By Steven R. Ariens, P.D. R. Ph.
Earlier this month CVS Health stated that it is using various tools to help keep the inflationary cost of medication down to 0.2%
How CVS kept drug costs down despite soaring inflation? (Check Here)
One of their methodologies that is mentioned at face value sounds rather benign, but according to Jon Roberts, executive vice president and chief operating officer, CVS Health. “At CVS Health, we always encourage the use of clinically appropriate therapeutic alternatives including generics.”
“The lower cost growth was due in part to utilizing low-cost generic drugs, which were dispensed to 86% of pharmacy benefit management (PBM) clients.”
In other words, 17 out of 20 patients were moved to generics.
Pay attention to the phrase, “we always encourage the use of clinically appropriate therapeutic alternatives.” The term “therapeutic alternatives” means that CVS will be (somehow) getting patients to use a less expensive medication within a therapeutic category.
To use an extreme example of how this could play out: Let’s take blood thinners, within that class are “new oral anticoagulants” which includes Paradaxa, Xarelto, Eliquis. These medications each costs several hundred dollars per month. The “old” generic anti-coagulant is Warfarin which typically costs a patient as little as $4.00/month.
When a patient uses Warfarin, there is no simple dosage transition between those new oral anticoagulants and Warfarin. The patient needs to adhere to some dietary restrictions and have lab/blood tests on a regular/ongoing basis.
In this example, there a reduction in the cost to CVS Health, but there are numerous costs that are shifted to the patient – as in co-pays – may be additional office visits and other costs to the patient’s insurance company.
How many dollars are saved and how many are shifted to other segments of healthcare that may (or may not) be less than the total monthly costs before therapeutic interchange was implemented.
Here is another process that CVS has recently implemented: “CVS Health introduced real-time benefits enabling prescribers to see the member-specific out-of-pocket costs of a prescribed medication as well as the costs of clinically appropriate alternatives in real-time allowing prescriber to make more informed decisions and offer members medication options that may be more affordable. “
Could this also include a message to the prescribers that the medication you chose for this patient requires a PRIOR APPROVAL but this other medication – same therapeutic category – is on the formulary and no further action/time needed on your part.
Since “time is money” –could this be the old “carrot & stick” motivational tactic? It may be hard to determine if cutting costs or patient’s health outcomes are CVS Health’s first priority?
Let’s see what happens—but be careful!
Steve Ariens is a retired pharmacist who is an advocate for chronic pain patients (his wife suffers from chronic pain). He is a frequent contributor to the National Pain Report.