CVS Caremark earns Health Information Products Certification

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CVS Caremark received Health Information Products (HIP) Certification from the National Committee on Quality Assurance (NCQA), for providing comprehensive pharmacy benefits information to its members. The certification was implemented on July 15, 2020, and will go through July 15, 2022. This marks the second consecutive two-year HIP Certification from the NCQA.
  
This helps affirm that CVS Caremark, through our Caremark website and customer call center, provides members with the information they need to understand and optimize their pharmacy benefits. NCQA's HIP Certification is a quality assessment program that health plans can use to help evaluate health care organizations that develop and provide content, tools and services to plan members.

This certification further underscores our ability to provide accessible and accurate pharmacy benefit information to the members we serve on behalf of our clients. 

“Earning NCQA’s HIP Certification demonstrates that an organization has expertise in gathering and disseminating health care information for members,” said Lisa Slattery, Vice President, Accreditation and Recognition Operations, NCQA.”

CVS Caremark provides pharmacy benefit information to members by mail, digitally and telephonically. This can include information about a member's prescriptions, drug coverage and plan design, such as in-network pharmacy locations and mail-order options.

HIP Certification is a voluntary review process in which NCQA evaluated CVS Caremark’s management of various aspects of its data collection and systems operation, and the process the company uses to continuously improve the services it provides. The HIP review includes rigorous evaluations conducted by a team of health care professionals. A national oversight committee of physicians analyzes the team's findings and determine certification based on the HIP organization's compliance with NCQA standards.

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website contains information to help consumers, employers and others make more informed health care choices.

Learn more about the pursuit of higher quality through third-party accreditations.

NCQA Health Certification
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Helping members stay well, at home

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In the wake of the COVID-19 pandemic, employers and other benefit plan sponsors are searching for more ways to support members’ health. People are experiencing both physical and mental challenges as they cope with isolation, economic hardship, disruptions to normal work and school routines, and the virus itself.

CVS Health is making it easier for employers and health plans to meet these growing challenges with the expansion of our Point Solutions Management offering. This program enables plan sponsors to more efficiently administer apps, online trackers and other digital point solutions that support their members’ self-care routines at home.

“Digital point solutions can help people manage important wellness areas like mental wellbeing, fitness and weight loss from the safety and convenience of their own homes,” said Sree Chaguturu, MD, Chief Medical Officer at CVS Caremark. “Employers and other plan sponsors increasingly are looking for better ways to include these kinds of tools in their benefits packages — especially in light of the COVID-19 pandemic.”

The recently added solutions have passed CVS Health’s rigorous vendor evaluation process to ensure that they support health outcomes while helping to reduce costs. The five new point solutions available to CVS Caremark clients through Point Solutions Management include:

  • Daylight: A fully automated and highly personalized mobile app to tackle worry and anxiety, based on cognitive behavioral techniques. 

  • Naturally Slim: An online program that uses informative videos and learning tools to teach individuals how to lose weight and improve their overall health.

  • Vida: A weight loss program with an app that pairs individuals one-on-one with a health coach, helping members achieve their health goals through phone and video conversations.

  • WW: Weight Watchers reimagined — A weight loss app providing access to food and fitness trackers, thousands of delicious recipes, and community support.

  • Kurbo: A digital program for children and teens ages 8 to 17 that teaches users how to make healthier choices and lifestyle changes through weekly video coaching, in-app chat, messaging, games, and educational videos.

These solutions join Hello Heart, Hinge Health, Sleepio, Torchlight, and Whil that are available to CVS Caremark clients through our Point Solutions Management program.

Point Solutions Management is a full-service offering that leverages the CVS Caremark pharmacy benefit management (PBM) infrastructure to help clients evaluate solutions, streamline vendor contracting, billing, eligibility verification and reporting. In total, ten solutions are now included as part of the program — addressing a broad range of health care concerns including chronic condition management, musculoskeletal health, stress reduction, mental health management, weight loss, and caregiver support.

This expansion is the latest in CVS Health’s ongoing innovation strategy, focused on meeting emerging client and member needs — while responding to acute concerns arising during the COVID-19 pandemic. We will continue to regularly evaluate and update the offering to include additional vendors that support improved outcomes and help lower costs across key areas of health, including fertility, financial wellness and the social determinants of health.

