Integration key to managing specialty patients
Specialty may be the fastest-growing segment, but it may also be the most complicated, as this segment is comprised of very complex medications to treat such serious diseases as cancer, multiple sclerosis and hemophilia. The good news for CVS Caremark is, unlike the typical PBM, it can serve specialty patients through multiple touch points that include specialty mail pharmacies, as well as CVS/pharmacy and retail specialty pharmacy locations.
Specialty pharmacy is expected to be a $15 billion business for CVS Caremark, growing 17% annually over the past two years as it has added PBM lives and the category itself has grown.
During the second quarter, the specialty business continued to achieve significant growth as revenues rose a robust 44%. According to the company, that growth was driven by new PBM clients, new product launches and drug price inflation.
As part of its effort to further advance the business, CVS Caremark has developed programs to manage the portion of drugs that are billed directly to the payer under the medical plan and that fall outside of the traditional PBM contract terms. As previously reported by Drug Store News, this largely involves injectable drugs that are administered in a clinical setting, and the drug is then billed by the physician to the payer. Through the program, CVS Caremark believes it can generate savings of 15% to 20%.
During CVS Caremark’s Analyst Day in December, Per Lofberg, EVP of CVS Caremark and president of Caremark Pharmacy Services, told analysts that its integrated assets afford CVS Caremark a unique opportunity to further improve its value proposition in the specialty field.
“By more tightly coordinating these member touchpoints and including a subset of CVS retail pharmacies, much like Minute Clinics are established in close to 10% of CVS retail stores, we can make a meaningful improvement in results for patients and clients. And this is another example of how we are reinventing pharmacy to help members improve their health,” said Lofberg. “This integration will provide patients with a truly seamless experience, from initial intake to dispensing and adherence management. It will give patients easier access to their medications, as well as personal access to expert clinical pharmacists.”