The Drug Trend Report
Low Specialty Drug Trend - Without Compromises
of Clients Had Negative Specialty Trend in 2021
Specialty medications continue to be the single largest driver of drug spending – and we know there is no single solution for managing costs.
That’s why we apply every lever possible to tackle this challenge:
- Use our purchasing power to negotiate with manufacturers
- Optimize utilization of critical, but costly, drugs
- Pay close attention to the latest clinical best practices
- Find reliable ways to reduce waste
- Working with clients to try new, innovative solutions that save costs while ensuring coverage
This year, we delivered an low specialty drug trend by using all these tools. We achieved this impressive trend while maintaining clinical integrity, avoiding disruption and satisfying the needs of plan members who rely on critical specialty medications.
Specialty Medications Drove 54% of Overall Drug Spending
in 2021
62.9% of Clients Had Less Than 10% Specialty Trend
27.6% of Clients Had Less Than 10% Specialty Trend 2 Years Running
Specialty Generic Dispensing Rate Reached 22% Delivering Nearly $873 Million in Savings For Clients and Plan Members
New Program Delivers Trend Difference
PrudentRx, a specialty program introduced to clients in 2020 and adopted by many for the 2021 plan year, prevents manufacturer copay assistance programs from circumventing a payor’s plan design, saving money for our clients. The results are significant, delivering an average double-digit negative trend for those who opted in.
The PrudentRx Effect
Graphic titled “The PrudentRx Effect” showing that clients with PrudentRx had -11.6% average specialty trend compared to those who did not have PrudentRx who had +8.2% Average Specialty Trend
Digital Connectivity Continues to Power Savings
Our investments in digital infrastructure and electronic health record (EHR) interoperability help us better engage specialty members and their providers throughout the duration of therapy. Digital connectivity continues to realize opportunities to lower costs and, importantly, improve care.
These close connections with members are foundational, allowing us to impact behaviors and create better outcomes. We can collect information to optimize member treatment plans and drug management, eliminate wasteful spending and reduce the chance of adverse events.
of Patients Actively Enrolled in Interactive Digital Communications
We connect directly with members to help support adherence, answer questions and take proactive steps that keep them engaged with their own health journey.
80%
of Specialty Patients’ EHRs
Our connectivity gives us access to the most pertinent patient information so that we can validate treatment without need for additional prescriber outreach, ensuring members start therapy with certainty.
Saved Per Effective Clinical Intervention*
We intelligently monitor medication use, engaging proactively with specialty patients to confirm that treatments work as hoped, assess possible side effects and intervene appropriately when a patient may no longer be benefiting from a specific therapy.
*CVS Specialty patients only.
Saved Per Targeted Specialty Patient Through Successful Interventions Managing Excess Supply**
Specialty drug regimens can be complex – and despite best efforts, many people do not fully comply with their treatment plans. We use our digital tools to confirm how much medication a patient should have on hand to help avoid unintended drug accumulation.
**Supply Management Optimization is a specialty pharmacy service performed by CVS Specialty pharmacy for members of select contracted PBM and CVS Specialty standalone payor clients who fill specialty prescriptions through CVS Specialty and is included as a core service in the payor agreement.
Trend Methodology
Unless noted, all cost savings data in this report was updated in March 2023 to reflect full-year 2021 data.
This report provides an overview of performance for CVS Health commercial PBM clients – employers and health plans. Data were calculated on a cohort of 1,029 clients, covering approximately 22 million lives. The cohort is built only on clients under our management throughout all of 2020 and Q1 through Q4 2021, excluding commercial clients with eligibility shifts exceeding 20 percent, as well as clients contractually prohibiting use of plan data. Prescription drug trend is the measure of growth in prescription spending per member per month. Unless otherwise noted, reported data are net of negotiated pricing, rebates and manufacturer discounts.