Unique PBM Capabilities

Transcription

1 Gaining Lives With Our Unique PBM Capabilities Jon Roberts Executive Vice President & President, CVS/caremark

2 Agenda Performance Highlights Pharmacy Trends and Cost Management Programs Well Positioned to Grow in Evolving Health Care Environment 2

3 Delivering on Our Promises with Strong PBM Performance Net Revenue ($, billions) Operating Profit ($, billions) 13.6% CAGR % CAGR E E Notes: excludes Provigil reflects midpoint of guidance ranges. 3

4 2015 Gross New Business of $6.6 Billion State of Florida $1.3 billion $6.6 billion $2.1 billion $3.2 billion Health Plan Government & Union Employer Notes: 1. As of 12/4/ Gross Wins excludes Medicare Part D SilverScript individual products. 4

5 Net New Client Business of $3.2 Billion with 96% Retention Revenues ($, billions) 75% of client nonrenewals due to acquisition and retirees Business Not Renewed Gross New Business Acquired Moved to Exchange (Primarily Retirees) Other Net New Business 4 million members implemented in 2014 clients highly satisfied Notes: 1. As of 12/4/ Net New Client Business excludes Medicare Part D SilverScript individual products. 3. Client retention rate is defined as: 1 less (projected 2015 lost revenues from known terminations occurring after January 1, 2014, divided by estimated 2015 PBM revenues) expressed as a percentage. Both terminations and PBM revenues exclude the individual PDP business. 5

6 How We Win: Compete on Price, Differentiate with Service and Capabilities Exclusive Specialty Network Strategies Preferred Network, Maintenance Choice Advanced Formulary Strategies Adherence Programs 6

7 Aetna: Continuing to Expand Our Partnership Aetna Medicare Coventry Commercial Business and Medicaid d Q Q Coventry Medicare Maintenance Choice and Pharmacy Advisor continue to expand Note: 1. Aetna Medicare Business lives are moving to the CVS/caremark platform in Q1 of

8 Maintenance Choice : Client and Member Value Drive Continued Adoption Maintenance Choice Adoption (members, millions) ~34 20 to E Runway Maintenance Choice 1.0 Maintenance Choice 2.0 Note: 1. Maintenance Choice 1.0 includes Mandatory, Mandatory Opt-Out and Incentive based. 8

9 Specialty Connect TM : Like Maintenance Choice, Only CVS Health Can Offer Counseling From Choose Where to Choose Preferred Therapy-specific Send / Bring Prescription CareTeams Delivery Location CVS/specialty Home / Location of Choice CVS/pharmacy Full Integration With CVS/specialty CVS/pharmacy ~75,000 patients served half choose the retail pick-up option 9

10 Pharmacy Advisor Serves All Our Lines of Business Cumulative Counseling Interventions (millions) Q4'11 Q4'12 Q4'13 Q3'14 Successfully deployed d across Commercial, Medicare and Medicaid Delivering value in Medicare on Clinical Star Measures Retail Call Center Note: 1. PBM: Commercial, Medicare, Medicaid and Exchanges. 10

11 CVS/minuteclinic Savings Strategy Continues to Grow Client Adoption (members, thousands) 14,500 ~14 fold increase in member lives enrolled in three years ~14X 1,200 Launched capability to adjudicate CVS/minuteclinic services through PBM benefit Runway Significant opportunity to grow lives with CVS/minuteclinic remains 1.2 million total implemented and committed lives to date Note: 1. CVS Caremark Product Team master client pipeline tracking. Based on implemented plans thru

12 Enterprise Share: ~40% of PBM Prescriptions Through CVS Health Channels CVS Health Share of CVS/caremark Prescriptions 58% 40% 28% Book of Business Employer Health Plan Opportunity to drive additional enterprise share with health plans Note: 1. Enterprise share (includes mail) for the nine months ended September Book of Business includes Medicare Part D SilverScript individual products. 12

