Helping Seniors Save Money Through SilverScript

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SilverScript, our Medicare-approved Part D prescription drug plan provider serving more than 5 million members, focuses on providing seniors and people with disabilities with consistent, worry-free coverage.

For Alexis Spina, one of our Pittsburgh-based colleagues, that focus is integral to her work every day. A clinical pharmacist, Spina works the Medicare call queue, educating members daily on lower cost drug alternatives that have the same clinical benefits as their current medications, tailoring her responses to each member’s specific level of understanding.

Her conversations with members have been so impactful that some of them have been developed into talk tracks that other colleagues on her team now use for their own calls.

Spina says that with each phone interaction she tries to make the patient feel like they are speaking with someone who truly cares about their well-being.

For her hard work and leadership, Spina was awarded a 2018 CVS Health Paragon Award, which recognizes the best-of-the-best among CVS Health colleagues who deliver direct care to patients and customers. Now in their 28th year, the Paragon Awards honor colleagues who embody the core values of CVS Health.

Watch to learn more about Spina’s passion for helping patients save money and live a healthier life.

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CVS Health Appoints Sree Chaguturu, M.D., Chief Medical Officer of CVS Caremark

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CVS Health has named Sree Chaguturu, M.D., as Chief Medical Officer for CVS Caremark, our pharmacy benefits management business (PBM) for the company. He will report to Troyen A. Brennan, M.D., M.P.H., Executive Vice President and Chief Medical Officer of CVS Health. Dr. Chaguturu will support the PBM and specialty pharmacy areas with a focus on enhancing the quality of services provided to millions of its members and patients, while also contributing to the overall mission of CVS Health.

Dr. Chaguturu will be joining CVS Health in early September from Partners HealthCare, where he was previously Chief Population Health Officer, and a member of the leadership team focused on ensuring the company met its mission of improving quality and reducing costs for the populations it serves. He was responsible for the oversight and implementation of Partners HealthCare’s Accountable Care Organization, which manages the health of more than a half-million patients. Earlier in his career, Dr. Chaguturu was a health care consultant at McKinsey Hospital Institute.

Dr. Chaguturu is a practicing internal medicine physician at Massachusetts General Hospital and a clinical instructor at Harvard Medical School. He received his internal medicine and primary care training at Massachusetts General Hospital and earned his undergraduate and medical degrees from Brown University.

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Helping Increase Access to Health and Wellness Benefit Solutions

Helping Increase Access to Health and Wellness Benefit Solutions
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Health care continues to evolve at a rapid pace and with that has come new technological advancements and care models. This includes tools and programs to help patients manage a wide range of conditions, from insomnia to weight loss to solutions that provide disease management and medication adherence support.

To help increase access to these tools and solutions, CVS Health has introduced Vendor Benefit Management, a first-of-its-kind service that allows CVS Caremark pharmacy benefit management (PBM) clients to more easily and efficiently onboard and manage third-party vendors and make their solutions available to members.

Our Streamlined Service

Increasingly, employers are supplementing their standard benefit offerings with novel digital and non-digital health and wellness solutions. In 2018, the average employer offered 14 supplementary health care solutions from different sources, including health plans and third-party vendors.https://www.castlighthealth.com/press-releases/castlight-releases-first-of-its-kind-report-on-digital-health-in-the-workplace/

However, the process to onboard and manage disparate vendors can be complex, resource intensive and time-consuming. Vendor Benefit Management aims to make this process easier for our PBM clients.

Specifically, the new service enables:

  • A more streamlined process to onboard and manage multiple vendors
  • An easy way to access negotiated pricing and standardized verification of member eligibility in real time
  • Simplified and streamlined billing and payment processing
  • Standardized measurement and reporting across all vendors

Big Health’s Sleep Solution

Poor-quality sleep and insomnia affect nearly 30 percent of adults and can underlie or impact a wide variety of mental health conditions. Big Health, a digital therapeutics company, is the first participating Vendor Benefit Management vendor and Sleepio, its personalized digital sleep improvement program, is now available to PBM clients via the service. The program is based on Cognitive Behavioral Therapy (CBT), which helps individuals make the changes necessary to improve their sleep problems.

