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CVS Caremark Cost Saver: Reducing Costs for Patients

More and more Americans are turning to drug discount cards or direct-to-consumer online pharmacies to save money on prescription medications. However, without benefit plan integration, this may be at the cost of coordinated clinical care. To help patients receive lower out-of-pocket drug costs without going off their benefit plan, CVS has developed Caremark Cost Saver.

How Caremark Cost Saver Works

Caremark Cost Saver will give eligible patients access to GoodRx’s low prescription pricing, when available, on non-specialty, non-rebatable, generic drugs that patients are responsible for paying 100%. The CVS and GoodRx pairing allows patients to receive the same discount they would from going directly to GoodRx, without straying from their CVS benefit plan. To utilize Caremark Cost Saver, patients will need to present their CVS Caremark ID card at their preferred in-network pharmacy. No additional action is required. It will automatically apply patient out-of-pocket costs to deductibles and out-of-pocket thresholds and ensures continuity of care through integrated data. Please note: Excluded and out-of-network pharmacies are not a part of the offering.

When a patient's prescription is sent to an in-network pharmacy, a pharmacist submits a claim using the patient's CVS Caremark ID card.
Behind the scenes, a drug price comparison occurs within the system and automatically processes the lower drug price between the covered benefit price and the GoodRx price.
When the patient pays their portion, it applies to their patient accumulations, i.e., deductible and out-of-pocket maximums.
Did you know, CVS Caremark benefit prices are lower on 95% of the top 100 non-specialty drugs? The remaining 5% will be addressed with the help of Caremark Cost Saver. Patients can be confident they are receiving the lowest available costs.

Receiving the Lowest Drug Prices with Confidence

Because CVS Caremark is the PBM vendor for National CooperativeRx, our participants are eligible to implement Caremark Cost Saver. This seamless program is a “win-win” for patients and their clinical care team. For example, patients will receive the lowest price for their non-specialty generic medications and these will count towards accumulators. At the same time, their clinical care team can review accurate utilization data and determine the best next steps to improve patients’ health.

The National CooperativeRx team has reviewed this program and contracting dynamics. With about 5% of patients potentially being positively impacted by this program on low-cost generics, any positive or negative impacts to plan sponsors are limited. While limited, some patients may reach their deductible and/or out-of-pocket maximum sooner because of these medications being tracked through accumulators under this program.

For more information about Caremark Cost Saver, please contact your Caremark account manager. With signed paperwork and 90-days to implement, this program can be put in place at any time.

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