Government Services

To effectively manage government programs, payors need a PBM with experience, proven programs, and a consultative model.

Payors within government programs operate in a constantly changing market, requiring a great deal of expertise, flexibility and focus on highly compliant operations. 

CVS Health's differentiated approach delivers industry-leading cost management and clinical solutions – including innovative tools for specialty pharmacy. We also provide ongoing consultation to help ensure payors have the right solutions in place to actively reduce health care costs while continuing to offer the highest quality care to Medicare and Medicaid beneficiaries.

From a regional health plan with a focus on Medicaid populations to large, national health plans with multiple lines of government business, our integrated model, investments in technology, and real-time data sharing enable us to offer a tailored approach to help meet each client’s unique needs.

Medicare

CVS Health is an industry leader with approximately 12.5 million Medicare beneficiaries, of which 83% of those beneficiaries are in a high performing Star* plan.

Medicaid

CVS Health covers 21 million beneficiaries across 34 states. Our experience and expertise in Medicaid makes us uniquely qualified to help clients navigate this complex and evolving market.

Our Differentiated Approach

Proven Cost Containment Strategies

Government payors face growing cost pressures in continuing to deliver a robust, lower cost pharmacy benefit. CVS Health has developed a range of versatile strategies tailored to fit the needs of Medicare and Medicaid payors and offer new ways to help reduce costs while continuing to provide high quality care. Our formulary management expertise, innovative network strategies, and suite of utilization management solutions help clients better manage the leading drivers of pharmacy spend.

Our integrated care points enable us to help better engage, and empower, members to make choices that will help lower costs and improve health outcomes. We utilize our frequent interactions, health engagement technology, and real-time data to deliver personalized messages to members when they are already thinking about their health. We can reach members in a channel of their choosing, whether they’re at the doctor, at the pharmacy counter, in a long-term care facility, at home or on the go. 

Comprehensive Resources to Help Clients Achieve Success

CVS Health continues to invest in our Government Services infrastructure to ensure flexibility in operations, adherence to stringent quality and compliance metrics, consultative support for all lines of business, and the ability to adapt programs to meet client needs and changing regulatory requirements.

Influencing Policy Reform

CVS Health Government Services teams are highly engaged with regulators and legislators at the federal and state level providing insights on the changing healthcare landscape, and discussing solutions that lead to savings for government payors while improving overall quality of care for their members. Our teams are active participants in the Pharmacy Quality Alliance and National Committee for Quality Assurance, and CMS often engages CVS Health to gain industry insight prior to introducing program opportunities to the broader community. 

Improved Pharmacy and Medical Quality Measure Ratings

Dedicated resources within our Government Services Quality Programs team provide a full range of services, including data-driven identification of improvement opportunities, real-time performance monitoring, and the ability to influence the evolution of quality measures.

Have a question about how we can best support your Government Programs? Ask Us

1. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html

* high performing plans are those rated four Stars or better

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