Outcomes don’t happen by accident

Every pharmacy dollar you spend is an investment in helping your plan members access cost-effective, clinically appropriate care. Evidence-based coverage and utilization management (UM) set the stage. But what happens after a member fills a prescription?

For many, the answer is: not enough. Therapy stalls. Side effects go unaddressed. Momentum fades. Without ongoing support, manageable conditions can worsen, leading to avoidable complications. Pharmacy benefits you’ve carefully managed can fall short of clinical goals — and overall cost of care can increase.

Care management is what keeps your pharmacy benefits on the path toward better outcomes and lower overall cost of care. Clinical-first and people-focused, it meets members where they are in the day-to-day reality of their treatment, so they’re not left to navigate complex therapies on their own.

Medication monitoring, adherence outreach and lifestyle support help members understand what to expect, build healthy habits and stay engaged. That continuity matters, especially as therapies become more complex. It helps protect your plan members' health — and makes coverage more affordable, realistic and sustainable.

A continuum of clinical oversight

It’s easy to think of UM and care management as separate strategies, but they work together to maintain clinical oversight throughout a member’s care.

UM helps establish the appropriate starting point for coverage. Care management supports what happens next, as members navigate treatment, including side effects, dosing adjustments, lifestyle changes and the practical challenges of following their treatment regimens — areas where many members need guidance beyond coverage decisions alone.

Even when coverage aligns with evidence‑based guidelines, real‑world use often requires monitoring, reinforcement and adjustment. Without follow‑through, members may remain on therapy that isn’t working, stop medication without proper support or fall short of their goals.

Care management helps members make the most of their therapy, while aligning your pharmacy benefits with better value. And it works, as we see every day in categories such as weight management.

Weight management as a case study

New therapies, especially GLP-1s, have expanded treatment options for obesity and weight-related health conditions. But they’ve also dramatically affected affordability for both you and your members and raised expectations for efficacy and sustainable results.

UM and care management support different points in the same journey. UM helps guide appropriate coverage at the outset. Care management helps members follow through as treatment becomes part of daily life, providing structure and support when lifestyle changes, adherence and persistence become harder to manage alone.

In weight management, these elements are closely connected. Medication can help, but progress also depends on daily habits, persistence through side effects and support when motivation or momentum falters. Individualized support can lead to better outcomes, which, over time, may help lower medical costs related to comorbid conditions.

One member’s experience with CVS Weight Management

CVS Caremark member Mistie Mace’s story shows how transformative it can be when members don’t have to manage complex treatment changes on their own.

Before she enrolled in the CVS Weight Management program, Mistie followed her prescribed therapy but wasn’t seeing the results she hoped for. That disconnect became discouraging — an experience many members face when they try to manage complex treatment changes without ongoing clinical support.

Through the program, Mistie’s care team took a closer look at her prescription and recognized it wasn’t meeting her needs. They adjusted her medication dose and coached her through managing side effects, staying engaged with therapy and making sustainable lifestyle changes.

That ongoing clinical oversight and follow‑through helped shift her experience and put her on a more positive path.

How care management influences outcomes and pharmacy spend

Mistie’s story shows the effect dedicated care management has on a person, but her story is just one among many. We see similar results across our CVS Weight Management program.

When GLP‑1 therapy is paired with structured lifestyle support, outcomes tend to be stronger and longer lasting.

• 18.5% average weight loss for program members taking weight management drugs within 1 year^*
• Up to 47% lower spend on GLP-1s approved for weight loss^*
• 90% of members maintain weight loss 10–12 months after ending therapy^*

For plan sponsors, this matters in practical ways. It supports better health outcomes, reduces avoidable waste tied to therapy that isn’t working or sustainable, and helps align pharmacy spend with long-lasting results.

What we see in weight management highlights a broader opportunity to drive better outcomes and align value across many treatment categories.

What comes next for care management in pharmacy benefits

As new specialty and non‑specialty therapies continue to hit the market, from oncology to cell and gene therapies, the stakes only go up. Success won’t come from rigid controls or coverage decisions alone. It will come from pairing evidence‑based coverage with scalable, compassionate support that helps members apply those decisions in real life.

That’s where CVS Caremark continues to focus, so innovation, access and affordability can move forward together.