Out-of-Pocket Costs for Diabetes Medicine Eliminated

January 31, 2020

New plan from CVS Caremark eliminates member cost as a barrier to medications without raising costs for benefits, premiums or deductibles.

CVS Health recently announced a new solution eliminating member out-of-pocket costs associated with all diabetes prescription medications, including insulin, according to a news release.

Offered through the company's pharmacy benefit manager (PBM), CVS Caremark, RxZERO enables employers and health plan sponsors to leverage formulary and plan design approaches which will offer all categories of diabetes medications at zero dollars out-of-pocket for their members without raising costs for the plan sponsor or increasing premiums or deductibles for all plan members.

"Eliminating out-of-pocket costs for diabetes medications ensures long-term affordability, improves adherence, and most importantly, puts patients on the path to better health," says Troyen A. Brennen, MD, chief medical officer, CVS Health. "A person living with diabetes is required to take many tasks to manage their condition annually. Unfortunately, that can include making difficult decisions about whether they can afford their medications and fill their prescriptions."

A CVS Caremark analysis shows members taking branded diabetes medications spend on average, $467.24 out-of-pocket per year, with nearly 12% spending over $1,000 annually. The new RxZERO plan design enables plan sponsors to eliminate member out-of-pocket costs for the entire diabetes therapeutic area including oral medications for Type 2 diabetes and fully adhere to American Diabetes Association standards, the release says.

Related: The Cost of Diabetes Care-And How to Help Patients Lower It

"There are more than 30 million Americans living with diabetes, and far too many of them are struggling to manage their diabetes because of the high cost of diabetes prescription medications," says Kelly Mueller, vice president of Community Impact for the American Diabetes Association. "The American Diabetes Association is committed to helping those living with diabetes thrive, and accessing the medications they need is critical. We are hopeful that by eliminating out-of-pocket costs for diabetes medications, CVS Health will remove one of the barriers many people face that prevent them from managing their diabetes successfully."

"Traditionally, the focus of affordability for diabetes medications has been on insulin, which is the cornerstone of therapy for the (5%) of people with diabetes who are living with type 1 diabetes," says Brennan. "However, the new CVS Caremark solution expands affordable options to include the entire range of diabetes medications improving affordability for the 95% of people with diabetes who are living with Type 2 diabetes."

CVS Health believes eliminating out-of-pocket costs for diabetes drugs could be an important feature to all insurance plans that will help address the growing diabetes epidemic without increasing other costs such as deductibles and premiums. CVS Caremark research demonstrates that by leveraging formulary and plan design approaches so plan sponsors can eliminate member out-of-pocket costs for all categories of diabetes medications without raising costs for the plan sponsor, or increasing premiums or deductibles. The analysis demonstrates the approach leads to savings for plan sponsors through improved adherence and a reduction in overall medical costs.

This solution, detailed in a CVS Health white paper, A Prescription for Better Diabetes Management, is part of CVS Health's integrated approach to chronic care management and commitment to making care more affordable, local, and easier to navigate. CVS Health also provides supportive care at its MinuteClinic and new HealthHUB store format that features a broader range of health care services to help patients better manage chronic conditions and complement the care that patients receive from their primary care physicians.