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.

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.

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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.

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CVS Health Statement on Ohio Auditor of the State’s Report on Pharmacy Benefit Managers

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CVS Caremark works hard every day to help its Ohio Medicaid clients manage their drug costs and make it possible for Medicaid recipients to have access to the vital medications that they need.  Overall, PBMs have saved Ohio taxpayers $145 million annually by servicing the state’s Managed Medicaid plans, even as drug manufacturers’ prices have continued to rise.

Ohio’s Medicaid expenditure per prescription is more than 13% below the collective average costs of states that manage their own program versus using a PBM.

We remain committed to continuing to work together with the state and the managed-care plans to improve the system, lower drug costs and serve the health care needs of Ohioans. 

When reviewing the Ohio State Auditor’s report on PBMs released this morning, it is important to keep the following facts in mind:

  • Government-mandated rebates in the Medicaid program are shared by the states and the Medicaid program. PBMs do not receive and, therefore, do not keep any of those mandated rebates. CVS Caremark also passes 100% of any supplemental rebates to our Ohio Managed Medicaid clients. In other words, we do not keep any amount of a drug manufacturer’s rebate for Medicaid prescriptions in Ohio. 

  • Counting the number of pharmacy closures does not paint the full picture, because it does not take new pharmacy openings into account, nor the growth of independent pharmacies within our PBM network. Independent pharmacies make up about 40% of all of the pharmacies in our national network. And we’ve added 63 independent pharmacies in Ohio to our network in just the last three years.

  • CVS Health maintains stringent firewall protections between our CVS Pharmacy retail business and our CVS Caremark PBM business to prevent any anti-competitive activity by either side of our enterprise.

  • Under the pricing model chosen by our Ohio Managed Medicaid clients, the “spread” paid to CVS Caremark is in lieu of our clients paying a separate administrative fee, and it funds vitally important benefit management services we provide to clients, such as clinical and customer support, programs to improve medication adherence, management of the drug formulary, and other services.  However, we are actively working with our Ohio Managed Medicaid clients to restructure our contracts to implement the new “pass-through” pricing model requirement, effective January 1, 2019.

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Roll Call Live: Empowering Patients as Partners in Health Care

Roll Call Live: Empowering Patients as Partners in Health Care
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With the expansion of high-deductible health plans (HDHPs), patients are taking on more responsibility in deciding what options work best for their budgets and health care needs. Roll Call Live’s “Empowering Patients as Partners in Health Care,” sponsored by CVS Health, explored consumer-driven health care – examining where progress is being made and where opportunities for improvement still exist.

The event included two keynote conversations by policymakers, an expert panel discussion and remarks by Tom Moriarty, CVS Health Chief Policy and External Affairs Officer and General Counsel, who highlighted solutions for improving prescription drug affordability.

Other participants included:

  • Joseph Antos, PhD, Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute

  • Brian Blase, National Economic Council’s Special Assistant to the President for Economic Policy

  • David Blumenthal, MD, MPP, President of The Commonwealth Fund

  • Representative Donald McEachin (D-VA)

Participants highlighted three potential solutions to help empower patients as consumers: enhancing meaningful price transparency information; providing greater benefit flexibility for HDHPs associated with health savings accounts (HSAs); and expanding personalized care. 

Providing Meaningful, Transparent Information to Empower Decision-Making

As steps are being taken to increase transparency, experts believe it is important to make sure that information about health care benefits and costs is actionable for consumers. For example, Rep. Donald McEachin emphasized that transparent cost information alone isn’t enough – it must direct patients to effective care at a lower cost.

