Issue link: https://beckershealthcare.uberflip.com/i/1233999
17 CFO / FINANCE CVS launches program with zero out-of- pocket costs for insulin By Alia Paavola C VS Caremark, the pharmacy benefit unit of CVS Health, launched a program that will eliminate out-of-pocket costs for diabetes drugs and insulin for its members. The program, called RxZero, allows employers and health plan sponsors using CVS Caremark to use formulary design approaches to offer all dia- betes drugs to their beneficiaries with no out-of-pocket payments. CVS Caremark said the program will not raise costs for employers or health plans sponsors, nor will it increase premiums or deductibles for patients. With the program, the company is aiming to ensure better medication ad- herence to improve diabetes management. A CVS Caremark analysis found that its members spent an average of $467.24 out of pocket on branded diabetes medications per year and that nearly 12 percent spent more than $1,000 annually. "Traditionally, the focus of affordability for diabetes medications has been on insulin, " said a CVS spokesperson. "However, the new CVS Caremark solution expands affordable options to include the entire range of diabe- tes medications, improving affordability for the 95 percent of people with diabetes who are living with Type 2 diabetes." n Cigna changes leadership at Express Scripts By Morgan Haefner C igna named new executives to pharmacy benefits manager Express Scripts, which is part of the insurer's health services business. Four things to know: 1. Cigna named Dave Queller president of Express Scripts. In that po- sition, Mr. Queller will lead PBM services and oversee supply chain and drug procurement. 2. Before the title change, he led Express Scripts' sales and account man- agement organization since joining the PBM in 2014. 3. Cigna also named Brian Seiz, PharmD, president of pharmacy. In that role, Dr. Seiz will lead the following pharmacy operations: Express Scripts home delivery pharmacy, Accredo specialty pharmacy services and Cu- raScript. He has worked in leadership positions at Express Scripts for the past 15 years. 4. Tim Wentworth, president of Cigna Health Services, will continue to serve in that role. n Anthem, Cigna & more launch prior authorization pilot By Morgan Haefner A merica's Health Insurance Plans, one of the largest trade groups for the health insurance industry, debuted a prior authorization pilot in January that aims to fast- track the process. e Fast Prior Authorization Technology High- way, or Fast PATH, uses automation soware from technology companies Availity and Sure- scripts to digitize prior authorization processes. Health insurers covering more than 60 million Americans have agreed to participate in the pi- lot. ese include Anthem, Blue Shield of Cal- ifornia, Cambia's affiliated health plans, Cigna, Florida Blue and WellCare. e pilot concerns two common prior autho- rization processes: approval for prescription medications and approval for medical and sur- gical procedures. • For medications, the health plans will use Surescripts technology to allow phy- sicians to immediately access a patient's pharmacy benefits while prescribing medication. is will allow them to see if the medication they want to prescribe re- quires a prior authorization and whether a clinically equivalent option is available that may not require prior approval. Ad- ditionally, physicians can submit requests for prior approval through their EHR and share out-of-pocket drug costs with pa- tients. • For medical and surgical procedures, the health plans will use Availity technolo- gy to help providers know immediately whether their ordered procedure requires prior authorization. If prior authoriza- tion is needed, the provider can submit information through the Availity portal and receive a response through the same portal. AHIP tapped RTI International, an indepen- dent, nonprofit research organization, to eval- uate how well the technologies work under the Fast PATH initiative. n