Ensuring access and affordability to critical medications
Pharmacy benefit managers (PBMs) like CVS Caremark play a crucial role in ensuring access and affordability to critical medications for millions of Americans. Selected by health plans and self-insured employers across the country to optimize benefits for plan members and their families, PBMs leverage their scale efficiencies and clinical expertise to deliver on that mission.
Access
Our national network includes more than 65,000 pharmacies, of which more than 43 percent are independent pharmacies. Constituting a $94 billion industry, independent pharmacies are key to optimizing access and convenience for members. They comprise 30 percent of CVS Caremark’s annual retail pharmacy spend.
At CVS Health, we apply continuous innovation to creating a more transparent, sustainable reimbursement system. New approaches such as CVS CostVantage and CVS Caremark TrueCost are milestone developments, building on our history of formulary innovation.
More information about independent pharmacies is available in this report.
Affordability
CVS Caremark is proud of the work we do to make medicine more affordable for all Americans.
$7.26 average member out-of-pocket cost per 30-day supply1
Independent analysis shows that net brand drug prices have declined six years in a row, despite significant inflation in the United States and substantial list price increases by drug makers. Manufacturers have sole discretion in setting the prices for their products. Pharmacy benefit managers are the only players in the health care industry actively working to bring down costs for plan sponsors and their members.
For more figures and insights, download the attached data summary.
15% real net price decrease for CVS Caremark clients, 2017-20212
Insulin provides a useful illustration. Three brand drugmakers control nearly the entire insulin market, and there are no true lower-cost generic alternatives. Despite list price increases, insulin costs for CVS Caremark plan members have declined substantially since 2017.
$23.54 average member out-of-pocket cost for 30-day supply of insulin3
CVS Caremark provides clients with options to help improve patient affordability, including:
- Preventive drug lists – Members pay $0 or standard copay/coinsurance for preventitive drugs, including during the deductible phase
- Point-of-sale rebates – Clients can elect to reduce out-of-pocket costs by aligning with net drug costs
- ReducedRX – Helps help insulin affordable for those who are uninsured or underinsured; available to every American
CVS Caremark has long prioritized affordable access to insulin, while also monitoring any downstream cost impact to our clients. In addition, we offer care management programs with personalized nutrition and support to help members reduce or eliminate their insulin dependence.
CVS Caremark works every day to put medicine within reach of people who need it. This work has never been more important.
Discover additional insights
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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 For brand rebated drugs (adjusted for inflation using CPI). Rebate and reimbursement data submitted in response to FTC 6(b) study.
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3 CVS Health Analytics, 2022.
