Cost Management

Controlling costs is most payors’ primary concern. Our market-leading solutions help clients get ahead of trend drivers and achieve lowest net cost.

In an era when the high cost of prescription drugs is a key topic in the national debate over health care, pharmacy cost management has never been more critical. Year after year, manufacturer-driven brand price inflation has been a key contributor to prescription drug trend. The pharmaceutical market is also rapidly evolving. New products are launched with high prices and often supported by direct-to-consumer marketing to drive demand.

All these factors require ongoing monitoring, innovative solutions, and the agility to act quickly to implement effective cost management strategies. Doing so can help blunt the impact of such spend increases while maintaining access to clinically appropriate medications for members.

In 2016, pharmacy benefit management (PBM) strategies helped keep payor trend in the low single digits — 3.2 percent. Thirty-eight percent of CVS Health PBM clients had negative trend, below zero percent. Our formulary strategies include hyperinflationary drug monitoring, and new-to-market evaluations for recently-launched drugs allowing for careful assessment of the drug’s potential value in the context of the overall category and market.

Network management is another area of innovation. Managed networks can help both lower costs and improve outcomes, maintaining high rates of member satisfaction. Our real-time surveillance tools also enable rapid identification of, and response to, client-specific trend drivers.

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Formulary Management

Formulary is the keystone of cost control. Our market-leading range of formulary management strategies help clients contain costs while maintaining access to affordable, clinically appropriate prescription drug benefits for members.

Network Strategies

Our innovative network strategies help drive results. Results show that a strong managed network reduces redundancy, not member access. Our managed networks meet the unique access needs of each plan’s member population while helping to generate savings for payors.

Dynamic Trend Management

In this rapidly evolving market, our real-time surveillance and monitoring tools identify emerging trend drivers on an ongoing basis, allowing the development and implementation of solutions to control costs.

Our Differentiated Approach

Intelligent Purchasing

Our purchasing decisions are guided by a comprehensive, strategic assessment of the marketplace with clinical input from our independent Pharmacy and Therapeutics (P&T) Committee. We take a holistic view of total cost for the client, not just the price for an individual drug.

Versatile Cost Management Strategies

While lowering costs is a priority for all payors, their approach may vary. Our broad range of solutions allows us to help clients implement strategies that align with their philosophy, and the unique needs and demographics of their plan population.

Real-Time Trend Surveillance 

Because the market is changing rapidly, we know that continuous monitoring of trend drivers and the ability to adapt quickly is essential. We proactively monitor the drug pipeline, as well as a plan’s population, to quickly identify what may cause client costs to rise so we can implement effective solutions.

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All data from CVS Health Enterprise Analytics.

Projections based on CVS Caremark data. Individual results will vary based on plan design, formulary status, demographic characteristics and other factors. Client-specific modeling available upon request.