The Value of Pharmacy Benefit Managers - CVS Health

People are more likely to take their prescribed medications when they know they can afford them.
CVS Caremark® negotiates lower costs for our customers and expands coverage to affordable medications that people need to stay healthy. We are transparent about medication costs and prioritize a high quality and more affordable approach to health care.

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Our approach begins with the latest clinical research, guidelines and best practices — and our formulary decisions are overseen by a committee of independent, unaffiliated clinical pharmacists and physicians. Across every therapeutic category, we strive to achieve low costs for our clients and their members. That means managing the two fundamental forces behind drug spending: price and utilization.

As one example of how we help lower out-of-pocket prescription costs, our members may use our proprietary online search tool for savings options that work with their prescription plan.

CVS Caremark goes above and beyond these basic services: We provide adherence counseling to make sure members take medications as prescribed, help close gaps in care, support members with chronic and specialty conditions, provide disease management support, and more.

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All in all, the goal of these added services is to help improve health outcomes, which helps lower long-term and overall health care costs. Almost half of our members use our digital tools to manage their prescriptions, find lower-cost alternatives and stay on track with their treatments.

With traditional medical health insurance, medical bills are covered by insurance benefits for hospital, doctors and other health care provider costs. Traditional medical health insurance also covers medications administered directly by the provider in the office or at the hospital.

The prescription drug benefit covers medications that are typically picked up at the pharmacy or delivered to the home.

PBMs work alongside health plans and employers to administer prescription drug benefits. Depending on a person’s insurance, they may be able to use their health insurance card when they pick up prescriptions at the pharmacy, or they may have a separate card specifically for prescription drug coverage.

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