Another Band-Aid: Pharmacists Shopping for Patients

As anyone who has ever filled a prescription knows, the arcane and mind-numbingly complex pricing framework for drugs makes it both impossible to know what the drug will cost in advance of filling the prescription and similarly challenging to shop for a lower-cost alternative. With hundreds, if not thousands, of pharmacy benefit manager (PBM) and employer-specific formularies (these are drug lists used to determine which drugs are covered and at which tier level), 10 neighbors who walk into the same store for the same prescription, will LIKELY pay 10 different prices.

In an effort to help its customers begin sorting through the confusion, CVS introduced a product called “Rx Savings Finder” that will allow its 30,000 pharmacists to dig through the member’s specific contract and determine if therapeutically equivalent, lower-cost alternatives are available. Initially, only enrollees in CVS Caremark’s prescription program will benefit, but eventually the goal is to roll the software out for any customers.

While I applaud CVS’s efforts here – and recognize that this type of product appears long overdue – it’s unfortunately nothing more than a band-aid on a 6-inch-wide gaping wound. Another treatment of the symptom and not the illness.

The primary problem with our pharmacy system, as has been repeatedly stated on these pages over the last several years (see just a few of our posts herehere and here), is not the lack of transparency tools enabling members to sort through the pricing clutter. It’s the intentional opacity and complexity inherent in the PBM’s pricing structure. Varying discount guarantees, rebate arrangements, Zero Balance Logic (ZBL) language, mail order provisions, step therapy terms, generic definitions and on and on.

We need to see a large PBM step forward with the courage and audacity to overhaul the system – not simply provide more navigation tools within the current framework. We need a paradigm shift. The problem will not be resolved until a time when buying prescriptions is similar to buying gum – with every person paying the same price for the same prescription as her/his neighbors. Unfortunately, this new product appears to be another admission we are still a very long time away.

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