Insights / Cost Management

2023 CVS Caremark Formulary Updates

Continuing to deliver the lowest net cost in the face of a rich drug pipeline

BRIEFING
September 30, 2022
Joshua Fredell, PharmD
Vice President and Head of PBM & Specialty Product Innovation

Savings and stability with 2023 Formulary Changes

$4.3B savings expected for those aligned to our template formularies $123 per member — for clients aligned to our template formularies
99.72% will not experience any changes from the formulary removals effective January 1, 2023**CVS Health, 2022. Client savings are determined using cumulative value over a 5-year period (upcoming year, current year, and 3 prior years). All data sharing complies with applicable law, our information firewall, and any applicable contractual limitations. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan, and other factors.

The changes we are making effective January 1, 2023, will help ensure our formulary strategies remain the most impactful tool for clients seeking to better manage costs.†

Delivering exceptional value and cost savings to our clients and members is our number 1 priority. We are committed to delivering clinically appropriate drug coverage at the lowest net cost. Our demonstrated record is built on a strong foundation of formulary principles:

  • Maintaining the highest clinical integrity: Focus on clinically appropriate medications through targeted drug class evaluation including appropriate specialty classes; leverage external therapeutic class review and clinical evaluation to help inform and verify all recommendations
  • Securing competitive pricing: Continually assess the market to find the lowest net cost options for generic, biosimilar, and brand-name drugs
  • Ensuring access to medications and supporting members for smooth transitions: Ensuring members impacted by formulary changes – and their prescribers – receive proactive outreach and support so they know exactly what to do to stay on track with their therapy

The drug marketplace is growing and changing rapidly. Our clinical expertise, ongoing surveillance, and reporting tools inform management decisions, contain rising costs, and achieve lower overall spend. Proactive and responsive tools are key:

Checkmark New-to-market reviews for day 1 control
Checkmark Strategic drug removals to prevent wasteful spend
Checkmark Quarterly formulary reviews and ongoing evaluations

Review of new-to-market drugs

Each week, we evaluate newly launched drugs prior to formulary inclusion to help control costs from day 1

63 
new-to-market drugs blocked from inclusion on our commercial template formularies in favor of lower-cost, clinically appropriate alternativesCVS Health internal analysis, Q1-Q3 2022.

Hyperinflation management

We identify drugs with hyperinflated costs and quickly remove them from the formulary to deliver timely savings*

$563M or $2.32 PMPM
client savings January-July 2022CVS Health, 2022. Book of Business, Commercial Clients enrolled in managed template formularies: January-July 2022. Hyperinflation Exclusions from 2019-2022. Baseline Rx calculated based on one month prior to exclusion month. Actual results may vary.

Review of new-to-market drugs

Each week, we evaluate newly launched drugs prior to formulary inclusion to help control costs from day 1

63 
new-to-market drugs blocked from inclusion on our commercial template formularies in favor of lower-cost, clinically appropriate alternatives1

Hyperinflation management

We identify drugs with hyperinflated costs and quickly remove them from the formulary to deliver timely savings*

$563M or $2.32 PMPM
client savings January-July 20222

Ensuring plan member access, affordability, and convenience

We are dedicated to keeping member costs low so they can afford their medications, working toward minimal member disruption. Our 2023 formulary update ensures that 99.72% of members will not be impacted.

This year we have optimized our member communications to deliver an enhanced digital experience. Members with a mobile preference that have opted into receiving short message service (SMS) messaging will receive text message notifications about upcoming plan changes that link them to a unique formulary microsite. Additionally, members who log in to their Caremark.com account will see personalized messaging on their homepage regarding changes to their medication(s). All of our communication touchpoints – direct mail, SMS, Caremark.com and Customer Care – clearly explain what is changing, what their options are, and the next steps they need to take.

Looking ahead: Evaluating the promise of biosimilars

We’re monitoring several significant biosimilar launches expected over the next few years. Biosimilars market competition will help drive down costs for reference brand products and biosimilars. Competition in the marketplace will enable us to help drive the lowest net costs for our clients and make drugs more affordable for members.

Through our formulary design, we’re able to achieve >94% of preferred drug use in all biosimilars categories combined

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CVS Health is committed to providing a clinically sound formulary that drives lowest net cost for clients while ensuring members have affordable access to the drugs they need to manage their health.

Want to learn how our formulary strategies help lower cost while maintaining member experience? Ask Us
BRIEFING
September 30, 2022
Joshua Fredell, PharmD
Vice President and Head of PBM & Specialty Product Innovation

*Subject to applicable law.

**Changes for Standard Control Formulary, Advanced Control Formulary, and Value Formulary, where applicable. Numbers may change with quarterly reviews and updates.

†Removals and add-backs as of January 1, 2023. Information is accurate as of the publication date; however, it is subject to change.

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