CVS Caremark reports single-digit drug trend for 2023

As the leading pharmacy benefits manager, our purpose at CVS Caremark is optimizing drug spend for our clients, while improving health outcomes for their plan members. Our comprehensive approach combines multiple strategies to keep costs down and help clients meet their business goals.

Delivering results across categories in 2023

Overall drug trend

Every day, we work to deliver exceptional value to our clients, and cost savings is our number 1 priority. Our unique approach to cost management includes multiple strategic levers to maximize savings over time. Clients have the flexibility to select the approaches that work best for them, their business, and their members.

PBMs are one of the few players in the drug supply chain working to drive down costs. By negotiating discounts and encouraging competition, we help drive adoption of lower-cost therapeutic alternatives and help lower the cost of prescription drugs. In 2023, we achieved single-digit overall drug trend for the seventh year in a row.

Specialty

Historically, specialty medications have represented the greatest percentage of clients’ drug spend, while covering a relatively small member population. Through analysis of that population, we can offer plan sponsors customized coverage through smart utilization management strategies that help to ensure members have coverage for the right medication, at the right dose, at the right time. Further, integrated specialty leads to economies of scale, informs coordinated care, and permits connectivity and insights that reduce waste.

In 2023, CVS Caremark delivered single-digit specialty trend. 

The autoimmune category is a notable success story. Despite positive utilization, overall spend in the category declined due to reduced price growth that more than offset the increased utilization. One contributing factor is the launch of multiple Humira biosimilars during the year, increasing marketplace competition.

We continue to take industry-leading actions to accelerate biosimilar adoption. In January 2024, CVS Caremark announced that we would be the first PBM to remove Humira from our commercial template formularies effective April 1, 2024, continuing our leadership in this area.

Following this strategic shift, 97 percent of Humira (adalimumab) scripts have been filled with a preferred biosimilar, demonstrating rapid adoption. Clients who remained on the standard commercial template formulary have realized $315 million in gross savings throughout April and May.¹ Additionally, for these plans that utilize intelligent benefit design, members experienced a $0 out-of-pocket cost for preferred biosimilars.²

GLP-1s

Smart utilization management is especially effective in managing the high prices of new, innovative therapies such as GLP-1s (glucagon-like peptide-1 receptor agonists).The spike in popularity of these therapies, which are used to treat metabolic health conditions including diabetes and obesity, created a new challenge for plan sponsors in 2023. Had it not been for the unprecedented demand for these drugs, overall drug trend would have been less than 2 percent for the year.

Our innovative approach to managing GLP-1s gives plan sponsors the flexibility to customize three key elements: coverage, cost, and care. Clients adopting low net cost and utilization management strategies experienced 68 percent savings in the GLP-1 weight management class.³

Low-cost focus extends to members

We’re working to improve health for plan members in several important ways. We know that medication adherence is critical to better health outcomes, and that affordability plays a key role in adherence. We’re committed to providing solutions that improve member affordability, a goal we have been pursuing for years. In 2023, average member out-of-pocket cost declined for the seventh consecutive year.

This represents a 29.3 percent reduction in average member OOP cost since 2016. Also in 2023, 68.4 percent of members spent less than $100 OOP on medications, and 85.6 percent of members spent less than $300.

One way CVS Specialty preserves affordability for members and clients is by eliminating waste. Through digital engagement with members and EHR connectivity with providers, CVS Specialty can deliver clinical interventions that optimize member treatment and drug management, eliminate unnecessary spending, and reduce the chance of adverse events or ineffective medication.

Optimizing member experience

Affordability is a crucial part of member experience. Through expertise gained from onboarding millions of new members every year, CVS Caremark has designed programs and solutions that support members’ unique health journeys. We do this by:

• Being proactive and supportive
• Making experiences easy and clear
• Helping members maximize their benefits and minimize costs

These 2023 results demonstrate our position as the PBM market leader.

We deliver an integrated suite of solutions and services to help plan sponsors address the biggest challenges in today’s health care landscape. Our whole health approach to care brings clinical expertise and innovation together, optimizing the impact of clients’ pharmacy spend.