For plan sponsors interested in learning more about Point Solutions Management, please visit the Point Solutions Management page on our Payor Solutions website.

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Heart At Work: Jackie DeJesus

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Jackie DeJesus, wearing a headset and working on a laptop computer in her home office.

Undaunted by COVID-19, Jackie used the reach of CVS to get our member the medication he needed. 

When the COVID-19 pandemic hit, LorenName changed for privacy purposes. thought he would be OK if he just followed the CDC guidelines and stayed home. Even though Loren never contracted COVID-19, his health was eventually impacted by the pandemic. Luckily, his case manager, Jackie, came to his rescue and quickly worked across CVS Health to provide a solution.

Loren has a history of psoriatic arthritis, among other health concerns, and was taking hydroxychloroquine to control his painful symptoms. He had been using his local pharmacy to fill his medications. But after hydroxychloroquine was named as a potential treatment for COVID-19, his pharmacy told him that they had exhausted their supply and couldn’t get any more. Not knowing what else to do, Loren began rationing his medication and eventually ran out too.

Jackie DeJesus, a registered nurse case manager on the Clinical Services Care Management team reached out to Loren because she saw he was prescribed hydroxychloroquine and heard there were shortages. “He was so happy to hear from us. He was very worried that his arthritis and skin conditions would quickly worsen and, because of the pandemic, didn’t feel like he had any choices,” said Jackie. “Loren didn’t feel safe shopping around for his medication since he was following quarantine protocols, and even if he located the medication at another pharmacy, he was concerned about the safety of leaving his community.”

Jackie explained to Loren that we had dedicated CVS pharmacists who can help. She worked with Caremark customer service to not only locate the medication, but also set up a 90-day mail order delivery right to his home.

Within 48 hours, Loren started taking his prescribed dosage and was better able to control his painful symptoms. He’s now aware of the Caremark mail order option and is excited to use it for all his medications during the pandemic and beyond. He is also thrilled to have Jackie as his personal contact.

Karen Lynch said, “The Aetna case managers provide a tremendous opportunity to connect with our members and identify solutions even when they don’t know those options exist. In this case, we not only helped a member overcome physical pain, we worked across CVS Health to simplify his access to care.”

Thank you, Jackie, for bringing your heart to work to help your patients when they need it most.

Jackie DeJesus, wearing a headset and working on a laptop computer in her home office.
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CVS Health helping protect supply of medicines potentially useful for COVID-19 treatment

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CVS Caremark, the pharmacy benefit management business of CVS Health, is working with clients to implement new measures to balance the burgeoning interest in off-label use of certain medicines to treat COVID-19 pneumonia with the ongoing needs of members who use these drugs for chronic conditions. These medicines include hydroxychloroquine, azithromycin, one protease inhibitor and albuterol inhalers, which are approved for treatment of lupus, bacterial infections, HIV, rheumatoid arthritis and asthma.

“Pharmacy benefit managers play an important role at the center of the pharmaceutical supply chain,” said CVS Caremark President Alan Lotvin, M.D. “Our advanced analytics allowed us to quickly identify changes in prescribing patterns and enabled us to take proactive steps to help ensure the integrity of the supply chain. We are taking additional steps today to limit stockpiling that could result in future shortages and gaps in care. We will continue to anticipate and support the needs of our clients, who collectively provide prescription drug coverage for more than 90 million members.”

With client consent, CVS Caremark is setting appropriate limits on the quantity of each of these medicines for potential use in treating COVID-19. Members who already take these medicines for approved uses will be able to bypass the new quantity limits.

“We continue to proactively study the latest clinical literature and consider what additional measures may be needed to help facilitate access to any other newly identified treatments as they emerge during this extraordinary public health situation,” said CVS Caremark Chief Medical Officer Sree Chaguturu, M.D.

Understanding that it may be harder for members to see their health care providers during the COVID-19 outbreak, CVS Caremark is extending previously-approved prior authorizations for most medications set to expire before June 30. For example, if a current prior authorization is set to expire on May 15, the expiration date will be extended to August 15. This step will enable members to refill most medications without renewing an existing prior authorization — not only providing them peace of mind, but also helping to reduce the volume of phone calls and other administrative burdens on physicians’ offices and pharmacies.

