Network Strategies

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

The latest enhancements to network strategies can offer payors a range of benefits. Networks designed to meet the specific geographic location and access needs of a plan’s population can help maximize cost savings while maintaining the right level of access. Performance-based networks, which include pharmacies that have agreed to meet higher clinical standards such as adherence improvements and formulary compliance can also help deliver better outcomes. Nearly 37 million of CVS Health’s commercial pharmacy benefit members are in plans that have adopted a managed network. Such pharmacy networks help ensure members have access to the medications they need to stay healthy, while helping control costs for clients, and minimizing disruption.

Performance Not Just Size

Networks can vary from broad and less managed to tighter and savings-centered. Our network recommendations are based on a client’s plan priorities and wellness goals, and patient demographics and prescription profile to help maximize value, access and clinical opportunities. Performance- or value-based networks are a further evolution of network strategy and are built around pharmacies that have agreed to meet a certain clinical standard. This helps drive better member outcomes while generating client value by tying reimbursements to meeting clinical goals. Performance-based networks can deliver up to 3 percent in incremental savings.

Managed Network Options

Different managed network options can help meet different client goals from a broad network based on maximum coverage, to those focused on savings, while maintaining access. Clients can see incremental savings from Advanced Choice and Exclusive Choice networks over the broad national network that includes more than 68,000 pharmacies, both chains and independents.

Advanced Choice

  • ~60,000 pharmacies including most major chains and some independents
  • Up to 2 percent gross pharmacy savings

Exclusive Choice

  • ~22,000 pharmacies for the tiered option, including Walmart, Cardinal Health affiliates and select independents
  • Up to 3.5 percent gross pharmacy savings

Maintenance Choice

  • >9,700+ pharmacies plus mail order
  • Network and plan design for 90-day fills of maintenance medications
  • Mail pricing and member copays at both CVS Pharmacy and Mail Order

Ensuring a Seamless Transition

Payors looking to benefit from the cost reductions in a managed network are often concerned about disruption and ensuring a positive member experience. Our comprehensive communication plans are designed using predictive analytics that help us identify which members are most likely to be affected by a benefit or plan design change. We also conduct extensive research and ongoing member surveys which, combined with decades of experience, help us design communications that fit the unique characteristics of each plan’s members. We work with the pharmacies in our network prior to implementation to ensure readiness and provide a seamless member experience. 

Learn more about how we optimize the member experience

Illustrating Success: Client success with managed networks

Pharmacy network case studies
Considerations for your business
  • Could your plan save money with a new network strategy?

  • What are your concerns about implementing a managed network?

  • Have you considered a performance-based network for expensive chronic conditions like diabetes?

Have a question about our Network Strategies programs?

Other Cost Management programs

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.

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.

1. https://mprsannounce.mckesson.com/MPRS/microsite/pdf/Pharmacy_Whitepaper_FINAL.pdf.

Projections based on CVS Caremark data. 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.

Unless otherwise noted, all data is from CVS Health Enterprise Analytics.