Our integrated PBM and specialty pharmacy model helps lower medical and pharmacy costs, improve outcomes and create a better member experience.

By 2020, spend on specialty pharmaceuticals will represent 55 percent of all prescription drug spend in the U.S.1 Several factors are driving this growth including high cost, inflation and big price tags for new brand drugs. Many classes have seen double-digit manufacturer brand price inflation for several years. Manufacturers are increasingly obtaining multiple indications for drugs, and more patients are being prescribed specialty medications, even for non-specialty conditions, which also push up spending on specialty medications.

Specialty patients have complex care needs. Patients on specialty therapies have an average of four comorbidities. That complicates their therapy regimens and presents additional adherence challenges. Patients often need comprehensive clinical support and counseling to effectively manage their condition, and consume significant amount of other health care services – half the spend for patients with specialty conditions is not related to their specialty medication or condition. All this makes specialty a key area of payor concern from a trend management and patient care perspective.

Specialty Cost Management 

The rapid growth of specialty spend requires an active and innovative approach to manage costs effectively. Our integrated model provides comprehensive management strategies to help manage spend, while ensuring quality of care, regardless of benefit. We offer a broad set of proven capabilities including formulary solutions, managed network strategies, and utilization management through specialty guideline management. 

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Medical Benefit Management

Spend under the medical benefit comprises nearly half of specialty spend for payors. Our differentiated solutions, including automated prior authorization across benefits, infusion services including site of care optimization and claims editing help enable payors to view and control specialty costs under the medical benefit effectively. 

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Patient Care

Our broad clinical approach supports the complex needs of specialty patients. Specially trained pharmacy teams, including pharmacists and nurses, provide therapy-specific expertise and support, to improve engagement and outcomes. Accordant nurses have extensive experience with rare conditions and can provide condition-level support to manage the whole patient, including comorbidities.

Our Differentiated Approach

Integrated PBM, Retail, Specialty Model

CVS Health has the broadest set of integrated capabilities to manage specialty spend and improve patient outcomes. 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. 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. 

Unmatched Support

Specialty CareTeams, including embedded nurses, offer members clinical counseling and adherence support. On the phone and through secure two-way text messaging, members always have the care they need close at hand to effectively manage their condition. We also offer safe, convenient, infusion support both at a patient’s home and at ambulatory infusion sites.

Convenient Access

Our specialty model provides members with industry-leading service and expertise, regardless of the channel through which they enter. With Specialty Connect, members can drop off and pick up prescriptions for specialty medications at any of more than 9,900 CVS Pharmacy locations, or have their prescription delivered to their home or office.*

Along with online access and digital tools, CVS Health resources offer members expanded choice and greater access to specialty medications and services.

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Alan Lotvin
There are important changes happening in Specialty today that require the right trend management approach. More


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1. CVS Enterprise Analytics, 2016. “Medicines Use and Spending in the U.S.” IMS, April 2016

2. https://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DrugInnov....

* Where allowed by law. In-store pick up is currently not available in Oklahoma and West Virginia. Some states require first-fill prescriptions to be transmitted directly to the dispensing specialty pharmacy. Products are dispensed by CVS Specialty and certain services are only accessed by calling CVS Specialty directly. Certain specialty medication may not qualify. Services are also available at Long’s Drugs locations.