Measures already in place to help ensure ongoing access

These additional steps build on actions previously taken by CVS Caremark to protect the drug supply and enhance members’ ability to refill and access their prescriptions from the comfort and safety of their own homes.

For example, CVS Caremark recently worked with clients to make it easier for members to refill most 30-day prescription maintenance medications earlier than usual — by waiving commonly used early refill limits, which require members to use most of the medication on hand before obtaining a refill. Since CVS Caremark announced this new policy on March 10, it has assisted more than 239,000 members in refilling their 30-day prescription maintenance medications.

In addition, most plan members have the ability to obtain 90-day prescriptions of maintenance medications delivered to their homes, or another location of their choice, at no extra charge. CVS Caremark and plan sponsors have been proactively reminding members of this plan option since the COVID-19 outbreak began. CVS Caremark expects to see a 20 percent increase in members receiving a 90-day prescription supply of prescription medicines in the coming weeks.

CVS Caremark also continues to closely monitor the global manufacturing environment. At this time, CVS Caremark does not see any disruptions to the supply chain, as a result of COVID-19, that will affect our ability to fill prescriptions.

CVS Caremark clients and other payors can access information about steps CVS Caremark has taken to support their plans and members during the outbreak, as well as useful turnkey resources for member communications, at the PBM’s COVID-19 PBM Partner Resource Center.

More information on steps that the CVS Health enterprise is taking to address the COVID-19 pandemic is available at the company’s frequently updated COVID-19 resource center.

About CVS Health

CVS Health employees are united around a common goal of becoming the most consumer-centric health company in the world. We're evolving based on changing consumer needs and meeting people where they are, whether that's in the community at one of our nearly 10,000 local touchpoints, in the home, or in the palm of their hand. Our newest offerings from HealthHUB® locations that are redefining what a pharmacy can be, to innovative programs that help manage chronic conditions are designed to create a higher-quality, simpler and more affordable experience. Learn more about how we're transforming health at https://www.cvshealth.com.

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CVS Health expands Point Solutions Management with new health and well-being benefits and comprehensive evaluation process

CVS Health expands Point Solutions Management with new health and well-being benefits and comprehensive evaluation process
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Five new point solution vendors added following rigorous evaluation to ensure high clinical, security and business standards

Simplified contracting, lowest price and performance monitoring helps PBM clients maximize benefits and minimize spend

WOONSOCKET, R.I. — CVS Health (NYSE: CVS) today added five new health and well-being point solution vendors to its Point Solutions Management service following a comprehensive clinical, security and business evaluation process. Point Solutions Management is a full-service offering that enables CVS Caremark pharmacy benefit management (PBM) clients to simplify contracting, secure lowest price and monitor ongoing performance of third-party health care point solutions, which can help maximize their benefits program while minimizing associated spend. Newly added point solutions address health care costs and support clinical outcomes in key areas, including chronic condition management, musculoskeletal health, stress reduction and mental health management, and caregiver support.

"Plan sponsors increasingly see the value in health care point solutions for improving workforce productivity, satisfaction and overall well-being, however with so many options on the market, it can be challenging to identify trusted solutions that best meet the needs of their members," said Sree Chaguturu, M.D., Chief Medical Officer, CVS Caremark, the pharmacy benefit management business of CVS Health. "We have analyzed pharmacy and medical claims to identify where these benefits can make a difference and employ a rigorous and transparent evaluation process to assure that any vendor included in Point Solutions Management meets high standards for safety, quality and user experience at the vendor's lowest price in the marketplace."

More solutions to meet client and member needs

Five new solutions are now available through Point Solutions Management, in addition to Sleepio, a personalized digital sleep program from Big Health, which was the first participating point solution when the service launched as Vendor Benefits Management in 2019. New point solutions available to CVS Caremark clients through the service include:

  • Hello Heart helps members understand and improve their heart health. It offers an FDA-approved blood pressure monitor coupled with an app that tracks blood pressure readings, weight and physical activity, alerts for out-of-range hypertension, and has patient-enabled medication adherence reminders.

