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CVS makes moves to strengthen PBM business

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WOONSOCKET, R.I. — CVS Health has announced two major agreements to boost pharmacy benefit management ­services.

The company late last month introduced a 30,000-store performance-based pharmacy network anchored by CVS Pharmacy and Walgreens designed to deliver savings and improved clinical outcomes for CVS Caremark PBM members.

That followed the company’s announcement of a five-year deal to service insurance company Anthem Inc.’s new PBM, IngenioRx, starting in 2020.

“Steadily increasing drug costs, and the current transition in health care from volume to value, require us to continually develop and implement innovative solutions to help our clients manage pharmacy costs while improving health outcomes,” said CVS chief operating officer Jon Roberts. He said the partnership with Walgreens, which includes up to 10,000 independent pharmacies, “enables us to offer a new kind of pharmacy network that provides our clients with opportunities to improve health outcomes and lower overall health care costs, along with comprehensive, nationwide access to medications for their patients.”

Performance measures for participating pharmacies will include demonstrated medication adherence for chronic conditions that are impactful to client costs (e.g., hypertension, diabetes, respiratory conditions and behavioral health). Participating pharmacies are encouraged to implement their own proprietary programs and work-flow processes to enable them to deliver results related to the measures being tracked.

“Walgreens is pleased to advance our commitment to improving patient care and health outcomes through improved medication adherence by participating in this new performance pharmacy network,” said Alex Gourlay, co-chief operating officer of Walgreens Boots Alliance Inc. and president of Walgreens. “This network recognizes that pharmacists do more than dispense medications; they are key members of the patient care teams and add value by helping and encouraging patients to take their medications as instructed, improving overall health and wellness while lowering costs for patients and payers. Tracking performance provides additional accountability and incentive to achieve measurable outcomes.”

“At CVS Pharmacy we know pharmacists play an important role in providing our patients with timely and relevant information about their prescription medications,” said chain president Helena Foulkes. “Given that our pharmacists are on the front lines of health care in their role as a trusted health care provider, their interventions can help patients take their medications as directed by their physicians, ultimately improving outcomes and managing overall health care costs.”

CVS Caremark will make the network available to eligible PBM clients for implementation beginning in March.

Under the deal with Anthem, CVS Caremark will manage certain services for IngenioRx, including claims processing and prescription fulfillment. In addition, CVS Health’s bundled suite of assets, including CVS Pharmacy and MinuteClinic, allow the company to apply its expertise in patient messaging and engagement at the point of sale to support the new PBM, broadening the scope of clinical services offered at the pharmacy counter to drive better outcomes. The agreement runs from January 1, 2020, through December 31, 2024.

“We believe that this agreement further validates the important role that CVS Health’s integrated and innovative pharmacy care model plays in today’s health care system, and we look forward to working with Anthem and IngenioRx to provide services to help ensure coordinated, holistic care for their PBM members,” said CVS Health president and chief executive officer Larry Merlo. “At CVS Health, we truly are the front door of health care, with nearly 5 million Americans walking into a CVS Pharmacy every day. Given our presence in the community, our pharmacists and nurse practitioners are able to engage in face-to-face personalized counseling and clinically effective interventions that will enable us to help improve health outcomes and lower overall health care costs for Anthem and its members.”

The pact is a blow to Express Scripts Holding Co. because it means Anthem, the country’s second-largest insurer, will not renew its PBM contract with Express Scripts when it runs out at the end of 2019. Anthem has sued Express Scripts on the grounds that it overcharged the insurer for prescription drugs for years, accusing the St. Louis-based PBM of getting “an obscene profit windfall.” Express Scripts, for which the contract with Anthem has been worth about $17.1 billion a year, has countersued.

Anthem chairman, president and CEO Joseph Swedish said that “we determined that our scale and experience best position us to deliver an innovative solution, and the launch of IngenioRx will allow us to break through what is now a complex and fragmented landscape. It also positions Anthem to take advantage of a unique opportunity to grow and diversify our business within our existing footprint as well as ­nationally.”

CVS expects to incur implementation costs related to the transition of members, as is typical of any large, multiyear contract. The costs are expected to be immaterial to 2017 ­results.


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