Specialty

Saving money for you and your plan members while putting the brakes on your specialty drug costs is our #1 priority.

By 2023, spend on specialty pharmaceuticals will total approximately $311B.CVS Analysis based on Evaluate Pharma, Market Research. U.S. specialty pharmaceutical market size including medical and pharmacy. June 2019. Several factors are driving this growth including costly brand drugs, inflation and increasing utilization – one of the biggest growth drivers since specialty drugs already on the market continue to obtain approval for additional indications, leading to an ever-expanding patient population.

Robust drug pipeline creates challenges and opportunities for payors seeking to balance member access and cost:

2020-2022 anticipated robust pipelinePipeline Services projections, data 2020 through 2022, as of November 19, 2019. New drug count includes new molecular entities, new biologics, biosimilars, new combinations, new formulations, projections by Pipeline Services. 571
new drugs
350
new specialty
218
supplemental specialty indications drugs
2020-2022 anticipated robust pipeline2
571
new drugs
350
new specialty
218
supplemental specialty indications drugs

Specialty patients have complex care needs and therapy regimens that present adherence challenges requiring active engagement and monitoring. They often need comprehensive clinical support and counseling to effectively manage their conditions. Proactive, hands-on management can support improved patient outcomes, and budget impact reviews can help reduce wasteful spend and provide better trend management and cost control for payors.

Our strategies and robust tools helped clients stay ahead of evolving market trends:CVS Health 2019 Trend Report; CVS Health Enterprise Analytics, 2020. (P1004950420).

CVS Health specialty trend stands at 8.9%, whereas unmanaged specialty trend is higher, at 13.2%.
CVS Health specialty trend stands at 8.9%, whereas unmanaged specialty trend is higher, at 13.2%.

Lowering Your Specialty Costs

The rapid growth of specialty spend requires an active and innovative approach to manage costs effectively. This includes increasing market competition to deliver lowest net cost, and supporting alignment with payor plan designs to drive appropriate utilization. We offer a broad set of proven capabilities including value-based formulary solutions, next generation utilization management, innovative plan designs and managed network strategies. Our connected high-touch model provides comprehensive, proactive management across medical and pharmacy benefits while ensuring quality of care.
 

Infusion bottle pictogram

Delivering Medical Benefit Solutions

Drug spend under the medical benefit comprises nearly half of specialty spend for payors.Barclays US Health Care Distribution and Technology Specialty Market Model 2017 Update: A Focus on Biosimilar Opportunities, Jan 30, 2017. Our integrated model applies the precision of pharmacy benefit management to complex and high-cost spend under medical, delivering more transparency and positively impacting clinical and financial outcomes. The automated cross-benefit platform, Novologix®, enables a variety of strategies at the point of prescribing, featuring integrated prior authorization and medical claims management, site of care optimization and medical preferred drug strategies targeting high-cost drug classes including oncology.
 

Woman and syringe icon

Maximising Patient Care

Our broad clinical approach supports the complex needs of specialty patients. Specially trained pharmacy teams provide therapy-specific expertise and support to improve engagement and outcomes. AccordantCare™ nurses have extensive experience with rare conditions and can provide condition-level support to manage the whole patient while ensuring costs are optimized. And Coram® infusion services teams deliver specialty infusion, nutrition therapies and support services for better clinical outcomes and lower overall health care costs. In addition, our advanced analytics and digital infrastructure enables us to better engage members throughout the duration of therapy to drive adherence that leads to better outcomes and cost control.

Our Differentiated Approach

Integrated PBM, retail, specialty model

$100M
investment in specialty to deliver your specialty cost and care results

CVS Health has the broadest set of integrated capabilities to manage specialty spend and improve patient outcomes and experience. Our unique model combines specialty and retail pharmacies, with pharmacy benefit and care management moving beyond traditional pharmacy to meet the unique needs of the complex specialty marketplace.

$100M
investment in specialty to deliver your specialty cost and care results

Our proven, in-market solutions deliver savings to payors while also helping to deliver a better experience and driving better outcomes. We continue to innovate specialty pharmacy services to bring additional value to payors, optimize clinical outcomes and enhance the patient experience.

Have a question about our Specialty programs? Ask Us

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