Today’s consumers live in a world of instant gratification
They expect easy access, intuitive apps and seamless digital experiences. And they’re bringing those expectations to their health care.
Members expect their care team — doctors, pharmacists and more — to have access to the right info at the right time, wherever they go. That’s why we’re investing in innovative solutions that deliver a pharmacy experience that’s easy, effortless and fast — because when it comes to health, no one wants to wait or wonder. We’re designing experiences that give consumers what they need: 24/7 access, real-time communication and easy-to-use digital tools that empower smarter decisions.
How a positive member experience benefits plan sponsors
As a plan sponsor, negotiating a low net cost while delivering seamless member experiences can feel like walking a tightrope. This balancing act is crucial because a cost-effective solution that leaves members frustrated is no solution at all.
Luckily, a positive experience is not only good for members, it’s a win for you and your HR team. When members have a positive experience, it takes a huge burden off HR. There’s real value when they don’t have to field endless cost and coverage questions. When members have clear, user-friendly tools and resources to find answers on their own, HR is freed up to focus on their main job functions. And when members are informed and supported, they make better choices.
- Better adherence: When members understand their medication options and costs, they’re more likely to take them as prescribed and refill on time.
- Healthier outcomes: Better adherence leads to improved health, fewer hospital visits/complications and a higher quality of life.
- Lower costs: Members who experience healthier outcomes are less likely to need costly treatments or hospital stays, reducing overall health care spend.
It's not just thoughtful design, it’s good business. We’re creating experiences that are easy for your members to navigate and built to work harder for your bottom line. Member experience is more than just a part of the benefit package, it’s a strategic advantage.
Efficiency by design: Innovating for faster answers and fewer delays
Digital-first engagement is more than a catch phrase, it’s a necessity. Today’s digital world moves fast and consumers expect their health care to keep up. Whether they’re on their phones, tablets or laptops, members want on-demand access to support wherever they are. That’s why we invest in experiences that meet them in the moment — making things easier, faster and more connected.
Innovating with purpose: Automation that anticipates members’ needs
Automation is streamlining processes, making it easier for members to manage their health care. We’ve designed support models that put the member at the center through 24/7 access to live agents, self-service platforms and artificial intelligence (AI) tools that anticipate issues, answer questions and connect them to resources.
AI to drive efficiency
We use AI to enhance our services but have clear guidelines to make sure it complements — not replaces — human interaction. We’ll never use AI for clinical diagnosis, denials or to prevent personal connection. And we safeguard data with data encryption and security protocols.
- AI call intelligence tool: This cutting-edge tool extracts key insights like call topics, call drivers and medications discussed. This allows us to proactively identify widespread or emerging member frustrations specific to your population, creating targeted interventions to improve their experience.
- Call summarization tool: Our call summarization tool generates standardized call summaries. Instead of taking notes, agents can focus on providing the support members need, reducing call times by 5%.
- Supply chain support: Automated monitoring and notifications allow for timelier and more proactive outreach during natural disasters or drug shortages, which helps avoid treatment disruptions.
Disruption Engine
GenAI reviews plan benefits and predicts member issues, helps with therapy adherence, reduces friction and triggers proactive member communications.
Members who received digital disruption alerts had a 26% drop in inbound call rates compared to members who only received letters.1
Innovation in action: Reimagining prescriber engagement
Prescribers play a powerful role in the health care journey. That’s why we’re not waiting until a prescription is written to engage. We’re meeting prescribers earlier, at key moments in members’ care journeys — even before they make treatment decisions.
We work closely with prescribers via electronic health records (EHRs), Real-Time Benefits (RTBs) and prescriber foresight technology to anticipate and address issues to prevent delays in care, reduce member friction and lower costs.
- In provider offices: Provides transparency into costs, benefit designs and medication history.
- At the pharmacy: Relieves administration burden and optimizes clinical reviews/verifications.
- Behind the scenes: Creates automated decisions and reduces unnecessary PAs and delays.
CVS Specialty processes that are embedded directly into prescriber workflow tools result in more than 50% of specialty prescriptions being processed without requiring additional outreach to providers.2
Our strategy is working3
36.3%
reduction in member out-of-pocket costs from 2016-2023
26%
reduction in member cost share
27.6%
reduction in non-specialty member cost share
25.4%
reduction in specialty member cost share
Transparent and streamlined PAs
We’re simplifying the PA process with real-time alerts and smart automation to help members get the treatments they need, without delays. And by proactively connecting with prescribers through EHRs, we make sure renewals happen on time, removing unnecessary roadblocks.
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80%
of PAs are submitted electronically4
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>40%
of ePAs are approved in <1 hour5
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3.5 hour
median turnaround for PA approvals6
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>90%
of approvals are completed within 24 hours6
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750K
PAs for diabetic GLP-1 members were initiated by using diagnosis and claim data
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Jan 2025
PAs were removed from pediatric oncology medications to prevent delays in care
Innovation that guides members forward: Powering better outcomes
Proactive care isn’t just smart, it’s essential. When members get ahead of their health with preventive screenings, wellness visits and timely support, outcomes improve and costs go down. That’s why we’re innovating to meet members before issues escalate.
