A unique focus for a PBM: Keeping members off medication

Lucille Accetta, RPh, MPH, MBA, is Senior Vice President for PBM and Specialty Product Development at CVS Health. In that role, she leads product development and management of all specialty, pharmacy benefit clinical, drug affordability, care management and formulary products and services for clients.

She joined CVS Health in July 2017 as Vice President, Specialty Program Management; she was responsible for specialty therapy strategy and benefits verification as well as the pharmaceutical manufacturer reporting and pharma account management teams.

You have been with CVS for four years. How has your role evolved since you joined the company?

I started at CVS Health leading the portfolio management team, which was the strategic team that looked at all of the therapeutic drugs that make up the specialty portfolio, where trends were going, pipeline and strategies to create value for our clients and their plan members.

Next, I was asked to head up specialty operations, a group of 600-700 people who manage all the benefits that are processed through our specialty organization. That role gave me the opportunity to hone my skills in process optimization – putting our customers first to deliver exceptional experience while creating efficiencies for clients and our enterprise.

Gradually, I shifted from operations and strategy to leading PBM and specialty product development, a role I have held for the past two years. My role pivoted from being primarily internal strategy to focusing on client- and member-centric products across all business units of CVS Health including Aetna and MinuteClinic.

How do these earlier roles in operations inform your current, product-focused role?

My experience in operations provided me with a process optimization lens to apply to ideas and projects. I also learned to go straight to the source for valuable information that could be useful in our improvement efforts.

When I managed the Benefit Verification team, I wanted to learn the process. I sat next to the call center reps, watching to see how many clicks and steps they had to go through to get their jobs done. Sitting with a person managing a patient over the phone, I could see how many systems and screens they had to open. This helped me understand what I could be doing when making decisions about technology, to help our people do their work more efficiently to provide better service to our customers. We also used their feedback on challenges to look at how we could use the data we have in-house to re-prioritize their work queues.

That was my favorite part of that role: working closely with our employees, obtaining their feedback about pain points and how we could make processes better for them. 

How do client needs inform the development of new products at CVS Caremark?

Thanks to great partnerships with the sales organization, consultant relations and clinical advisors, my team learns what is important to clients and what we need to develop. This cross-functional collaboration helps us better understand what we may be missing in the marketplace and identify new products to fill those gaps.

One example is the specialty copay optimization program. We heard from the sales organization that this was a key capability that could help our clients save money on their drug spend.

We launched the PrudentRx copay optimization program and launched our first client in August 2020. By February 2021, we had 200 clients, and to date we have more than 400 clients who are realizing average gross savings of 22 percent.¹ Its rapid adoption shows that when you listen to your market and deliver a good product, you will be able to serve new clients and be successful.

In new product development, how do you strike a balance between innovation and caution

It takes courage to be first to market with anything. Take the rheumatoid arthritis (RA) pilot we’re launching soon, in which we are working to optimize first-line therapy and drive smarter biologic management through pharmacist-led, concierge-like member care and provider engagement. It’s new and different, and we believe it will reduce costs and improve outcomes. 

For us as a company, the key is partnership between product development and the sales organization. It’s about having leaders who are willing to be arbiters of new ideas; they give us the opportunity to discuss those ideas with clients who will try them out. 

Similarly, we are piloting ultraviolet (UV) light therapy for the treatment of psoriasis. This is a game-changer: Before a member starts a high-cost biologic, we’re asking them and their providers to consider using UV therapy. It is part of a clinical protocol, but most physicians tend to go straight to the biologic. Clients have already expressed interest in participating in the pilot. 

Although delaying progression to a biologic might not seem what a specialty pharmacy would want, we’re trying to do the right thing for our patients while reducing costs for our clients.

How do you evaluate ideas, how do you refine them and how is success measured?

We usually start with a pilot for a new product to ensure that it will work operationally – we manage outcomes, assess experience and evaluate savings impact from the start. For example, with the devastating impact of COVID-19 last year, businesses were making difficult choices and tough decisions to maintain business continuity. At the same time, we were thinking innovatively about how to support our clients and their employees.

We launched a drug discount card program, RxSavingsPlus. It is available at no cost to clients and enables them to offer discounts to part-time and new employees that are not yet eligible for pharmacy benefits including employees losing pharmacy benefit coverage. We believed it was such a great program that, rather than recruit one client at a time, we gave it to all clients on an opt-out basis. All we asked them to do was try it. At the end of the trial period, the vast majority of clients saw the program's value. So that was one trial and one measure of success.

We also test and learn on ourselves. We recently launched our new Maintenance Choice program, which was replacing the mandatory 90-day fill for brand-name prescriptions, to a 30-day supply. We monitored the data and feedback across CVS Health employees who use this benefit. Out of 300,000 members, we received only two complaints. , we wanted to understand how our own members would react. It sends a positive message to the market that we are making these big changes as well.

Is there equivalent opportunity for innovation in regular PBM and Specialty?

There are many innovations that spring from the impetus of specialty spend. If we can manage a client’s utilization by getting the right patient on the right drug at the right price at the right time, we can apply that same approach more broadly to impact overall spend.

In PBM, we focus on how we can help all clients manage all kinds of drug spend. There are some therapeutic areas that are becoming very expensive even though they are not specialty, such as diabetes and cardiovascular disease.

In the future, we’re considering a de-prescription option in our diabetes program. If we can manage someone’s diabetes with diet and exercise, we could probably decrease their drug utilization over time. That will resonate in the market because, despite the fact that we are a PBM, we want people to be on medication only if they require it. We’re at a pivotal time when we’re trying to figure out how we can aggressively manage these high-cost drugs. That would truly be a way to disrupt the industry.

You’re going to see us take a more up-front, proactive approach to reduce costs, not only in specialty but in many therapeutic areas, especially the higher-cost ones.

You once worked in a CVS Pharmacy. How does that experience come into your work today? Whom do you picture when you think about members and patients?

I often picture the senior patients. I always felt a strong connection to them; many of them take multiple medications, so I got to know them well. I became part of their families and their lives.

Although I sometimes miss that close connection, being a single touch away from patients, I also know that whereas I might have served a few hundred people per day in the pharmacy, my current work at CVS Health serves millions. I try to apply that customer-centric mentality from my retail days to everything we do as an organization.

The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted.

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

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