Health plans are critical to transforming health care, making it more personal, accessible and affordable. Transparency is at the core of this transformation, with health plans driving value-based care models and visibility into provider pricing and coverage. Transparent pharmacy pricing is the next step to help health plans, their clients and members gain more insight and control – and avoid unwanted regulatory scrutiny.
New approaches for pricing models are needed for the future
Historical pricing models worked when members filled all prescriptions through their pharmacy benefits. Now, with 60 percent of members in high-deductible health plans – often not reaching their out-of-pocket maximums – many fill outside their plan. When fewer prescriptions go through the plan, it reduces the plan’s value and limits the ability to monitor medication use, which can impact safety and clinical outcomes. This behavior challenges the health plan’s ability to deliver on value-based care – where better outcomes and smarter spending depend on informed, connected care.
Transparent pharmacy benefit solutions will help payors and consumers
Employers want transparent solutions that provide more insights into the basis of drug prices, like drug-level pricing that provides greater visibility and financial predictability.
Employees want benefits they can easily understand. They want to know how much they must pay as well as ways to save, allowing them to budget accordingly without any surprises at the pharmacy counter. They also want a member experience that includes clear and transparent communications delivered in a way that’s most convenient for them.
Pharmacy benefit managers (PBMs) help clients and their members understand the factors that influence prescription drug cost, while providing the tools and insights to empower them to make better decisions.
Transparent pricing: A strategic advantage
Employers need a transparent partner they can trust – a partner who can negotiate the best prices and interpret regulatory and market changes to support strategic decision making. And they want regular, transparent updates and innovative solutions to help them understand the cost of prescriptions and how their dollars are being spent.
CVS Caremark TrueCost® is the industry’s first pricing model that gives insight into drug-level costs. While only pharmaceutical companies control drug list prices, adopting transparent pricing models creates more clarity, control and trust in pharmacy spend. Transparent pricing isn’t a trend – it’s the new standard for pharmacy pricing.
As a pharmacy benefit manager, CVS Caremark is committed to helping clients and members understand prescription costs while providing innovative solutions and insights to empower them to make better decisions, leading to improved health outcomes. Read more about how transparency is critical to driving down prescription drug costs, making medication accessible and affordable.
