Affordability
We help keep members’ out-of-pocket costs low by providing our clients with a range of plan design options to fit their unique needs. And we provide members with proactive savings advice and alerts, as well as digital tools that give them 24/7 visibility into medication prices and lower-cost alternatives.
Committed to making drugs more affordable for your members
Prescription drugs are essential to managing and maintaining good health – so it’s critical that they’re affordable and accessible. Plan design strategies like $0 copays, point-of-sale (POS) rebates, and copay assistance programs help soften the impact of drug price increases, improving the likelihood of members taking them. Despite rising drug costs from 2016-2023, CVS Caremark lowered the average cost of a 30-day supply from $11.38 to $7.26.1
$7.26 average member out-of-pocket cost per 30-day supply
We encourage clients to have a preventive drug list in place to lower prescription costs and help improve adherence. We help offset member costs for rebated drugs by sharing rebates directly at the point-of-sale. Clients benefit as well with no administrative fee, a streamlined enrollment process, and the ability to apply rebates to select drug classes or lists.
68.4% of members spent less than $100 out-of-pocket in 20231
Uncovering savings opportunities throughout the journey
We don't want members to pay more for their medications than they have to. That’s why we’ve invested in tools that help us identify savings opportunities and alert members (and their providers) about their options. That way, we can guide members to the best decision for them, no matter where they are.
More than 49 percent of providers receive real-time benefits information in their electronic health records (EHRs), giving them access to drug costs, prior authorizations and lower-cost covered alternatives.2
CVS Caremark plan members experienced a 36.3% reduction in member out-of-pocket costs from 2016-20231
Case study
Supporting affordability with point-of-sale rebates
Clients offering a high-deductible health plan wanted to reduce member cost share (and member complaints).
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CVS Caremark.
Employer Case Study: Supporting affordability with point-of-sale rebates.
Situation.
Members in a high-deductible health plan voiced concerns about drug costs.
The client wanted to improve the member experience and lower costs while being transparent about rebates.
Solution.
Implemented POS rebates.
Promoted reduced brand drug member cost share.
Implemented Cost Saver to help reduce generic drug member cost share.
Results.
Client feedback has been positive and member complaints have virtually disappeared.
The strategy is working:
27.6% reduction in non-specialty member cost share.
25.4% reduction in specialty member cost share.
$1.7 million of rebates applied to reduce member cost share within 6 months.
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1 The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted. Adherence results may vary based upon a variety of factors such as plan design, demographics and programs adopted by the plan. Client-specific modeling available upon request. Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan. CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall. CVS Health Analytics, 2023.
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2 CVS Health Analytics, 2022. All data sharing complies with applicable law, our information firewall and any applicable contractual limitations. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors. Client-specific modeling available upon request.
