Specialty Carve-out: Promises vs. Performance

No clear indication of tighter management or greater specialty savings

Perspective from Josh Fredell, PharmD, CVS Health

Niche specialty vendors continue to emerge in the market, promising that disintermediating specialty management will result in greater savings than working with one integrated pharmacy benefit manager (PBM). But these savings claims are unsubstantiated if not patently false.

Estimates provided by these vendors often are rooted in the unlikely assumption that the payor is not currently employing any form of specialty management. Hidden costs to the payor further obscure the true potential for savings. Carve-out plans may add costs in the long term because they are paying for multiple vendors to administer their benefit. And fragmented patient care could lead to a rise in overall health care costs.

When CVS Caremark looked closely at carve-out vendors and the strategies they employ, we are unable to find credible evidence of reduced net cost. To the contrary, the reality is quite different from the promises.