- Programs & Services
- Cost Management
- Specialty Management
- Care Management
- Member Engagement
- Health Plan Client Engagement
Delivering low net cost remains the foundation of our formulary approach
Earlier this year, the market witnessed drug manufacturers adjusting prices in response to public policy changes and then in July, the launch of several Humira biosimilars. In response to these market dynamics, we ensured our clients had a choice in how they reach low net cost, and a way to confirm that their formulary design continues to deliver savings while optimizing plan member experience.
Clients aligned to one of our existing core template formularies can achieve low net cost with lower list price strategies when appropriate and applicable, or rebated product strategies with our new Choice formularies.
Significant client savings. Minimal member impact.
Our 2024 managed formularies are expected to deliver:
in client savings1
|$138 in savings
|98.6% of members will not be impacted by formulary removals1|
Using a combination of comprehensive surveillance and strategic drug removals, we promote clinically appropriate coverage, preserve member experience and help prevent wasteful spend.
We remove hyperinflated drugs from our formularies that have readily available, clinically appropriate and more cost-effective alternatives, delivering timely savings for clients.
|$555M or $2.28 PMPM client savings 2|
Delivering a positive member and prescriber experience
We are dedicated to keeping member costs low so they can afford their medications, while limiting member disruption. Our 2024 formulary update ensures that 98.6 percent of members will not be impacted.1
And the members and their prescribers who may experience impacts will receive proactive outreach in ways they prefer, so they know exactly what to do to stay on track with their therapy.
We have made investments in technology and optimized our member communications to deliver an enhanced digital experience. Members with a mobile preference who 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. All of our communication touchpoints – direct mail, SMS, Caremark.com and Customer Care – clearly explain what is changing, their options and the next steps they need to take.
Staying ahead of the market in 2024 and beyond
In September, CVS Health launched Cordavis, a wholly owned subsidiary that will work directly with manufacturers to commercialize and/or co-produce biosimilar products for the U.S. market.
As the U.S. pharmaceutical environment continues to evolve, biosimilars represent one of the biggest opportunities for reducing drug costs for payors and patients. Through Cordavis, CVS Health intends to develop a portfolio of products that is expected to facilitate broader access to biosimilars, creating more competition that drives down prices while encouraging investment in future products.
CVS Caremark welcomes competition in the marketplace and will work with Cordavis and other manufacturers, enabling us to deliver on our commitment to driving low net cost for you and helping make drugs more affordable for your plan members.
1. CVS Health, 2023. 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.
2. CVS Health, 2023. Book of Business, Commercial Clients enrolled in managed template formularies: January 2023-July 2023. Hyperinflation Exclusions from 2020-2023. Baseline Rx calculated based on one month prior to exclusion month. Actual results may vary.
This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health.