NEW YORK — CVS is revamping the way it reimburses its pharmacies for prescription medications, a move that could change how much consumers pay for their prescription drugs.
The company said in an announcement Tuesday that its new pharmacy reimbursement model will bring more transparency and simplicity to its drug pricing system.
Currently, the prices customers pay for drugs and the payments pharmacies receive are largely determined by middlemen known as pharmacy benefit managers, which negotiate rebates from drug manufacturers to insurers. These complex reimbursement formulas aren’t directly based on what pharmacies spent to purchase specific drugs.
The new approach, named CVS CostVantage, will use a simpler formula that includes the cost of the drug, a set markup and a fee to determine the drug’s price and reimbursement with pharmacy benefit managers. It is expected to launch for commercial payors in 2025. The Wall Street Journal was first to report the news.
The move could change the cost of prescription drugs for some patients, although it will not necessarily make all medicine cost less. Some drugs may cost less, while others might rise in price, CVS executives said. More prescription costs should fall than rise for consumers, employers and health insurers, they said.
“We are leading with an approach that will shift how our retail pharmacy is compensated by implementing a more transparent and sustainable model that fairly aligns pharmacy reimbursement to the quality services we provide,” said Prem Shah, co-president of CVS Pharmacy and chief pharmacy officer at CVS Health, in a statement. “It provides our [pharmacy benefit managers] and payor clients a foundational step towards more pricing clarity for consumers.”
The announcement is the latest in series of changes that are roiling the prescription drug pricing model.
The high cost of medications is one of Americans’ biggest healthcare headaches, and the lack of transparency surrounding how prices are set has been a focus of a multitude of players, including Congress, which is considering several bills to force more light into the process.
CVS Caremark’s business suffered a significant blow over the summer when a major California health insurer, Blue Shield of California, announced it would no longer use the company as its pharmacy benefit manager and instead would partner with several companies, including Amazon Pharmacy and Mark Cuban Cost Plus Drug Company.
Cuban’s company uses a pricing model similar to the one CVS announced Tuesday. Blue Shield said earlier this year that Cuban’s pricing model will be “simple, transparent and more affordable.” The move could shake up the prescription drug pricing system beyond Blue Shield’s 4.8 million members.
