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 * CVS.com
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 * About
   
   We enter our 60th year as one of the most trusted brands in America.
   
   
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 * Our Strategy
 * Diversity, Equity and Inclusion
 * Company History

 * Our People
 * Our Purpose


 * Public Policy
 * Public Health
 * Value-Based Care
 * Access to Coverage
 * Drug Costs



 * COVID-19
 * Timeline

 * Health Care and Wellness
 * Health Services
 * Condition Management
 * Mental Health
 * Health and Wellness Products
 * Other Health Care Services

 * Prescription Drug Coverage
 * Pharmacy Benefits Management
 * Health Care Affordability

 * Health Insurance
 * Commercial Health Coverage
 * Medicare
 * Medicaid
 * Individual and Family Plans
 * Vision and Dental Management
 * Medical Management

 * Pharmacy
 * Mail Order Pharmacy
 * Neighborhood Pharmacy
 * Prescription Delivery
 * Prescription Savings
 * Specialty Pharmacy


 * Featured Content
 * CVS Health Live
 * Healthy Communities
 * Healthy Conversations
 * Heart At Work







 * Healthy Community
 * Health Zones
 * Our Giving
 * Disaster Relief
 * Volunteerism
 * Our Opioid Response

 * Healthy Planet
 * Climate Action
 * Sustainability


 * Health Equity
 * Social Determinants of Health

 * ESG Reports
 * Annual Report

 1. Home
 2. Services
 3. Prescription Drug Coverage

Prescription Drug Coverage


PHARMACY BENEFIT MANAGER

Designing and administering cost-effective prescription drug plans that meet the
financial and health care needs of our customers and members




THE IMPACT OF PHARMACY BENEFIT MANAGERS (PBMS)

As part of CVS Health®, CVS Caremark® plays a critical role in the health care
system by negotiating low net costs for our customers while supporting safe and
clinically effective products for consumers. Beyond traditional PBMs, we use an
integrated model to increase access to care, deliver better health outcomes and
help lower overall health care costs. 

 * Discover the Caremark difference
 * CVS Caremark facts at a glance (PDF)
 * 5 facts to know about PBMs (PDF)




GET TO KNOW PHARMACY BENEFIT MANAGERS

WHAT ARE PBMS

Pharmacy benefit managers, or PBMs, manage prescription drug benefits for
clients ranging from health insurers and Medicare Part D drug plans to large
employers. PBMs are one of the few parts of the prescription drug supply chain
specifically dedicated to lowering costs.

 



HOW CAREMARK HELPS LOWER COSTS

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.

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.

Find ways CVS Caremark helps keep drug costs down

WHICH ESSENTIAL SERVICES DO PBMS PROVIDE

The basic services PBMs provide include:

 * Negotiating low drug costs and rebates with pharmaceutical manufacturers
   
 * Creating and administering retail pharmacy networks
 * Helping members understand the best use of pharmacy benefits
 * Developing and maintaining formularies, which are lists of covered drugs
 * Providing mail pharmacy and home delivery services
 * Ensuring providers have the latest clinical information to prescribe
   clinically appropriate medications
 * Processing pharmacy claims

Explore our mail service pharmacy

WHY PBMS MAY PROVIDE ADDITIONAL SERVICES

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.

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.


Discover our approach to care management

HOW PBMS ARE DIFFERENT FROM AN INSURANCE COMPANY

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.






HEALTHIER HAPPENS TOGETHER™


QUICK LINKS

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SERVICES

 * COVID-19
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 * Prescription Drug Coverage
 * Health Insurance
 * Pharmacy


IMPACT

 * Initiatives
 * Public Policies
 * Our Opioid Response
 * Political Contributions


DISCLOSURES

 * Vulnerability Disclosure Program
   


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