CVS Pharmacy achieves CVS CostVantage milestone
All commercial prescriptions dispensed at CVS Pharmacy will be reimbursed through CVS CostVantage starting this year
Innovative approach uses a transparent formula built on the drug acquisition cost, a set markup, and a fee to reflect the quality of pharmacy services provided
New reimbursement model supports future of retail pharmacy and paves the way for improved PBM transparency
WOONSOCKET, R.I., Jan. 6, 2025 /PRNewswire/ -- Delivering on the promise of a simpler, more transparent, and more sustainable approach to retail pharmacy services, CVS Health® (NYSE:CVS) today announced that all of the commercial prescriptions dispensed through CVS Pharmacy® are contracted through the company's innovative CVS CostVantage reimbursement model starting this year.
"Delivering on our commitment to transform the pharmacy model, we successfully led the way forward, contracting with pharmacy benefit managers and other payors to advance a more transparent approach to reimbursement for the prescriptions we dispense and the services we provide," said Prem Shah, group president, CVS Health. "In our discussions and negotiations, we found common ground and a commitment to a simpler approach to reimbursement and a more sustainable path forward for retail pharmacy. As the leading pharmacy in America, we take our responsibility seriously to continually improve and advocate for community pharmacy. We will also continue to move forward in our work to eventually expand CVS CostVantage to Medicare and Medicaid managed prescriptions as well."
CVS CostVantage
Community pharmacies today do more than fill prescriptions. Patients rely on pharmacists to help fill the gap between provider visits.
Pharmacists are local, accessible and one of the most trusted health care providers. In fact, in a recent survey, 81% of consumers said they trust their local pharmacist, and 88% believe their pharmacists are the most accessible and frequently visited health care providers. Nearly 1 in 3 Americans visit their pharmacy at least once per week—approximately twice as often as they visit their physician(s)*.
Continuing to maintain community pharmacy is important. The way community pharmacies have historically been reimbursed for services has not fully reflected the value delivered or the underlying costs of doing business.
By removing the market reliance on cross-subsidization caused by market basket approaches to reimbursement, CVS CostVantage provides more clarity, ensuring that CVS Pharmacy has a way of pricing and contracting that reflects the reality of today's marketplace and anticipates the future.
The CVS CostVantage formula is based on the underlying cost of a drug plus a defined markup and a dispensing fee tied to the care and value we provide. This approach helps reduce the need for higher rates on some medicines to help subsidize losses on others.
Beyond resetting the approach for drug reimbursement at the pharmacy level, CVS CostVantage also helps provide greater transparency for PBMs and payors and serves as a crucial building block for PBMs to create simpler, more transparent models for plan sponsors and patients.
About CVS Health
CVS Health® is a leading health solutions company building a world of health around every consumer it serves and connecting care so that it works for people wherever they are. As of September 30, 2024, the Company had more than 9,000 retail locations, more than 900 walk-in medical clinics, more than 225 primary care medical clinics, a leading pharmacy benefits manager with approximately 90 million plan members and expanding specialty pharmacy solutions, and a dedicated senior pharmacy care business serving more than 800,000 patients per year. The Company also serves an estimated more than 36 million people through traditional, voluntary and consumer-directed health insurance products and related services, including expanding Medicare Advantage offerings and a leading standalone Medicare Part D prescription drug plan. The Company is creating new sources of value through its integrated model allowing it to expand into personalized, technology driven care delivery and health services, increasing access to quality care, delivering better health outcomes and lowering overall health care costs.
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* FOR TWICE AS OFTEN AS THEY VISIT THEIR PHYSICIAN SOURCE: Berenbrok LA, Gabriel N, Coley KC, et. al. Evaluation of Frequency of Encounters With Primary Care Physicians vs Visits to Community Pharmacies Among Medicare Beneficiaries. JAMA Netw Open. 2020 Jul 1; 3(7):e209132.
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SOURCE CVS Health