Breaking News: (12/5/2023) CVS announces “CVS CostVantage™ and CVS Caremark TrueCost™ to drive aligned incentives and deliver a more transparent and sustainable reimbursement model..” What does this mean for plan sponsors and members?
Overall, acquisition-based pricing is a positive model. CVS’s new reimbursement model is not using this pricing framework; rather an algorithm that shifts money from the pharmacy reimbursement to the PBM (vertical integration) spread. This new pricing scheme protects the CVS umbrella of companies from the outside pressure of “cash” price entities such as Mark Cuban Cost Plus Drugs or discount card pricing such as GoodRx. This announcement spurs pharmacy pricing conversation, providing an opportunity to educate others who are unfamiliar with the complexity of drug pricing but will not work towards lowering overall drug costs in our country. Despite CVS’s pharmacies taking a loss in reimbursement, the global enterprise is poised to make more profit and disadvantage competition.
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