USA — In a bid to alleviate the burden of out-of-pocket drug expenses, major pharmacy benefits manager (PBM) CVS Caremark has joined forces with drug discounter GoodRx to launch a collaborative program.

The partnership aims to provide commercially insured customers with discounted pricing through GoodRx when filling commonly prescribed generic prescriptions at in-network pharmacies.

Notably, the payments made under this program will be automatically applied towards deductibles and out-of-pocket limits.

Known as Caremark Cost Saver, the program is set to benefit tens of millions of CVS Caremark clients’ members at in-network pharmacies starting from January 2024.

This initiative marks GoodRx’s second partnership with a large PBM, following a similar deal with Express Scripts, owned by health insurer Cigna, announced last year.

Through these collaborative programs, patients will no longer face the dilemma of choosing between their pharmacy benefit or utilizing GoodRx to save on prescription costs.

Now, they can seamlessly access both options at the counter, ensuring they always secure the lowest available price.

Scott Wagner, interim CEO of GoodRx, emphasized the significance of this partnership, stating, “patients don’t have to choose between using their pharmacy benefit or using GoodRx to save on their prescriptions – now they can do both right at the counter so they have confidence they are always paying the lowest available price.”

While expanding the accessibility of drug discounts for consumers, these programs also serve as a revenue stream for GoodRx.

The company earns income through contracts with PBMs, receiving either a percentage of fees charged by PBMs to pharmacies or a fixed amount for each prescription filled utilizing GoodRx’s discounted pricing.

Generally, GoodRx’s compensation increases with higher prescription volumes within a given payment period.

In addition to its core offering of drug discounts, GoodRx provides telehealth visits and other health services through its digital health platform.

These value-added services contribute to the company’s holistic approach to improving healthcare access and affordability.

For PBMs, offering patients access to discounted card pricing brings about a twofold benefit. First, it encourages greater prescription activity within the pharmacy benefit, resulting in more comprehensive claims records for beneficiaries.

Secondly, there is a potential for CVS to generate a new fee stream through its partnership with GoodRx, although specific financial terms have not been disclosed.

The rising cost of prescription drugs has thrust PBMs into the spotlight, attracting scrutiny from government entities such as the House Oversight and Accountability Committee and the Federal Trade Commission.

Investigations are underway to address concerns about complex and opaque contracts, as well as pricing models that may contribute to escalating drug costs.

Several states, including Ohio and California, have filed lawsuits against PBMs, alleging price fixing and challenging the pricing of insulin.

CVS Caremark, alongside Express Scripts and OptumRx, represents one of the three major PBMs controlling 80% of the prescription drug market.

Notably, all three are owned by health insurers, with Caremark falling under CVS, which also owns payer Aetna; Express Scripts under Cigna, and OptumRx under UnitedHealth, which owns payer UnitedHealthcare.

Through collaborations like the one with GoodRx, CVS Caremark aims to make a positive impact on the accessibility and affordability of prescription medications for consumers.

For all the latest healthcare industry news from Africa and the World, subscribe to our NEWSLETTER, and YouTube Channel, follow us on Twitter and LinkedIn, and like us on Facebook.