As David Blumenthal pointed out, “price information is as complicated as the health needs of the individual consuming the care,” and therefore, information should be presented clearly and be specific to a patients’ benefit plan. Supporting this, Joseph Antos explained that for information to be useful, it needs to be tailored to what patients care about – “for example, what they will actually be paying for at the pharmacy counter.”

Finding opportunities to increase transparency that improve health care decision-making is a top priority at CVS Health. Our solutions, including the Rx Savings Finder and real-time benefits, provide greater transparency from the point of prescribing to the point of sale with actionable results that are saving patients money.

Making HDHPs Work Better for More Patients

As the number of patients enrolled in HDHPs continues to grow, there are opportunities to improve how these plans work for patients, particularly those managing a chronic disease. Brian Blase outlined how the Administration is considering a proposal that would permit HDHPs associated with HSAs to cover more services, such as providing insulin at no cost to patients. Blase referred to this concept as “one possible way to help use insurance design to drive value by empowering patients as consumers of health care.” 

At CVS Health, we advocate changing the rules governing HSAs to give HDHPs the option to cover all prescription drugs — including generic and brand drugs — outside the deductible. That way, patients can access these drugs for little or no copay if that is how the plans want to structure their benefit. CVS Health also works with PBM clients to offer preventive drug lists for many common chronic diseases, including diabetes and heart disease, making it easier to access and afford care that puts people on a path to better health.

Connecting Patients to High-Value, Personalized Care

Incentivizing personalized care delivery that meets patients’ specific health needs can reduce costly complications and improve outcomes. The experts agreed that in the era of consumer-driven health care, more can be done to connect patients to the right care at the right time. David Blumenthal noted, “Insulin for diabetics is high-value care…hypertensive treatment, hypolipidemics for elevated lipids, exercise programs for people who are post-heart attack. These things are proven life-savers, and they shouldn’t be treated the same way as an unnecessary MRI for back pain.”

Whether it’s delivering preventive services that help keep people healthy or supporting chronic disease patients in adhering to their medications, we help connect patients to high-value care when and where they need it.  

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 Addresses Prescription Drug Affordability at Roll Call Live

Moriarty Addresses Prescription Drug Affordability at Roll Call Live
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In the midst of a very important discussion around prescription drug pricing in Washington, DC, CVS Health sponsored an event with CQ Roll Call titled “Empowering Patients as Partners in Health Care” to focus on the issue and the consumer experience in health care today. At the event, policymakers and health care policy experts discussed the progress being made to make the health care system work better and identified areas where more solutions are needed. Tom Moriarty, Chief Policy and External Affairs Officer, and General Counsel for CVS Health, addressed the affordability of prescription drugs – one of the most critical issues impacting patients today.

Moriarty emphasized how high drug prices can have an adverse effect on patients’ health. For example, when medications are above $200 in out-of-pocket costs per prescription, more than 40 percent of patients do not pick up their prescriptions. To ensure patients can afford their medicines and take them as directed, Moriarty outlined the importance of the pharmacy benefit management (PBM) tools and solutions CVS Health is pioneering to improve medication adherence and reduce patients’ out-of-pocket costs. He also highlighted policy ideas that can increase market competition and provide the transparency that consumers, providers and pharmacists need to get the most effective drug at the lowest cost.

Innovative Solutions to Address Rising Drug Costs

The status quo of rising drug prices is not acceptable. Moriarty highlighted how CVS Health is implementing solutions to mitigate the effects of manufacturer-driven price increases. We are:

  • Pioneering the use of point-of-sale rebates and started by offering them to our CVS Health colleagues. As a result, we’ve seen adherence improvements of four to six percent. Additionally, we offer point-of-sale rebates to our clients – making this benefit available to 10 million people covered by CVS Caremark plans.

  • Utilizing preventive drug lists for colleagues to make medications for common chronic conditions, including diabetes, hypertension and asthma, available at a zero-dollar copay. Data show that this can lead to better adherence and provide medical cost savings and productivity gains.