Our Customer Care team is a key part of this approach. Members can call to get answers, referrals and even connections to mental health support – helping them make informed decisions and stay on track. This kind of high-touch engagement leads to better adherence, fewer readmissions and lower costs.
Proactive member engagement and advocacy
We make member experiences more timely, focused and personal with a 93% member satisfaction.7 We don't wait for members to reach out — we contact them directly so they can understand their benefits and know how to use them. We advocate for members, providing proactive support during key milestones.
Onboarding
- Making sure members feel welcomed and informed from the very beginning.
- Transferring existing mail-order prescriptions and sending refill reminders.
- Results: 7.2% adherence lift when we send digital refill messages8
- Calling members who may need additional support with new conditions or treatments.
Formulary/benefit changes
- Guiding members through transitions and alerting them when changes impact their medications.
- Transitioning coverage to preferred alternatives so additional PAs aren’t required.
- Allowing providers to process formulary exceptions (when required) ahead of changes to avoid disruption.
- Using digital channels to inform members and providers of changes.
Proactive savings advice and alerts keep member out-of-pocket costs low
Our connections with providers through RTBs allow them to see — and select — the most relevant, lower-cost alternatives based on members’ plans. This helps them save from the point of prescribing and avoid surprises at the pharmacy counter.
Learn about our tools that help members save
Affordability
Out-of-pocket costs stay low because we provide clients with a range of plan design options to fit their needs. We give members proactive savings advice and real-time visibility into costs.
Access
Nationwide access and scale offer comprehensive services and the largest network of covered pharmacies. This allows us to provide personalized support and connections.
Support
Member communications are timely, focused and personal. We provide clinical support and contact members directly so they understand their benefits and how to use them.
Transitions
Member advocacy is our top priority. We do the heavy lifting to help keep members on track, providing additional support during important milestones.
Personalized, preventive care at the pharmacy counter11
- Counsel members about medications, side effects and adherence — offering preventive services and mental health support.
- Identify gaps in care, comorbidities and risk factors — referring to services as needed.
- Connect to providers via EHRs to discuss in-network drugs, affordable medications and PAs.
Our people make the difference
We approach member experience differently. We’re not just chasing the latest tech trends, we’re leading. We’re training every colleague in every department to adopt a mindset that puts members at the center of every solution. And we have a 99.4% first call resolution rate12 to prove it. Backed by the strength of CVS Health, voted one of the country’s most trusted brands13, CVS Caremark is powered by a culture that puts members first.
We’re proud to be recognized for having the #1 culture and #1 Employee Net Promoter Score (eNPS) in the industry.14 When colleagues feel supported, valued and proud of where they work, they bring that energy to each member interaction. And we don’t just prioritize member experience, we reward it. Net Promoter Score (NPS), which measures how likely members are to recommend us, is built into how we incentivize and compensate our teams.
So, when members thrive, our colleagues do, too.
Innovations in member experience: It’s a competitive advantage
Members shouldn’t have to jump through hoops to get the medications they need. That’s why we advocate for your members – designing innovative processes that remove extra work and making sure they face fewer hassles and lower costs at the pharmacy counter.
Innovation isn’t just part of our strategy, it’s what drives our entire approach to member experience. From engaging prescribers earlier in the care journey to empowering members with digital-first tools and proactive support, we’re reimagining how care is delivered.
In pharmacy benefits, delivering a positive member experience isn’t just about keeping members happy, it’s a strategic advantage for clients (and a time-saver for your HR team). It drives better adherence, improves health outcomes and reduces overall health care costs. We’re not just making things easier for members, we’re designing experiences that work harder for your bottom line. We’re creating better experiences and delivering smarter health care, which is good for your business.
Interested in elevating your member experience?
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All statistics are generated from CVS Health Enterprise Analytics unless otherwise noted.
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2 More than 50% of Rxs processed without additional outreach [to prescribers or providers] with CVS Specialty Expedite P1015401223
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3 Employer Case Study on an employer with 20K members who was experiencing member abrasion with their full replacement, high-deductible health plan (HDHP) design. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors. Client‐specific modeling available upon request.
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4 CVS Health Analytics, 2022. Data from 8/1/22 – 9/27/22. Analysis of EHR records includes the 10 highest volume specialty therapies: AutoImmune, MS, IPF, growth hormone, PAH, IG, CF, HAE, hemophilia, oncology. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors. P1012821022
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5 CVS Health Analytics, July 2024, Prior authorization data from EDW P1016780824
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6 CVS Caremark Analytics, 2025. Data from Jan 2025. P1017530325
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7 CVS Caremark Member Experience Survey. P1009480721
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8 Analysis period: January 2021 through Dec 2021, Caremark employer book of business population. P1014920823
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9 Surescripts Industry Report, 2023.
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10 ePrescribing Operations Proprietary Data Analytics, January 2025.
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11 Preventive pharmacy services can differ based on pharmacies. They are available to members where they are offered.
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12 CVS Caremark Customer Care Book of Business, 2023. P1013150123
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