CVS Health eliminates out-of-pocket costs for diabetes medications

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Diabetes is potentially fatal when unmanaged by medication — CVS Caremark designed a program to ensure cost isn’t a barrier to treatment.

People living with diabetes typically spend around $467 out-of-pocket for brand name prescriptions every year, according to a CVS Caremark study. A small segment of those patients (12%) spend up to $1,000 on diabetes medications. CVS executives say their new RxZERO program, announced today, provides these medications without raising costs for employers or their workforce.

“Eliminating out-of-pocket costs for diabetes medications ensures long-term affordability, improves adherence and, most importantly, puts patients on the path to better health,” says Troyen A. Brennen, MD, chief medical officer at CVS Health. “A person living with diabetes is required to take many tasks to manage their condition annually. Unfortunately, that can include making difficult decisions about whether they can afford their medications and fill their prescriptions.”

RxZERO works by requiring employees with diabetes to use only approved generic medications — instead of brand name — which saves employers around $170 per member. A CVS diabetes study also concluded that regular use of diabetes medications prevents future healthcare complications that can end up costing employers over $2,000. All of these factors combined can save employers $1,225 in pharmacy costs.

“While this is not a huge amount of savings, it means clients can help their members better afford their medication and approve healthcare outcomes without raising premiums or deductibles,” a CVS white paper says.

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High copayment or coinsurance costs, and high deductible health plans, often make it difficult for people to afford diabetes treatments, the CVS Health white paper says. Rebates can help lower the cost of prescriptions when employees receive them, but many employers direct that discount back into the plan to keep premiums, deductibles and copays down.

Some employers try to offset the costs of HDHPs by increasing the plan’s premium and lowering the deductible — a move that lowers out-of-pocket costs for employees with chronic illnesses, like diabetes, the report says. However, that option isn’t always popular with healthy employees, who’d be paying more in premiums without added benefit. As an alternative, employers will increase the deductible to lower the premium; meaning higher out-of-pocket costs for people with chronic diseases.

While diabetes is federally recognized as a condition that qualifies as “preventative care,” not every category of diabetes medication is exempt from meeting deductibles.

“Traditionally, the focus of affordability for diabetes medications has been on insulin, which is the cornerstone of therapy for the five percent of people with diabetes who are living with type 1 diabetes,” Brennan says. “However, the new CVS Caremark solution expands affordable options to include the entire range of diabetes medications improving affordability for the 95% of people with diabetes who are living with type 2 diabetes.”

CVS says that although RxZERO works for a variety of health plans, results will vary based on individual situations. Employers using RxZERO will also have access to CVS Health’s clinical support, which provides a five-step program for preventing and managing diabetes.

“Our holistic care model combined with our zero out-of-pocket solution for diabetes medications, which ensures affordability and improves adherence, can lower costs and, more importantly, keep members on their path to better health,” the CVS white paper says.

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Healthcare costs CVS Prescription drugs Diabetes Chronic care HDHPs