  • Expanding visibility into prescription drug costs – starting at the doctor’s office and culminating at the pharmacy counter. At the doctors’ office, we provide real-time benefits to ensure prescribers have information on patients’ covered benefits and what patients will pay out-of-pocket under their plan for a specific drug. At the pharmacy counter, our retail pharmacists are using the Rx Savings Finder to help members save, in some instances, an average of $420 per year.

Rebates are Discounts that Help Lower Costs for Patients and the Government

There has been a lot of discussion about the role of rebates in the drug pricing system, which are discounts used to reduce costs for patients and government programs. Moriarty debunked the myth that drug companies increase prices as a result of having to pay rebates, pointing to the fact that there is no correlation between manufacturer-driven price increases and these rebates and discounts. In fact, list price is increasing faster for drugs with little competition than it is for medications with competition and substantial rebates and discounts.

Despite the fact that brand drug manufacturers increased list prices by an average of 9.2 percent annually between 2008 and 2016,QuintilesIMS Institute, Medicines Use and Spending in the U.S. (May 2017). https://structurecms-staging-psyclone.netdna-ssl.com/client_assets/dwonk/media/attachments/590c/6aa0/6970/2d2d/4182/0000/590c6aa069702d2d41820000.pdf?1493985952 CVS Caremark has been able to keep drug price growth nearly flat at 0.2 percent by negotiating rebates and discounts and encouraging the use of lower cost, clinically appropriate medicines.

Policy Solutions to Lower Drug Costs for Patients

PBMs are very effective at lowering drug prices when there is competition, but there is still a substantial number of products that face limited to no competition. In addition, due to the increased enrollment in high-deductible health plans, the deep discounts being driven by PBMs are not being seen at the pharmacy counter by patients when they are in their deductible phase. To address these challenges, Moriarty presented four patient-centric solutions:

  • Medicare should drive the adoption of real-time benefits to give patients and their physicians visibility into lower costs and offer an option for a point-of-sale rebate Part D plan.

  • For plans associated with health savings accounts, policymakers can take immediate action to change Internal Revenue Service (IRS) rules to allow those plans to provide first-dollar coverage for drugs outside of the deductible, even for maintenance medications intended to treat an existing chronic condition.

  • By prohibiting pay-for-delay agreements and passing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act to stop Risk Evaluation and Mitigation Strategy (REMs) abuse, we can curb anti-competitive practices and help bring lower cost, clinically equivalent generic medications to market more quickly.

  • Lastly, we must accelerate the pathway to bringing biosimilar drugs to market. Biosimilar drugs have the potential to save the health system $54 billion dollars over ten years, but our country is far behind in accessing these medicines. In Europe, 53 biosimilar medicines have been approved. In contrast, only seven are on the market in the U.S. today.

CVS Health will continue to innovate and use every tool at our disposal to bring down the costs of drugs while also advocating for effective policies that increase access to affordable medications.

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.

Tom Moriarty speaks at a recent CQ Roll Call event
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CVS Health Statement on Ohio Department of Medicaid's Pass-Through Pricing Requirements

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WOONSOCKET, R.I., Aug. 14, 2018 /PRNewswire/ -- CVS Health (NYSE: CVS) is actively working with its Ohio Managed Medicaid clients to restructure its contracts to implement the Ohio Department of Medicaid's new "pass-through" pricing model requirement, effective January 1, 2019. Contrary to an inaccurate news report in The Columbus Dispatch, which was later picked up on social media, the pharmacy benefit managers (PBMs) servicing Ohio's Managed Medicaid Plans have not been "fired."

PBMs have saved Ohio taxpayers $145 million annually through the services they provide to the state's Medicaid managed care plans. CVS Health will continue to help its Ohio Medicaid clients manage their drug costs and improve their members' health outcomes in 2019 and beyond.

