Dynamic Trend Management

CVS Health is a leader in providing innovative, proactive solutions that help to cost-effectively manage trend while still ensuring member satisfaction.

Effective trend management in today’s rapidly evolving health care market requires ongoing market surveillance, identifying trend drivers, and adapting quickly. CVS Health offers clients real-time monitoring as well as a range of trend management strategies that help control costs for payors while making sure members have access to the medications they need to stay healthy.

Real-Time Monitoring To Stay Ahead of Market Trends

Formulary management can raise GDR and lower PMPM costs
Formulary management can raise GDR and lower PMPM costs

Our dynamic trend management includes Interactive RxInsights, which enables clients to see their trend drivers in near-real time. Account teams can model cost management opportunities specific to a plan’s patient population. RxInsights includes a range of components that offer in-depth insight into year-over-year performance data, budget modeling and forecasts, and an interactive trend dashboard that provides class- and drug-level insight into what’s driving trend including price inflation and utilization increases.

Addressing Price Inflation 

In addition to double digit price inflation in branded drugs for several years, many medications have seen even higher cost increases. The trend dashboard, a component of RxInsights, enables payors to see those drugs impacting their trend such as hyperinflationary drugs – those with significant price inflation – in near-real time. CVS Health is continually monitoring the market for these drugs with egregious price increases. We help payors mitigate the impact of such cost drivers through quarterly hyperinflation management updates.

Ensuring Appropriate Utilization 

Interactive RxInsights helps detect sudden increases in utilization, enabling us to identify potentially inappropriate or unnecessary use and quickly apply effective management strategies. For clients who were early adopters of our management for lidocaine, a high-cost compound ingredient, per member per month spend dropped by nearly 90 percent in a matter of weeks – without any adverse member impact.

Managing the Drug Pipeline

As the pharmaceutical pipeline continues to evolve, payors need timely, effective monitoring, and management to mitigate the impact of branded drugs coming to market with ever-higher price tags. Data analysis and proactive monitoring of the drug pipeline enables us to more thoroughly assess cost-saving opportunities as well as the value of new-to-market drugs before including them on our formularies. For instance, when the generic for Gleevec, an oncology medication to treat chronic myeloid leukemia came to market we made sure members had access to, and when appropriate could change to, the lower-cost alternative, as soon as it became available. This led to clients achieving a generic substitution rate of 92 percent, and dramatically reduced costs for both members and payors.

Fraud, Waste and Abuse

Prescription fraud, waste and abuse (FWA) is a pervasive problem across the health care market. It can occur on various levels including member, prescriber and pharmacy, and adds cost for both clients and members. We constantly evaluate strategies to address concerning trends and can work with clients to ensure members have access to the prescription medication they need to stay healthy, while helping to reduce the number of people who misuse or abuse these drugs. Our complete view of a member’s prescription utilization, and comprehensive prescription monitoring before and after medications are dispensed, led to more than $2,000 in average savings per member. Audit and investigatory activities also detect suspicious dispensing activity at the pharmacy.

Considerations for your business
  • Do you have the right trend management strategies in place to help you reach your goals?
  • How often are you using data to make plan design or coverage decisions?
  • Are your formulary solutions protecting you from pharmaceutical pricing changes?
Have a question about our Dynamic Trend Management programs?

Unless otherwise noted, all data is from CVS Health Enterprise Analytics. Savings results will vary based on a variety of factors including demographics, plan design and other programs implemented by the client. Client-specific modeling available upon request.

This page contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health.