CareSource plans to make a major change to its business model, switching to a new pharmacy contractor and as well as making broader changes on how it operates pharmacy services.
The Dayton-based insurance company, which primarily manages private Medicaid plans, said Tuesday morning that it will be contracting with Express Scripts, switching from CVS Caremark.
CareSource’s current contract with CVS Caremark will expire at the end of 2019.
“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,” said Erhardt Preitauer, president and CEO of CareSource.
CareSource manages over half of the Medicaid plans in Ohio and has nearly 2 million policy holders in Georgia, Indiana, Kentucky, Ohio and West Virginia.
The move comes at a time when pharmacy benefit managers are facing scrutiny at the state and national level over their business practices.
While the companies say they negotiate deals and save members money, critics have said the companies aren’t transparent and keep too much of the money they manage, including money they manage on behalf of public insurance programs such as Medicaid.
CareSource said in a statement that their new approach will drive pharmacy savings for states by providing:
Price transparency validated by a third-party. CareSource said states will have full visibility to where pharmacy dollars are being spent for their Medicaid beneficiaries.
A custom pharmacy network to provide the same access members have today while “protecting independent pharmacies from volatility created by the traditional pharmacy benefit manager model.”
Value-based programs to drive increased quality, leveraging incentives to local pharmacists for educating patients and preventing adverse drug events.
A data platform to help improve member health outcomes and lower costs.
CareSource members will continue receiving pharmacy services through CVS Caremark through the end of 2019. CareSource stated that once the transition to happens in January 2020, members should expect no disruptions in receiving their prescriptions.