Driving medical benefit savings
We empower our health plan clients with precision across
both medical and pharmacy benefits for maximum savings.
Data-driven tools and forward-thinking strategies drive our approach to improve spend management and facilitate higher-quality care. Our proprietary technology, Novologix, gives payors more precise utilization management and more visibility to control costs and simplify processes across benefits.
Access to the right therapy, right now
We know speed and convenience are key. With CVS Caremark as your trusted partner, health plans can rely on more accurate prior authorization (PA) approvals and members can get started on the right therapy, faster. This streamlined, real-time process helps improve the provider and plan member experience and delivers greater savings for you.
$5.66PMPM savings achieved for medical drug PA and site of care1
$0.41PMPM savings through medical benefit management programs 2
Our flexible medical benefit management solutions
CVS Caremark’s proactive drug pipeline review and actionable insights can impact specialty care and cost. Learn how our solutions, enabled by powerful technology, can drive better financial and clinical outcomes.
Medical preferred drug strategies
Identify products that are clinically appropriate and cost effective
Transform Oncology Care
Helping health plan clients manage the complicated cancer journey
Case study
Optimizing site of care to reduce specialty pharmacy spend
CVS Caremark identified site of specialty infusion care as an opportunity to drive savings.
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CVS Caremark.
Health Plan Case Study: Optimizing site of care to reduce specialty pharmacy spend.
Situation.
A regional health plan was looking to reduce their specialty pharmacy spend.
We identified site of specialty infusion care as an opportunity to drive savings.
Specialty infusion drugs cost up to 3 times more in a hospital outpatient facility than other sites.
Infusions outside of the hospital setting can help improve member satisfaction and outcomes.
Solution.
The plan redirected members to receive infusions at lower cost, in the comfort of home or at infusion suites.
Advance communication was key, including:
Letters to members and providers.
Outreach and coordination from a dedicated nursing transition team.
Results.
Site of care optimization led to significant savings over two years:
Growing 131% year over year, for more than $286,000 in savings.
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Solutions to support your members’ unique health journeys
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