Real-Time Benefits, providers can see their patients’ drug costs within their electronic health records (EHRs). Over 50% of providers receive Real-Time Benefits information within their EHRs.^*

• Biosimilars — When applicable, biosimilars represent one of the single biggest savings opportunities, transitioning members from a high-cost, specialty branded medication to a biosimilar with the same clinical efficacy at an 80% discount. Our biosimilar strategy is centered on clinical standards and member affordability. Caremark was the first PBM to remove Humira from its major formularies and has achieved 96% adoption for Humira biosimilars, while overall market share average for top 10 biosimilars is 23%. This bold action has afforded our clients and members $1.5B in savings with 85% of members having $0 out-of-pocket costs.

• GLP-1s — Innovation in health care brings us new treatments that help people live healthier lives. CVS Caremark has a longstanding commitment to using formulary strategy to drive competition and cost savings. We recently made the decision to prefer Wegovy on our commercial template formularies. Based on positive past results with formulary management, this decision will drive competition in the market to lower drug pricing and enable wider, more affordable coverage for weight management drugs. 

About 60% of Americans report taking at least one prescription medication, and over one in three reports taking three or more. As the pipeline of innovative, yet costly, therapies continues to grow, it is important for PBMs like CVS Caremark to continue identifying opportunities to help reduce out-of-pocket spend and work with plan sponsors to help improve access to prescription medications.

All data sharing complies with applicable law, our information firewall and any applicable contractual limitations. Savings projections are based on CVS Caremark data. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors.