New Performance Network Delivers Better Outcomes, Cost Savings

Pharmacist filling prescriptions in a timely manner
BRIEFING
October 25, 2017
Executive Vice President and Chief Operating Officer, CVS Health

CVS Health today announced a new 30,000-store performance-based pharmacy network anchored by CVS Pharmacy and Walgreens, along with up to 10,000 community-based, independently owned pharmacies across the United States.* The network is designed not only to deliver unit cost savings but also to improve clinical outcomes that will help lower overall health care costs for CVS Caremark pharmacy benefit management (PBM) clients and their plan members.

Participating pharmacy performance will be evaluated based on member adherence to medications for chronic conditions and compliance with plan formulary guidelines.

With prescription drug prices on the rise — at launch and year-over-year — payors continue to look for ways to control costs and derive the most value for their pharmacy spend. We offer strategies like indication-based formulary and outcomes-based contracts in formulary management. With the CVS Caremark performance network, we are extending this approach to networks.

High-Quality Care at Lower Costs

Health care is rapidly moving
toward a value-based
management approach,
which ties reimbursement
to quality and performance,
rather than quantity.

Paying-for-performance is the future of pharmacy management

Learn how CVS Health helps >

Health care is rapidly moving
toward a value-based
management approach,
which ties reimbursement
to quality and performance,
rather than quantity.

Paying-for-performance is the future of pharmacy management

Learn how CVS Health helps >

CVS Caremark’s performance network is an innovative solution that utilizes a value-based management approach to achieve improved outcomes through adherence for diabetes, hypertension, respiratory conditions, depression, and behavioral health. It also helps to provide cost savings through formulary compliance. Savings will vary, but clients moving from a national network can expect to save up to 4 percent in gross pharmacy spending.** Medication adherence will be evaluated through a neutral third party to maintain objectivity.

Adherence improvements in disease categories such as diabetes and hypertension are key to payors seeking to lower medical costs in high-impact, highly utilized drug classes. Our research has shown that patients with multiple chronic conditions, who become adherent after being non-adherent, have lower overall annual health care costs of up to $5,300.

In programs such as Medicaid, there are incentives tied to improvements in such therapy classes.*** In 2017 alone, there are $2.7 billion in pay-for-performance incentives at stake for payors, as well as 500,000 auto-assignee lives in government programs, including Medicaid. Fifteen managed Medicaid states also have quality measures tied to adherence and gaps in care closures in many of these conditions.

Value-Based Management

High launch prices and year-over-year inflation have accelerated the trend toward a more value-based management approach in the pharmacy benefit. Targeted formulary strategies that provide preferential placement to cost-effective treatments also help payors lower costs. Our performance network further helps control costs by tracking pharmacy compliance to a client’s formulary. For payors on a broad national network, it offers the opportunity to move to a managed network that delivers added value while giving their members access to two broad pharmacy chains, in addition to a range of independent pharmacies.

Innovative Tools to Minimize Member Disruption

Transitions can be difficult, particularly for members with complex conditions. We use more than 500 baseline characteristics to identify the members who may need additional support during a transition, such as a network change. Using advanced predictive modeling, data analysis and a broad range of member research that helps inform our member communications, we design interventions that can target members’ specific needs and potential challenges to minimize disruption. Our communications and member engagement programs are targeted to each member’s unique health care journey and offer them the most appropriate support during a transition so that clients can continue to implement innovative tools that help lower cost and improve outcomes.

Our processes are designed to facilitate a seamless transition for any member that needs to move from an out-of-network pharmacy to CVS Pharmacy, Walgreens, or participating community-based, independently owned pharmacy.

Want to learn how our new performance network can deliver unit cost savings and improve clinical outcomes to help lower overall health care costs? Ask Us
BRIEFING
October 25, 2017
Executive Vice President and Chief Operating Officer, CVS Health

Explore Programs

Network Strategies

Managed networks can help reduce costs as well as help improve clinical outcomes by supporting health and wellness initiatives.

Improving Health

Optimizing prescription therapy is key to improving outcomes for chronic conditions that drive a majority of health care spend.
 

Adherence

Investing in adherence helps reduce overall health care costs and drive better health outcomes.

*Network available for commercial (employer and health plan) and Medicaid clients who do not already have other managed network features in place for certain disease states or maintenance products.

**CVS Health internal data analysis. Savings compared to National Network adoption. Results will vary based on a variety of factors including demographics, plan design and implementation of other programs.

***Implementation of the network for Medicaid clients is subject to eligibility, including legal/regulatory review.

Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan.

Adherence results may vary based upon a variety of factors such as plan design, demographics and programs adopted by the plan. Client-specific modeling available upon request.

CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall.

©2017 CVS Health. All rights reserved.