  • Hinge Health, a coach-led digital program for members with musculoskeletal conditions such as chronic back or joint pain. Hinge Health combines wearable sensor-guided exercise therapy with behavioral change through 1-on-1 health coaching and education to reduce chronic pain, opioid use, and surgeries.

  • Livongo (Nasdaq: LVGO), an Applied Health Signals company, offers an integrated platform and includes diabetes, hypertension, weight management, and diabetes prevention solutions. Livongo provides support through personalized coaching and connected devices including weight scales, blood glucose meters, and blood pressure monitors to deliver appropriate interventions and help improve health outcomes.

  • Torchlight, a caregiver support solution that guides families through the complexities of educational, financial, social, health, and legal demands related to caring for a loved one, no matter the age, stage, or concern. With a digital platform and team of expert advisors, Torchlight helps reduce stress and enhance caregiving outcomes

  • Whil, a digital training platform for mindfulness, stress resilience, mental well-being and performance. It addresses 12 different aspects of wellbeing and performance through
    5-minute daily sessions and 250+ mini-courses. Users have access to 2,000+ video and audio sessions on demand, reinforced with ongoing tips, exercises and articles to improve employee health and happiness.

Rigorous vetting, evaluation and ongoing performance management

The CVS Health vendor evaluation and selection process starts with identifying the specific areas of health and well-being that meet the clinical and cost management priorities of CVS Caremark clients and where vendor point solutions are most likely to have a positive impact. Each selected solution then undergoes a rigorous clinical, data security, and business evaluation, which includes testing of the end-to-end consumer experience by a team of CVS Health clinicians. Once solutions are adopted by payors, the Point Solutions Management service also provides member eligibility and real-time billing verification and ongoing performance monitoring.

"As a large employer with a diverse workforce, health care point solutions are an essential component of our overall benefits package, but it can be time-consuming and costly to identify, evaluate and contract individually with each vendor," said Kristen Brown, Director of Benefits, JetBlue. "CVS Health's Point Solutions Management helps make the process easier and more efficient." CVS Caremark client JetBlue adopted Point Solutions Management in 2019 to help streamline contracting with point solution vendors and supplement their medical and pharmacy benefits.

CVS Health will continue to expand Point Solutions Management to meet growing client and member needs, including in weight loss, women's health, metabolic health, mental health and other categories that help to address social determinants of health.

For plan sponsors interested in learning more about Point Solutions Management, please visit: https://payorsolutions.cvshealth.com/point-solutions-management.

About CVS Health

CVS Health employees are united around a common goal of becoming the most consumer-centric health company in the world. We're evolving based on changing consumer needs and meeting people where they are, whether that's in the community at one of our nearly 10,000 local touchpoints, in the home, or in the palm of their hand. Our newest offerings from HealthHUB locations that are redefining what a pharmacy can be, to innovative programs that help manage chronic conditions are designed to create a higher-quality, simpler and more affordable experience. Learn more about how we're transforming health at http://www.cvshealth.com.

Media contact

Christina Beckerman
CVS Health
401-770-8868
Christina.Beckerman@cvshealth.com

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Streamlining Prescription Onboarding with Specialty Expedite

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As CVS Health looks to transform health care and contribute to a better, more efficient system, we are looking at ways to leverage and improve the use of technology to improve quality of care and patient outcomes.

This is especially important in specialty pharmacy and why we’ve introduced Specialty Expedite.Specialty Expedite is available exclusively for providers who use compatible electronic health record (EHR) systems including Epic Systems and others that participate in the Carequality Interoperability Framework. All data sharing and usage complies with applicable privacy laws. Patients receive real-time prescription status updates only after providing consent to CVS Specialty. Our connected capability transforms prescription onboarding for our CVS Specialty patients, on average shortening the specialty pharmacy onboarding process to as little as three days and ultimately helping to get patients started on appropriate therapy faster.

Getting Patients the Medications They Need Quickly and Efficiently

For patients with complex medical conditions requiring specialty medications, getting started on their prescriptions quickly and efficiently is crucial to their care. But the process has not always been that simple, with patients sometimes having to wait as long as several weeks to complete the manual onboarding and prior authorization process.

Specifically, the process to get started on a specialty medication often requires physician’s offices and insurers to fax appropriate patient records and/or required approvals before a prescription can be filled, which can be time consuming but is a critical step to ensure that patients are receiving the most appropriate medication.

