Walmart pharmacies are expected to leave CVS Caremark pharmacy networks over a dispute about reimbursement rates, potentially making it more difficult for millions of patients to get the drugs they need.
The split will affect Walmart’s commercial and Managed Medicaid retail pharmacy patients.
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Essentially, what this means is that Medicaid beneficiaries and people who get CVS drug benefits from commercial payers will be unable to get prescriptions filled at Walmart locations. Less than 5 percent of affected CVS Caremark members use only Walmart to fill their prescriptions, according to CVS.
Walmart will continue to participate in the CVS Caremark Medicare Part D pharmacy network. The company’s Sam’s Club division is also currently unaffected by the dispute.
Besides its business role in operating more than 9,800 retail pharmacies around the country, CVS Health also owns CVS Caremark, one of the country’s largest PBMs.
PBMs, which function as third-party administrators for prescription drug programs, have come under fire for their opaque pricing models and role in driving up drug prices.
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Walmart said its decision to pull out of CVS Caremark’s pharmacy network was driven in part by the desire not to give “value to the middle man” and its practice of funneling members to specific pharmacies.
“This issue underscores the problems that can arise when a PBM can exert their unregulated power to direct members on where to fill their scripts, disrupting patients’ healthcare. Walmart is standing up to CVS’s behaviors that are putting pressure on pharmacies and disrupting patient care,” the company said in a statement.
For its part CVS has said that Walmart’s requests for higher reimbursements would drive prices higher across their client and customer base.
“Walmart’s requested rates would ultimately result in higher costs for our clients and consumers,” CVS Caremark President Derica Rice said in a statement. “While we have enjoyed a long relationship with Walmart as a low cost provider in our broad national networks, based on our commitment to helping our clients and consumers manage rising pharmacy costs, we simply could not agree to their recent demands for an increase in reimbursement.”
CVS Caremark has requested that Walmart pharmacies continue to fill prescriptions as an in-network pharmacy until the end of April, but it’s still unclear what exactly the timeline for the Walmart’s pullout will be.
Photo: Stuart Ritchie, Getty Images
