Effective July 1, 2025, CVS Caremark is no longer automatically enrolling pharmacies in its Cost Saver prescription discount card program. As such, pharmacies must now actively opt-in directly with all or some of the participating third-party drug discount operators (GoodRx, IntelligentRx, RxPartner, and RxSense).
By opting in to the Caremark Cost Saver program with a third-party discount operator, CVS Caremark may forward any claims to that third party for processing them as consumer card claims. The third party will then return the claim response to CVS Caremark, which will then pass it on to the pharmacy. Pharmacies that take no action will be removed from the program and will no longer have claims forwarded to third parties for processing as part of the Caremark Cost Saver program. Instead, such pharmacies will only have claims processed on Caremark networks, which could result in higher member cost-share amounts than if the pharmacy had opted in to the Caremark Cost Saver program.
This change in policy follows a class action lawsuit filed in 2023 whereby CVS Caremark was sued for improperly applying discount card rates without pharmacy consent, raising legal and reimbursement concerns. That said, the updated opt-in policy appears to be an attempt to increase transparency and ensure that pharmacies are knowingly participating in third-party prescription discount card networks. Pharmacies should be aware of this important change to the Cost Saver program and take the necessary steps to opt-in should they wish to continue their participation.
How Frier Levitt Can Help
At Frier Levitt, we understand the operational and legal complexities that policy updates like these can bring. Our team of attorneys that can assist your pharmacy with opt-in guidance, contract review, regulatory and compliance support, as well as dispute resolution procedures related to claims processing and reimbursement, etc. Contact us today.
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