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CVS Caremark (CVS) may revisit a plan that allows its clients to exclude coverage of most new, high-priced drugs after advocacy groups complained the effort would discriminate against very sick or disabled patients.

At issue is a cost-effectiveness program the pharmacy benefits manager touted last month for assessing value — in this case, any new drug exceeding $100,000 per QALY, or quality-of-life years, a benchmark that measures both the quantity and quality of life generated by providing a treatment. New drugs exceeding the threshold may be excluded from health plan and employer formularies, or coverage lists.


CVS took this step in response to pressure from some clients to take a stand against newer medicines with higher price tags, according to a source familiar with the matter. For its part, the PBM maintained the plan was undertaken at its own initiative and portrayed the effort as a way to push back against complaints that PBMs fail to sufficiently lower drug costs.

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  • CVS is among the worst exploiters of our current broken healthcare system. They consistently discriminate against patients with chronic pain, the elderly, and low income patients while spreading like a cancer across the US. Their stores ad to crime and urban blight, attracting alcoholics,and panhandlers due to their liquor sales. Their entire business model is based on exploiting patients, misleading consumers and phony public relations campaigns. These parasitic corporations have the help of corrupt politicians, in maximizing their profits at the expense of Medicare, and the insurance system. CVS is one of the worst corporate offenders, as they continue to monopolize the pharmaceutical market. Their biggest source of profit is the US Taxpayer, who pays for all of their corporate expansion, with little in return.

  • One significant reason why I am no longer a patient with CVS. I hope that everyone is capable of recognizing this situation as one that is also referred to as discrimination against the individuals who are amongst the citizens who are over sixty- five years of age.

    Not everyone who is in that population, is retired. Countless individuals are working full time, and often have to travel great distances for their business. Yet the individuals who are responsible, and working over ten hours daily, are being discriminated against by the pharmaceutical industry, the er, and in many cases, by their own private physicians. The sooner we realize these reprehensible reasons for the way that CVS is doing this, the sooner everyone will also end their experiences with this pharmacy.

  • This would be cruel and inhuman. My 5 year old grandson has Cystic Fibrosis and will soon qualify for Orkambi. That medication would be considered “not cost effective “ so someone says “too bad, not approved”. God help us!

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