13 Agenda Performance Highlights Pharmacy Trends and Cost Management Programs Well Positioned to Grow in Evolving Health Care Environment 13

14 Fewer New Generics to Mitigate Trend: Spend Management Programs Increase in Importance Total Brand Market Sales of Expected Generic Launches ($, billions) E 2015E 2016E 2017E Note: and prior includes all actual launches E forward includes all actual and expected generic launches in total brand numbers. 3. Forward-looking information assumes no at risk launches. Source: Total brand market sales estimates represent 12 months of sales as reported in the IMS Health NSP file. 14

15 Specialty is Growing in Absolute Dollars and Percent of Total Spend Total Industry Specialty Spend ($, billions) % CAGR E 2016E 2018E Specialty 30% 38% 45% 50% Percent of Total Drug Spend Pharmacy spend Medical spend Infused oncology Source: NHE, Artemetrix, CVS/caremark internal analysis,

16 Return of Double-digit Trend Requires Tighter Cost Controls Payor Trend 10.3% 3.8% 0.1% E Source: Enterprise Analytics as of Q314; excludes compounds due to client-specific strategies. 16

17 Our Unique Set of Tools to Manage Trend Traditional / Non-specialty Drugs Specialty Drugs In Pharmacy Specialty Drugs In Medical Formulary Managed, Advanced, Value Advanced Specialty Networks 30- and 90-day Retail, Mail, Maintenance Choice Preferred, Exclusive and Infusion Networks Utilization Management Prior Authorization, Retrospective review Cross-Benefit Clinical Guideline Management and PA Site Of Care Site of Care Transition Management with Coram Nurses Claims Editing Prior Authorization, Retrospective Review Pharmacy Benefit Claims Edits Medical Benefits Claims Edits with Novologix Technology Care Coordination Pharmacy Advisor CareTeam including Pharmacist, Accordant and Coram Nurses 17

18 A Closer Look: Our Formulary Options Save Clients Money and Drive Increased Use of Generics Managed Formulary CVS/caremark led industry with introduction of strategy to exclude certain branded drugs from formulary Approach delivers savings to clients and their members Improved rebates on formulary brands Increased penetration of generics Have excluded more drugs to date than other traditional PBMs Incremental savings of over $3.5 billion expected 12 through 15 Source: CVS/caremark internal data,

19 A Closer Look: Our Formulary Options Save Clients Money and Drive Increased Use of Generics Less Savings More Managed Formulary Advanced Formulary Value Formulary Client Savings 1% to 2% 3% to 5% 10% to 12% GDR Increase 05% 0.5% 10% 1.0% 8% to 10% Incremental savings of over $3.5 billion expected 12 through 15 Source: CVS/caremark internal data,

20 A Closer Look: Our Network Options Offer Savings and Choice Less Savings More Retail 90 Maintenance Choice 2.0 Maintenance Choice day Network National Advanced Choice TM Exclusive Choice 30-day Network 68,000 50,000 19,000 pharmacies pharmacies pharmacies 20

21 Agenda Performance Highlights Pharmacy Trends and Cost Management Programs Well Positioned to Grow in Evolving Health Care Environment 21

22 Evolving Health Care Environment: Consumer is at the Center 150% 3X growth in CDH enrollment CONSUMERS expected covered lives by K 40+% people per day turning 65 projected increase in lives from 2013 Source: CDH - Employer Health Benefits Survey 2014; Exchanges - CBO 2014 beginning with 2013 enrollment; Medicaid Avalere 2014; Medicare: Pew Research Center. 22

23 Five Factors Positioning Us for Solid Growth Positioned To Grow With Our Integrated t Assets and Deep Expertise Only CVS Differentiated Member Experience Growth in Government Programs: Medicare and Medicaid Winning With Health Plans Supporting Providers in New Reimbursement Models Exceptional Service Investing for the Future 23

24 Only CVS Differentiated Member Experience: Helps Members Better Manage Health and Costs CVS Retail Pharmacist CVS/minuteclinic Nurse 1 Call Center Pharmacist CVS/specialty Care Team Benefit Opportunity Specialist Infusion Nurse Digital Tools 24