In addition, across the health care system, the Federal government is looking at ways to help enable and improve health information technology (IT) systems and as part of that, officials have even called for health care to be a “fax free zone by 2020.”

How It Works

Specialty Expedite works by securely gathering appropriate patient information, including insurance, lab work and diagnosis codes via a doctor’s electronic health record (EHR) system instead of sharing through fax. The process also cuts down on paperwork and phone calls, resulting in fewer errors and more efficiencies.

In addition, patients also now have the option of receiving real-time status updates via email or text, so that they can stay informed on the status of their prescriptions and any prior authorization requirements. Patients are also able to choose how they want to get their specialty medications — at their local CVS Pharmacy or though specialty mail serviceWhere allowed by law. In-store pick up is currently not available in Oklahoma. Puerto Rico requires first-fill prescriptions to be transmitted directly to the dispensing specialty pharmacy. Products are dispensed by CVS Specialty and certain services are only accessed by calling CVS Specialty directly. Certain specialty medication may not qualify. Services are also available at Long’s Drugs locations. via Specialty Connect. Research shows that when patients have more flexibility and choice, they are able to start their therapies sooner and adherence and satisfaction improves.

Helping patients with complex medical conditions get the specialty medication they need more quickly and efficiently through technology and solutions such as Specialty Expedite is one more way we are helping people on their path to better health.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Pay Flex CEO Shines Light on Opportunity for Payers, Providers to Collaborate on Revenue Cycle

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When it comes to health care costs, many consumers feel left in the dark. In fact, the No. 1 reason people do not pay their health care bills is due to confusion over the often antiquated and clunky payment process.

At the HIMSS Annual Conference & Exhibition in Las Vegas this week, PayFlex CEO and President Erin Hatzikostas hosted a session, “Equipping Consumers To Be The Chief Financial Officer Of Their Own Health Care,” to discuss how providers and health plans can work together to engage consumers to better understand and manage their health care expenses. PayFlex is a part of the Aetna family.

With the rise of consumer directed health plans turning patients into larger financial stakeholders in their care, “Consumers are left woefully behind in getting the information they need,” said Hatzikostas.

Consumers cannot make informed choices about their elective health care if they do not know what it costs. Furthermore, even after patients receive care, they are often left in a thicket of mail from providers and their insurer, including Explanations of Benefits (EOBs) which may look like bills, bills from providers that look like EOBs, etc.

While this is confusing for the patient, it also negatively affects doctors who performed services with the promise of getting compensated quickly. Collections typically take 3-5 months to process and only 17 percent of bills are collected. This delay is not linked to an unwillingness or inability by the patient to pay – three-fourths of people are willing and/or able to pay for their health care costs – but a lack of understanding of the payment system and process. “The No. 1 reason is that people were confused,” said Hatzikostas.

As a complex issue, the health care payment crisis requires a complex solution. Convenience and consumerism are hard to balance and simple solutions will not work.

In 2014, PayFlex launched Money Square for Health to help equip consumers to be better financial stewards of their health care. After just three years, the service earned over 200,000 users, with many repeat users. Beta testing confirmed the huge opportunity in the ecosystem to engage consumers and, with the learnings from Money Square for Health, Aetna launched AetnaPay to further empower consumers to become the CFO of their health care finances.

There is still much work to be done in supporting consumers to own their health care finances, but progress is being made. As we continue to shine a light on the payment black box, it will be imperative for providers to collaborate with health plans on solutions and work together to share quality data and advance work flows.

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CVS Health Introduces New Service to Help PBM Clients Manage Health and Wellness Benefit Solutions

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Vendor Benefit Management helps streamline onboarding and management of both digital and non-digital third-party solutions

WOONSOCKET, R.I. — CVS Health (NYSE: CVS) today announced the availability of Vendor Benefit Management, a new service developed to help CVS Caremark pharmacy benefit management (PBM) clients more easily contract, implement and manage their choice of available and emerging third-party health and wellness benefit solutions both digital and non-digital. This new service offers clients a seamless way to access negotiated pricing, standardized member eligibility verification in real-time, simplified billing and payment processing, and standardized results measurement and reporting across multiple vendors. Big Health, a digital therapeutics company, is the first participating vendor, and Sleepio, its automated, personalized digital sleep improvement program, will be available to CVS Caremark clients via Vendor Benefit Management.

