CVS Caremark gets aggressive with PBM

WOONSOCKET, R.I. If you ask Tom Ryan, it’s more about the offer and the outcomes than it is about the price that is driving its pharmacy benefit management business these days. And that has the CVS Caremark chairman, president and CEO optimistic about the 2011 selling season.

“While it is still early, results to date are encouraging and we are optimistic. The clinical strategies and value proposition are resonating with clients and consultants,” Ryan told analysts during the company’s first-quarter conference call on May 4. Ryan noted that its PBM business — which posted a 2.6% boost in revenues during the first quarter — has a fair amount of new prospects for 2011 and is in a “net positive position to date.”

With a Bloomberg BusinessWeek report published just days earlier that indicated CVS Caremark is challenging competitor Medco with aggressive pricing for 2011 health plan contracts, it came as no surprise that pricing was top-of-mind for a few industry analysts.

CVS Caremark had declined to comment for the Bloomberg BusinessWeek article, but Ryan told analysts during the May 4 call that “from a pricing standpoint, we think the market is similar to what it has been in the last five to 10 years. It is competitive and aggressive and, at the end of the day, clients want the right service and they want the right clinical programs that are going to lower their overall healthcare costs, so it is a balance between pricing and service. I think pricing in the market is still rational and competitive. … Overall, I think our pricing is pretty rational and consistent with where it has been in the past.”

Ryan reiterated that its PBM business leverages a range of tools — in order to reduce pharmacy and overall healthcare costs to clients and drive generics and 90-day pricing — as well as clinical programs that reduce wasteful spend and improve medication adherence.

Its Maintenance Choice program now stands at 494 plans, representing 5.6 million lives. Lives switching from voluntary mail plans to Maintenance Choice typically see a significant increase in 90-day utilization and substantial savings for clients and their members, as well as better adherence and better generic penetration, Ryan said.

Furthermore, pharmacogenomic testing and specialty pharmacy continues to represent significant opportunities for CVS Caremark.

With its stake in Generation Health, CVS Caremark is scheduled to begin a pilot program on July 1 that will feature retrospective interventions for six traditional PBM-dispensed products and also will facilitate genetic testing to help determine whether the target drugs will be effective or safe for certain members prior to the physician prescribing the drug therapy. The comprehensive genetic benefit program will be available to all clients beginning January 2011, according to Ryan.

With regard to the retail side of the business, Larry Merlo, EVP of CVS Caremark and president of CVS/pharmacy, told analysts that the company expects the second half to benefit from, among other factors, merchandising initiatives at the front end.

“We have been working with suppliers to improve margin performance on a category-by-category basis, and we’ve also been working to refine and tailor our store merchandising programs, recognizing that not all stores are shopped the same,” Merlo said. “We are in the process of rolling out our ‘urban cluster program,’ and that group of stores represents about 20% of our base. And we are improving the category assortment, hours of operation and the checkout experience. At the same time, we are also doubling the consumables space in about half of our stores to take advantage of quick shopping trips.”