About CVS Health

CVS Health is a pharmacy innovation company helping people on their path to better health. Through its more than 9,800 retail locations, more than 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, expanding specialty pharmacy services, and a leading stand-alone Medicare Part D prescription drug plan, the company enables people, businesses and communities to manage health in more affordable and effective ways. This unique integrated 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 Contacts:

Christine Cramer
401-770-3317
christine.cramer@cvshealth.com

Mike DeAngelis
401-770-2645
michael.deangelis@cvshealth.com

SOURCE CVS Health

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A New Approach to Pricing of Pharmacy Benefit Management Services

A New Approach to Pricing of Pharmacy Benefit Management Services
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Across our CVS Health enterprise, we are transforming the way we deliver care to help more people on their path to better health. As part of this, our pharmacy benefit management (PBM) company, CVS Caremark, today introduced the new Guaranteed Net Cost pricing model, which will help redefine the industry by offering drug cost predictability and pricing simplicity for our clients.

We sat down with CVS Caremark President Derica Rice to learn more about the company’s innovative new PBM pricing model and how it will deliver value to the health care system.

Why is CVS Health introducing the Guaranteed Net Cost pricing model?

The pharmaceutical market continues to be highly dynamic and managing costs effectively can be challenging for payors, patients and the entire health care system. PBM strategies such as preferred formulary placement and drug exclusions have helped create, and keep up, the pressure on pharmaceutical manufacturers and have been successful in keeping drug prices in check.

However, as the marketplace has continued to change at a rapid pace, it is clear that the PBM model must also evolve to continue to deliver value to the health care system, while also optimizing the quality of care. And, the time is right for change.

We believe the Guaranteed Net Cost pricing model will better serve our payor clients by providing them cost predictability and to help them clearly see the net cost of their pharmacy benefit, ultimately enabling them to select their PBM provider based on who can deliver lowest net cost. This also helps plan sponsors continue to provide an affordable benefit.

How is this new model different than what is currently in the market?

While current pricing models offer discounts and rebates, they do not provide net cost predictability, and the variability between PBMs can make it difficult for plan sponsors and PBM consultants to draw direct comparisons.

Our new model more closely aligns PBM incentives with plan sponsors’ objectives by focusing on a simple concept – net cost per drug claim. It simplifies the financial arrangements underlying PBM contracts by guaranteeing the average net spend, after discounts and rebates, per prescription for each distribution channel. Overall this model will help provide our clients more predictability related to their drug spend and eliminates the need for clients and consultants to project drug price inflation, shifts in drug mix and the total value of rebates.

In addition, under this new model, we will also pass through 100 percent of the rebates to clients. Clients also continue to have the option to implement point-of-sale rebates for their members, as CVS Health does for its own employees. In turn, this can help to lower out-of-pocket costs for consumers.

How will Guaranteed Net Cost change the PBM industry?

At CVS Health, we are working to help redefine the PBM industry in a way that better serves payors, patients and the entire health care system by helping to lower prescription drug costs and maximize payor cost savings.

We believe guaranteeing the net cost is in the best interest of the client, and we are confident clients and consultants will also see it that way. We think this model is the right choice for any PBM that wants to demonstrate the value of its cost-control strategies and alignment with clients’ objectives. As such, we believe that other PBMs will also want to adopt this model, which will help to collectively deliver even greater value to the entire health care system over time.

We are confident that this new model is the right thing to do and the right approach for the future and believe that payors, consultants and other PBMs will agree that a simpler approach to PBM pricing can deliver better drug cost predictability and ultimately, help better show the value of a PBM.

What’s next for CVS Caremark and the PBM industry?

By simplifying the way we contract with our clients, we can focus on maximizing the effective PBM tools we already employ to reduce costs for the client and the consumer, and direct our energies toward developing additional innovative tools and approaches.

We anticipate that PBMs will continue to play an invaluable role in the health care system in the coming years and are working with partners and stakeholders across the industry to continue to find new ways to help improve access to care and lower overall health care costs.

Learn more.

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.

12.05.18

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