"As health care continues to evolve, plan sponsors have begun looking beyond the standard medical, pharmacy, dental and vision health benefit offerings, and are increasingly considering supplemental benefits to help improve health outcomes and reduce overall medical spend," said Derica Rice, President, CVS Caremark, the PBM business of CVS Health. "We asked our clients what they needed and are now proudly easing their administrative burden so their members can more quickly and easily access these solutions that are growing in availability and importance. Our new proprietary service enables us to leverage the sophisticated infrastructure, technologies and processes we have honed as a leading PBM to further benefit our clients and their members."

Vendor Benefit Management is an open-platform service designed to help CVS Caremark PBM clients manage relationships with digital and non-digital health and wellness benefit solution vendors with which they choose to contract. Moving forward, CVS Health will be actively working to identify and onboard additional vendors to participate in the new service. This may include solutions such as smoking cessation and substance abuse support, care management solutions, medication optimization and adherence, and tools that help members navigate their benefits.

Big Health becomes first available vendor with their digital therapeutic, Sleepio

Sleepio, Big Health's personalized digital sleep improvement program, is accessible via app or web. The program is based on Cognitive Behavioral Therapy (CBT), which helps individuals make changes to improve their sleep, individualizing the program to their specific challenge. Sleepio's research is referenced in guidelines published by the American College of Physicians that recommend CBT as the first line treatment for chronic insomnia in adults, ahead of sleeping pills. To date, Sleepio has been studied in eight randomized controlled trials. Improvement in sleep is associated with better outcomes in mental health.

"Given that poor-quality sleep and insomnia affect approximately 30 percent of adults, and is a condition that can impact a wide variety of mental health conditions, we are pleased to be working with Big Health to help make their digital therapeutic product, Sleepio, more accessible," said Troyen A. Brennan, MD, Chief Medical Officer, CVS Health. "Big Health's commitment to clinical evaluation and research aligns with our focus on applying evidence-based medicine to provide our clients and their members with access to appropriate health solutions and services, and many of our clients are interested in adopting this platform to help increase member access to these types of solutions, including Sleepio."

"The scientific evidence is overwhelming that improving sleep represents a destigmatized way to improve wider mental health," said Big Health co-founder and Chief Medical Officer, Professor Colin Espie. "So it's exciting to see a leader in health care like CVS Health commit to bringing our digital therapeutic for sleep to their clients and members."

"Millions of Americans suffer from chronic physical and mental health conditions for which there are proven behavioral solutions," said Peter Hames, co-founder and CEO of Big Health. "These interventions were previously not available at scale, until the advent of digital therapeutics. We're proud to be working with CVS Health as they help to make solutions, such as Sleepio, available at scale for the first time."

As the health care industry continues to evolve at a rapid pace, CVS Health is committed to helping to meet the dynamic needs of our PBM clients through our continued effort to bring to market standardized and scalable platform solutions. As part of that, the company plans to continue to evaluate other, enhanced features for Vendor Benefit Management.

About CVS Health

CVS Health is the nation's premier health innovation company helping people on their path to better health. Whether in one of its pharmacies or through its health services and plans, CVS Health is pioneering a bold new approach to total health by making quality care more affordable, accessible, simple and seamless. CVS Health is community-based and locally focused, engaging consumers with the care they need when and where they need it. The Company has more than 9,900 retail locations, approximately 1,100 walk-in medical clinics, a leading pharmacy benefits manager with approximately 94 million plan members, a dedicated senior pharmacy care business serving more than one million patients per year and expanding specialty pharmacy services. CVS Health also serves an estimated 38 million people through traditional, voluntary and consumer-directed health insurance products and related services, including rapidly expanding Medicare Advantage offerings and a leading standalone Medicare Part D prescription drug plan. The Company believes its innovative health care model increases access to quality care, delivers better health outcomes and lowers overall health care costs. Find more information about how CVS Health is shaping the future of health at https://www.cvshealth.com.