25 Growth in Government Programs: Medicare Growth Through SilverScript and Our Health Plan Partners 2 SilverScript Choice and SilverScript Plus Competitively priced Zero deductible and low premium Personalized marketing OptumRx Express Scripts Medicare Members By PBM (millions) 7.2 CVS Health Humana Catamaran Cigna 1.6 Prime MedImpact Envision Captive PDP Captive MAPD NonCaptive 8.4 Source: CMS (Membership figures as of October 3, 2014) 25

26 Growth in Government Programs: Medicare Membership Projected to be ~7.5 Million 2 January 2015 CVS/caremark Projected Medicare Members (millions) Medicare Members Individual PDP Health Plan & EGWPs 2015E Medicare Members Note: Preliminary projections on 12/8/14 after the close of the Medicare Annual Enrollment Period. 26

27 Growth in Government Programs: Increased Medicaid Enrollment with Lives Growth 2 Managed Medicaid Enrollment (lives, millions) 40+% 2015 Managed Medicaid PBM (estimated % of lives) Other 34% Express Scripts 21% 2013 MCO Enrollment Increased Utilization of MCOs and Organic Growth New Enrollees from ACA Eligibility Expansion 2016 MCO Enrollment MedImpact 8% Prime 2% Catamaran 6% OptumRX 10% 19% Source: CVS/caremark analysis, Avalere September MCO = Managed Care Organization 27

28 Winning with Health Plans: $3.2 Billion Gross New Business and 30 Total Exchange Clients in Unique PBM Model Comprehensive services that meet needs for cost control, quality, enhanced capabilities Comprehensive Specialty Solutions Holistic approach to manage specialty pharmacy across both pharmacy and medical benefits Member Access and Engagement Enterprise services that create competitive advantage in the B2C environment Expertise in Government Programs Line of business expertise to drive growth, compliance and innovation 28

29 Supporting Providers in New Reimbusement Models: Patient-centered Medical Home Example 4 CVS/pharmacy Adherence counseling and Electronic Health Record notification of patient non-adherence and gaps in therapy CVS/caremark Pharmacists provide counseling on adherence and comprehensive medication review for vulnerable patients CVS/minuteclinic Support their patient management with programs such as diabetes counseling and smoking cessation Patient-centered Medical Home CVS/specialty CareTeam pharmacist and Accordant nurse serve as extension of clinical team 29

30 Supporting Providers in New Reimbusement Models: Patient-centered Medical Home Example 4 CVS/pharmacy Adherence counseling and Electronic Health Record notification of patient non-adherence and gaps in therapy CVS/caremark Pharmacists provide counseling on adherence and comprehensive medication review for vulnerable patients CVS/minuteclinic Support their patient management with programs such as diabetes counseling and smoking cessation Patient-centered Medical Home CVS/specialty CareTeam pharmacist and Accordant nurse serve as extension of clinical team 30

31 Exceptional Service: We re Raising the Bar to Ensure Continued Success 5 Continue to Evolve Service Culture Define success Make the metrics visible Reward achievement Invest in Infrastructure Integrated delivery channels Automated benefit builder Artificial intelligence in call centers Digital capabilities Monitor Performance Metrics Holistic view of operational performance Early detection of trends; avoidance of escalated issues Speedy resolution 31

32 Positioned for Today, Preparing for Tomorrow Made the Right Moves Investments and Innovations address payor needs Effectively engaging members and providers Winning in the marketplace with integrated model Still Only CVS Scale and expertise ensure competitive pricing i Differentiated offerings drive client retention and wins Looking Ahead Continued Innovation Continue to expand unique breadth of capabilities Partnering with health plans to meet their needs Sustainable Growth Unmatched capabilities to win in fast-growing sectors Positioned for sustainable growth as market evolves 2014 CVS Gaining Health Lives With Our Unique PBM Capabilities 32