CVS manages pharmacy benefits for employers and health insurers and negotiates prices on their behalf with drug manufacturers. It designs how prescription drug coverage will work for the members, setting the co-pay levels and how easy it is for a patient to get medicine.
The rising cost of insulin and other diabetes treatments has become a top issue for both Democrats and Republicans ahead of the U.S. presidential election in November.
The cost of insulin, a life-sustaining medicine for people with type 1 diabetes, nearly doubled from 2012 to 2016. Individuals with high-deductible health insurance plans often face thousands of dollars of out-of-pocket costs before their insurance starts paying.
Some large corporate health plans already cover all out-of-pocket cost of preventive medicines like diabetes treatments for employees in high-deductible plans. The U.S. government paved the way for broader adoption of these policies last year.
CVS said its data shows that by eliminating the out-of-pocket cost for metformin, insulin and high-priced diabetes drugs like those in the SGLT2 inhibitor class, patients will take their drugs more regularly, which is better for their health.
When combined with a drug coverage plan that limits the number of drugs available with full insurance coverage, the PBM customers should save a little bit of money overall, CVS Chief Medical Officer Troy Brennan said.
CVS said an analysis showed that members taking branded diabetes drugs spend $467.24 in out-of-pocket costs per year. CVS currently offers the plan for its own customers and it will be available largely for 2021 health insurance plans.
CVS’ biggest rival, Cigna Corp’s Express Scripts, has a diabetes program that limits members’ out-of-pocket costs for insulin to $25 per month and is cost-neutral for the employer that sponsors their health insurance.
OptumRx, part of UnitedHealth Group Inc, said it offers customized pharmacy benefit programs that include discounts for members and an affordability program that limits out-of-pocket costs for life-sustaining drugs like insulin and HIV treatments.
Drugmakers such as Eli Lilly and Co, Sanofi SA and Novo Nordisk have recently been making some of their insulin products available at lower costs to counter heavy criticism from lawmakers and patients.