How CVS Caremark Kept Specialty Drug Trend To An Industry Low In 2021

CVS Caremark kept overall drug trend for clients to 2.4% over the first three quarters of 2021, marking multiple years of single-digit trend in drug price growth.

The pharmacy benefit management arm of CVS Health also kept its specialty drug trend to single digits through the third quarter, at an industry-low 5.8%, according to the company’s annual Drug Trend Report released Thursday. Caremark found that 35.9% of its clients saw negative specialty trend in 2021.

In addition, 65.3% saw specialty trend under 10%, according to the report.

Alan Lotvin, M.D., president of Caremark and executive vice president of CVS Health, told Fierce Healthcare that while a coming wave of biosimilars holds the greatest promise to address growing specialty drug costs, there are steps that can be taken now to mitigate those expenses effectively.

For one, there is a growing selection of generic options in specialty that can offer a lower-cost alternative, he said. In addition, PBMs can track whether patients are using the appropriate dose or medication regimen, which can mitigate costs. If a patient is taking a drug that doesn’t benefit them or inadvertently stockpiling doses, that can drive up expenses, he said.

Plans that are able to consistently drive down cost also have their arms around waste, and take advantage of programs that can capture lower costs, such as by taking advantage of manufacturer copay cards.

“Some of it, I would say, is good pharmacy benefit management hygiene,” Lotvin said. “Highly managed plans can get control over their drug spend.”

CVS’ copay card program, PrudentRx, was introduced in 2020 and adopted by a number of clients for 2021. Those that signed on with the program saw 12.5% decrease in their specialty drug spend on average, while those who were not enrolled in the program saw costs increase by 7.4% on average.

The program aims to prevent drug companies’ copay card programs from circumventing the insurance plan, according to the report.

Digital intervention and communication have also proved critical in managing drug costs, according to the report. Most members, about 92%, are actively enrolled in digital communications with CVS, which allows the PBM to track adherence, answer questions and act proactively about their treatment plan.

In addition, Caremark is connected directly to 75% of members’ electronic health records, according to the report.

These digital channels have led to savings of about $3,000 per effective clinical intervention and $2,300 for each patient that was targeted by interventions to manage excess supply.

While these successes have been noted, the true promise in managing growing costs is in the coming wave of biosimilars products to challenge costly, popular therapeutics. While the industry awaits true challengers to industry leaders like Humira, there are already examples of biosmilars driving down costs.

Biosimilar drugs for Remicade, an immunosuppressive drug, hit the market about five years ago. Since then, they’ve driven down the therapy’s price by nearly half.

“That deflationary pressures on drug cost from the biosimilars will be substantial,” Lotvin said.


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