CVS Health PBM and Pharmacy Price Changes

CVS Health PBM and Pharmacy Price Changes Explained.

Adam Fein from DrugChannels.net did an excellent job explaining the new CostVantage and TrueCost price changes at CVS Health.

The CVS Caremark PBM will now reimburse pharmacies (including their own CVS pharmacies) the Acquisition Cost of the medication PLUS a dispensing fee. The reimbursement by the PBM to the Pharmacy is called the Maximum Allowable Cost (MAC).

Previously, the PBM and Pharmacy negotiated the MAC independent of the Acquisition Cost. Therefore, some pharmacies were actually paid LESS by the PBM than it cost them to acquire some medications. I.e. The Pharmacy lost money every time they filled these particular medications.

To understand the ultimate impact of the CVS CostVantage and TrueCost pricing program on employee health plans and plan sponsors, the video provides a rubric of example prices that can be filled in with an employer's actual prices per medication.

Sources:
https://www.drugchannels.net/2023/12/...

https://www.wsj.com/health/healthcare...

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