- Programs & Services
Better Management for Complex Regimens
Oncology accounts for 37 percent of all medical pharmacy spend.
The National Comprehensive Cancer Network (NCCN), an alliance of 28 leading cancer centers, publishes clinical practice Guidelines to help inform therapy decisions. The Guidelines cover 97 percent of all cancers affecting patients in the U.S., are widely regarded as the gold standard, and are one of the official sources
In 2018 alone there were more than 500 updates made based on evolving treatment landscape.
Beginning in 2018, we partnered with NCCN to directly integrate the Guidelines into Novologix, CVS Health’s proprietary technology platform and serve as the clinical backbone of multi-drug regimen prior authorization for physicians and patients. The integration enables streamlined, automated PA process. Review and approval of PA requests at a regimen level rather than for individual therapies helps ensure clinical efficacy, enhanced safety and better cost management.
The integration offers:
A single front-end interface and effortless navigation through the NCCN compendium
The ability to review all NCCN-supported regimens prior to treatment selection, enabling real-time decision support.
Regimen-specific dosing authorizations that drive clinical appropriateness and claim accuracy
Optimized therapy selection supported by peer-to-peer oncologist review and panel consensus for treatment regimens
Our integrated PBM and specialty pharmacy model helps lower medical and pharmacy costs, improve outcomes and create a better member experience.
Medical Benefit Management
By 2020, nearly half of all specialty medication spending will be under the medical benefit, making it critical to have a comprehensive cost management strategy in place across benefits.
Image source: Licensed from Getty Images, 2019.
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