CVS Health Retains Pharmacy Services with Service Benefit Plan, Adds Specialty Pharmacy Care


(Photo courtesy of CVS Health)

CVS Caremark, CVS’s manager of pharmacy benefits, enters into a larger PBM contract with the government-wide benefit plan, also known as the Federal Employee Program. CVS Health has been the Pharmacy Benefits Manager for the Service Benefits Plan, which provides benefits to the federal workforce, since 1993.

The new contract, which will come into effect on January 1, 2022, allows CVS Health to regain the specialty pharmacy business it lost in 2018 and to retain other services such as mail and retail. With the reintegration of the specialty into pharmacy services, the goal is to achieve cost savings for service plan members, CVS said.

More than 700 CVS Caremark colleagues dedicated to the Service Benefit Plan are ready to take advantage of the agreement.

WHAT IS THE IMPACT ?

Specialty drugs are a critical and growing area of ​​pharmaceutical spending, and effectively managing these drug costs, while ensuring better outcomes for members, requires a holistic approach covering all aspects of pharmacy management.

The specialty conditions are complex, making patient support and clinical engagement a central part of managing the specialty to ensure a good fit between patient and therapy.

In this case, the integrated management of specialized and traditional pharmacy services essentially means that CVS Health can help the Service Benefit Plan manage expenses by reducing costs and waste.

THE BIGGEST TREND

Pharmacy Benefit Managers are a unique American concept, acting as third-party administrators of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, and employee plans of state government. Some feel that they operate with a lack of transparency.

Apparently, PBMs are responsible for maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims.

But they were dogged by controversy. In 2019, the Centers for Medicare and Medicaid Services tackled PBM broadcast pricing practices that they say lead to increased care plans managed by Medicaid and CHIP, as well as higher costs for states and communities. taxpayers.

Price averaging occurs when health plans contract with a pharmacy benefits manager to manage their prescription drug benefits, and PBMs retain a portion of the amount paid to them by health plans for drugs. on prescription, instead of transferring all payments to pharmacies.

The difference is the amount between what the health plan pays the PBM and the amount the PBM reimburses the pharmacy for a recipient’s prescription. If spread prices are not properly monitored and factored in, a PBM may profit from billing health plans for an excess amount greater than what is paid at the pharmacy dispensing a drug, CMS said.

CVS Health has been active lately. In February, he partnered with Lyft, the YMCA and other nonprofit partners to address inequities in access to the COVID-19 vaccine in vulnerable communities, with a particular focus on black and Hispanic populations.

In March, CVS Health increased the number of locations that offer COVID-19 vaccines, nearly doubling the number of states where eligible patients can receive vaccines through the health giant.

Through the federal retail pharmacy program, the company now administers vaccines to approximately 1,200 stores in 29 states and Puerto Rico.

Twitter: @JELagasse
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