Don’t fall for the carve-out hype

Perspective from Josh Fredell, PharmD, CVS Health

Carving out specialty pharmacy perpetuates a fragmented system, compromises member care, adds administrative complexity that can negate any perceived savings and may even cost payors more in the long-term. The lofty promises of niche specialty vendors just don’t stack up against the proven performance of CVS Health’s integrated approach.

Joshua Fredell, PharmD, Vice President of Product Development, explains.

Video Transcript

JOSH FREDELL: Hi, my name is Josh Fredell, vice president of product development with CVS Health. As we look at the strategy within CVS Health, we very much want to make sure that our strategy is first starting with certainty.

Is the medication needed? If it's needed, can we get to the lowest cost opportunity, whether that be a preferred product, a preferred brand, a biosimilar, or a generic drug? And we do that through our formulary designs, and our utilization management designs.

We also want to eliminate waste throughout. We do that through quantity limits, and intervening throughout therapy to make sure it's still necessary for that patient to be on therapy. And then we're going to intervene when needed. We do that through connectivity to the member to make sure that the drug is delivering the efficacy that they want and deserve, and if not, making a change or a stop in therapy— or assessing are there side effects or other issues going on that need to be managed so that the medications delivering the best results for that patient? We know our care team can support that.

And a critical element we see to being able to do that efficiently in today's market, as well as really keep that member and physician experience in mind, is through digital connectivity. And so what we have done is we've invested heavily in connectivity with physicians through the electronic medical record. And when we've done that, we see, actually, an improvement in the efficacy of utilization management designs like prior authorizations.

Those simply get better because of the connectivity that we can have with that source of truth, the medical record. And of course, that leads to greater savings for the client, but also better experience with the physician, and that patient.

We've also invested heavily in that connectivity with members. We do that through our digital connectivity throughout therapy, and that's allowed us to, one, make sure we eliminate waste where there is supply management optimization that can take place, or through connectivity to the patient to make sure we're finding out directly from them is the drug working, or are there side effects, or other adverse events that we can help intervene on. So that connectivity is not just good for making patients feel connected to their care provider— but that's a great positive— and not only help to improve their care, but it helps reduce costs, as you see here, creating savings through improvements in utilization management designs, eliminating dollar waste through supply management and optimization, and removing other waste, and reduced costs through changing therapies, reducing therapies when they're shown they're not being effective.

We can do that effectively through a very coordinated, connected design through formulary, utilization management, co-pay optimization, but connectivity to the physician, to the electronic medical record, and to the patient. I think this is all extremely critical in today's specialty management market to— again, to get the best for cost management, but also to best care for the patients on these medications.