- Programs & Services
- Cost Management
- Specialty Management
- Care Management
- Member Engagement
- Health Plan Client Engagement
We delivered savings to plans, lowered plan member costs, and helped improve outcomes
April 11, 2019
The rising cost of health care and prescription drugs affects every household in the nation and is a critical issue for consumers, policymakers, payors, and providers. As a health care innovation company, our steadfast focus is on helping to reduce costs and improve outcomes for our pharmacy benefit management (PBM) clients and their plan members, as well as the communities we serve.
In 2018, our PBM solutions reduced the impact of price growth to 1.2 percent. Trend was largely driven by utilization increases and adherence improvements. We also kept drugs affordable for members – two out of three utilizing members spent less than $100 on their prescriptions in 2018. That helped more people reach optimal adherence to their prescribed drug regimens in key categories like cholesterol, depression, and diabetes. Our analysis indicates that moving a member to optimal adherence in these categories can save up to $1,900 a year in medical costs.
In 2018, we blunted the impact of drug price inflation.
Formulary strategies enable the PBM to take advantage of market competition, effectively negotiate rebates, and promote the use of lower-cost clinically appropriate options. In 2018, clients and members saved due to our decision to exclude the high-cost long-acting insulins (LAIs) Lantus and Toujeo, and make Basaglar, a less expensive form of the same insulin, a preferred formulary product. Costs for a 30-day supply for members using Basaglar were 9 percent lower than costs for those using Lantus or Toujeo, and clients benefited from a 21.7 percent reduction in cost per LAI prescription.
Despite high inflation, we helped keep insulin costs in check for clients and members.
In our commercial cohort, only 1 percent of claims were for specialty drugs in 2018, yet those claims accounted for 45 percent of costs, up from 42 percent in 2017. Plans that adopted two or more of our management programs were able to cut specialty trend substantially. Due to a robust pipeline and limited competition, specialty spend will continue to grow and requires a tight management approach.
Growing specialty spend needs tight management to reduce trend.
Over three years, 2016-2018, PBM solutions saved clients more than $141 billion on pharmacy spend. We also estimate clients saved more than $18.3 billion in medical cost avoidance due to adherence improvements that resulted from lower member out-of-pocket costs and targeted interventions.
Over three years, PBM solutions helped clients save >$141B on their pharmacy spend.
April 11, 2019
Our Market-Leading Solutions Help Clients Stay Ahead of Marketplace Trends and Achieve Lowest Net Cost.
Helping Lower Client Cost While Ensuring Members Have Access to Clinically Appropriate Medications.
Savings and adherence will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan.
This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health.