CVS, GoodRx to launch drug discount program for commercially insured
Through the new Caremark Cost Saver program, eligible CVS Caremark commercially insured members will have access to GoodRx’s prescription pricing on generic medications starting January 1, 2024.
Drug discounter Good Rx announced on Wednesday that it is partnering with pharmacy benefits manager CVS Caremark on a program to bring down out-of-pocket drug costs.
Commercially insured customers will be able to pay GoodRx’s discounted prices when filling commonly prescribed generic prescriptions at in-network pharmacies. The payments automatically will be applied to their deductibles and out-of-pocket limits. The program, called Caremark Cost Saver, will be available for tens of millions of CVS Caremark clients’ members at in-network pharmacies starting in January 2024.
“Patients don’t have to choose between using their pharmacy benefit or using GoodRx to save on their prescriptions,” said Scott Wagner, interim CEO of GoodRx. “Now they can do both right at the counter so they have confidence they are always paying the lowest available price.”
CVS Caremark is a part of CVS Health but is separate from the retail pharmacy chain. Last year, Good Rx announced a similar deal with ExpressScripts, which is owned by Cigna.
GoodRx is paid through contracts with PBMs as either a percentage of fees that PBMs charge the pharmacy or a fixed amount for every prescription that is filled originating from its discounted pricing. GoodRx generally is paid more if its discount cards generate a higher volume of prescriptions over a payment period.
The new relationship gives the company access to 70% of people who are commercially insured, cofounder Doug Hirsch told Yahoo Finance. “Everyone likes to think we’re only serving low-income people who just pay cash,” he said. “The reality is 75% of people who come to GoodRx have insurance.”
More partnerships may be on the horizon. “We’re also looking to get into the Medicare market,” Hirsh said, “and there’s more complexity there,” noting it would add yet another large portion of the American population to the database for the company.
Related: Negotiating with PBMs for lower drug prices: New ‘aggressive’ playbook for employers
PBMs have come under scrutiny as drug prices continue to rise. The House Oversight and Accountability Committee and the Federal Trade Commission are investigating PBMs over concerns that their business practices — including complicated and opaque contracts and pricing models — are contributing to rising drug costs. Some states have targeted PBMs with lawsuits this year, including Ohio, which is suing three PBMs over alleged price fixing, and California, which is suing PBMs and drugmakers over insulin prices.
CVS Caremark is one of three major PBMs that control 80% of the prescription drug market. All three are owned by health insurers: Caremark by CVS, which owns payer Aetna; Express Scripts by Cigna; and OptumRx by UnitedHealth, which owns payer UnitedHealthcare.