Media contact

Christina Beckerman
CVS Health
401-770-8868
Christina.Beckerman@cvshealth.com

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Addressing Rising Drug Prices

Addressing Rising Drug Prices
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Rising drug prices hurt patients and lead to negative and costly outcomes throughout our health care system. For example, data show that 40 percent of patients do not pick up their prescriptions when out-of-pocket costs per prescription exceed $200.CVS Health Internal Analysis. Completed December 2015, Retail RxDw; Analysis Timeframe of 1/1/15 – 12/28/15 When patients don’t take their medications as prescribed, the cost to our health care system is approximately $290 billion.https://www.nehi.net/writable/publication_files/file/pa_issue_brief_final.pdf

At CVS Health, we recognize that one of the most important things we can do is to help people afford and take their medications. That’s why we’re working to improve transparency and pioneering solutions to help patients get the right medicine at the lowest possible cost.

Providing Information across Multiple Points of Care

Information about how much a drug costs is not always readily available. According to a poll sponsored by CVS Health, more than half (57 percent) of patients do not know how much a drug will cost them, and nearly as many (54 percent) believe it would be helpful to have information about the cost before they fill their prescriptions.

CVS Health is working to expand visibility into drug cost information across multiple points of care.

  • At the physician’s office: Our real-time benefits technology – used by 100,000 prescribers nationwide – enables visibility into what a patient will pay for a specific drug under their benefits plan and presents up to five lower-cost, clinically appropriate alternatives for consideration by the prescriber.
  • At the pharmacy counter: Our more than 30,000 retail pharmacists use the Rx Savings Finder tool to search for potential savings opportunities.
  • For CVS Caremark members: About 230,000 times per month, CVS Caremark members search the Check Drug Cost tool to find lower-cost, clinically appropriate alternatives to more expensive medications.

Helping Control Costs While Promoting Better Health

As a Pharmacy Benefit Manager (PBM), we use every tool at our disposal to bring down drug prices. For example, we encourage the use of lower-cost, clinically appropriate generic alternatives, which data show can lead to a 3-percent decrease in overall mortality.https://www.ncbi.nlm.nih.gov/pubmed/2522238. We offer evidence-based guidelines to help prescribers connect patients to the most cost-effective medicines, resulting in more than $2.9 billion in savings.CVS Health White Paper. Current and New Approaches to Making Drugs More Affordable. Published August 2018 We also provide point-of-sale rebates and zero-dollar copay drug list options to clients, helping to deliver savings directly to patients at the pharmacy counter.

Keeping Costs Down for Patients, Employers and Government Programs

Our PBM strategies rein in costs across the health care system and also increase access to affordable medications for patients. While brand manufacturers have increased prices on average 9.2 percent annually from 2008 to 2016,https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05147 we have worked to stabilize drug costs for our clients and patients. In fact, CVS Health kept drug price growth to just 0.2 percent in 2017.

For more information on how CVS Health is working to expand access to more affordable and effective health care, check out our Cost of Care information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.

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Moriarty Discusses Health Care Leadership with U.S. News & World Report

Moriarty Discusses Health Care Leadership with U.S. News & World Report
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At the 2019 World Economic Forum, Tom Moriarty, Chief Policy and External Affairs Officer, and General Counsel for CVS Health, sat down with Bill Holiber, President and CEO of U.S News & World Report, to discuss how leadership in the health care industry can drive meaningful solutions for patients.

The conversation first focused on the important role leaders can play in driving a transformative vision forward. Moriarty explained that leaders, particularly in health care, need to listen and engage at a very human level.

Emphasizing the importance of providing human interactions in health care, Moriarty outlined CVS Health’s commitment to delivering high-quality, community-based care. According to Moriarty, the democratization of care delivery – giving patients greater control of their health care decisions – provides an opportunity to help patients find the right care at the best possible cost.

As an example, Moriarty referenced the real-time benefits program, which improves transparency for patients and their prescribers by showing what patients will pay for a specific drug under their benefits plan and presenting up to five lower-cost, clinically appropriate alternatives. Moriarty described the potential for solutions like this to improve health care outcomes and reduce overall costs to the system, so that those savings can be reinvested in other societal priorities, like education and infrastructure.

For more information about CVS Health’s efforts to improve access to quality care across the nation, visit our Quality & Access information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.

Tom Moriarty and Bill Holiber talk at Davos.
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