WOONSOCKET, R.I. — CVS Caremark has unveiled a new medical benefit drug management service for its pharmacy benefit manager and specialty pharmacy clients.
According to the company, the offering is the first of its kind to provide a comprehensive management solution for the buy-and-bill drug model currently used by physicians — whereby the physician purchases specialty medications, administers them to the patient and directly bills the payer. The payer-centric offering will employ both prospective and retrospective drug utilization management strategies to drugs billed under the medical benefit, while ensuring minimal disruption to the physician's workflow and facilitating the delivery of evidence-based care.
CVS Caremark stated that it will work with New Century Health, a specialty care management company, to offer its clients integrated evidence-based medicine, treatment care pathways, quality improvement programs and peer-to-peer review through an innovative Web-based decision support platform.
This offering broadly will be available to CVS Caremark customers for implementation beginning Jan. 1, 2012.
Management of specialty drugs under the medical benefit poses a significant challenge to health plans and employers today. In fact, more than 50% of specialty drugs are billed under the medical benefit, many of which are administered in a physician's office. Payers are less able to identify and apply effective clinical and cost-management strategies, similar to those applied to specialty drugs billed under the pharmacy benefit, because of current medical claims, processing limitations and limited visibility to its clinical applications, according to CVS Caremark.
Through analysis of CVS Caremark data, the company found that among its PBM clients, cancer and associated supportive care specialty drugs — such as hematopoietics for anemia and neutropenia — accounted for approximately 53% of the total specialty drug spend billed to the medical benefit. As a result, CVS Caremark's new offering initially will focus on improving the quality, safety and management of oncology drugs billed under the medical benefit. Estimated savings of up to 15% of a payer's oncology spend are expected.
"This offering will enable CVS Caremark to identify the unrecognized specialty pharmacy spend currently billed through the medical benefit for oncology patients," stated Per Lofberg, president of CVS Caremark's PBM business. "By systematically tracking and analyzing this activity, we can provide our clients with an opportunity to better manage these expensive drugs while also improving the quality of care for their members."