CareSource Announces Innovative New Approach to Managing Pharmacy Transparency, Services and Costs

April 18, 2019

CareSource, a nonprofit multi-state health plan serving government sponsored programs, announced its intent to implement a new, integrated approach to administering pharmacy benefits and services.

“We believe the current PBM model has significant room for improvement,” said Erhardt Preitauer, President & CEO, CareSource. “CareSource saw an opportunity to reinvent the model with a focus on transparency, driving real value for stakeholders, building stronger partnerships with local pharmacies and controlling costs.”

The new approach, CareSource RxInnovations, will drive pharmacy savings for states by providing:

  • Full price transparency validated by an independent third-party. States will have full visibility to where pharmacy dollars are being spent for their Medicaid beneficiaries
  • Custom pharmacy network to provide the same access members have today while protecting independent pharmacies from volatility created by the traditional PBM model
  • Value-based programs that drive increased quality, leveraging incentives to local pharmacists for their critical role in educating patients and preventing adverse drug events
  • An integrated, industry-leading data platform driving real time opportunities to improve member health outcomes and lower costs

“This is the culmination of a year-long effort to address the major areas of opportunity in the current PBM model,” said Clayton Edwards, Senior Vice President, Pharmacy, CareSource. “We want to create something that better serves members through the integration of all clinical data—medical, behavioral, social and pharmacy. This will allow us to provide holistic care coordination, while also meeting the needs of our other key stakeholders—the states in which we do business and our pharmacy partners.”

CareSource’s contract with the new Pharmacy Innovation Partner, Express Scripts, will begin on January 1, 2020. CareSource will leverage Express Scripts’ claims management technology to power pharmacy innovation. CareSource’s current contract with CVS Caremark will expire at the end of 2019.  

“We are proud to partner with CareSource, because they share our focus on transforming pharmacy for the people we serve,” said Tim Wentworth, President, Express Scripts. “With our patient-centered, clinical care focused model, we will accelerate CareSource’s innovative approach to pharmacy. We look forward to what our two organizations can do better together to improve care, expand choice and lower costs.”

No Member Disruption 
CareSource members will continue receiving pharmacy services through CVS Caremark through the end of 2019. Once the transition to CareSource RxInnovations occurs in January 2020, members should expect no disruptions in receiving their prescriptions.

CareSource RxInnovations will continue fueling job growth for CareSource throughout the organization.

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