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Private Sector Solutions
to America’s Health Care
Challenges
Thomas M. Moriarty
Executive Vice President, Chief Policy &
External Affairs Officer and General Counsel
The Impact of Chronic Disease
2
1 in 2 Americans have a chronic disease.
1 in 6Americans have three or more chronic conditions.
85% of all health spending on Americans with chronic conditions.
46% of all Medicare dollars spent on patients with 6+ chronic conditions
Source: 2013 CVS Caremark Enterprise Analytics. Projections based on CVS Caremark data. Individual results will vary based on plan design, formulary
status, demographic characteristics, and other factors
FDA’s Drug Approvals Backlog Hampers
Competition
1FDA’s Generic Drug Review Dashboard. Updated July 1, 2016.
Quicker entry of generic drugs and biosimilars would remove barriers to greater competition.
•  Quicker entry of generic drugs and
biosimilars would remove barriers
to greater competition.
•  Over 4,000 generic drug
applications are pending at FDA.1
3
Market Dynamics Driving Up Drug Costs
1.  High launch prices for branded products
2.  Price increases for older drugs
Pricing Dynamics:
•  Sales and marketing outpace R&D
•  Slow drug approval timeline
•  More ‘me-too’ drugs, less innovation
•  High deductible health plans
Causes of High Cost Drugs:
$
4
Reducing Preventable Hospital Readmissions
Source: 2013 CVS Caremark Enterprise Analytics. Projections based on CVS Caremark data. Individual results will vary based on plan design, formulary
status, demographic characteristics, and other factors
1 in 7 patients are readmitted within 30 days
2/3 of hospital readmissions are due to medication issues
(non-adherence and adverse drug reactions)
Up to ¾ readmissions are preventable
65% savings, totaling $3,324 per patient, from reduced
readmissions as a result of pharmacist interventions
5
Improved Medical Adherence is Essential
•  Prescription drugs are ”first, logical choice
for medical intervention” for nearly 90% of
people with chronic and complex diseases.
•  In-person interventions are 2-3X more
effective at increasing medication
adherence.
•  Improved medication adherence could
save nearly $300 billion in unnecessary
medical costs each year.
Source: Medco 2011; CVS Health Insights, “adherence,” Fall 2014 6
Prioritizing Affordable Medicines for Consumers
Adrenaclick
$109.99 Cash Price
EpiPen
$649.00 Brand
$339.99 Authorized Generic
7
Zero-Copay Preventive Drug List Improves
Adherence and Reduces Costs
•  Consumers are less likely to pick up
scripts with more expensive co-pays.
•  As an employer, our high deductible
health plan includes preventive drug
list, where plan pays the full cost of
preventive generics and brand
insulins.
•  A model for other employers and
health care plans to improve health
outcomes and reduce costs.
8
Patient OOP Cost on Prescription
Pharmacy return to stock rate increases steadily
as patient out of pocket costs rise
9
Integrated Delivery Models to Improve Access,
Cost and Outcomes
25%
market share 12,000+
long term care
facilities served
25%
market share
1,100 MinuteClinics
in 33 states and DC
with more than
27 million patient visits
34,000
pharmacists, nurses,
nurse practitioners and
physician assistants
9,700
retail pharmacies
27
Specialty
pharmacies
12
mail-order
pharmacies
10
MinuteClinic as Low Cost Site for Quality Care
•  Address gaps in care with
providers, payors and PBMs
•  Provide health risk
assessments/biometric
screenings
•  Electronic record integration
with health systems
Investing in:
•  Scheduling tools and
walk-in options
•  Expansion of primary
care services
•  Telehealth
•  Up to 80% less expensive
than other sites of care
•  MinuteClinic Savings
Strategy can further reduce
costs
Low-Cost Care Population Health Patient Engagement
and Access
More than 50% of U.S. population is within 10 miles of a MinuteClinic
Market-Oriented Reforms Promote Competition,
Curb Rising Costs
1.  Increase the flow of generics and
biosimilars to market. Promote policies
that do not delay generic and biosimilar
entry.
2.  Empower pharmacists to support patient
care.
3.  Acknowledge the role of PBMs in
keeping drug costs down.
11
Thank You
12

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National Association of Attorneys Generals’ Presidential Initiative Summit April 2017

  • 1. Private Sector Solutions to America’s Health Care Challenges Thomas M. Moriarty Executive Vice President, Chief Policy & External Affairs Officer and General Counsel
  • 2. The Impact of Chronic Disease 2 1 in 2 Americans have a chronic disease. 1 in 6Americans have three or more chronic conditions. 85% of all health spending on Americans with chronic conditions. 46% of all Medicare dollars spent on patients with 6+ chronic conditions Source: 2013 CVS Caremark Enterprise Analytics. Projections based on CVS Caremark data. Individual results will vary based on plan design, formulary status, demographic characteristics, and other factors
  • 3. FDA’s Drug Approvals Backlog Hampers Competition 1FDA’s Generic Drug Review Dashboard. Updated July 1, 2016. Quicker entry of generic drugs and biosimilars would remove barriers to greater competition. •  Quicker entry of generic drugs and biosimilars would remove barriers to greater competition. •  Over 4,000 generic drug applications are pending at FDA.1 3
  • 4. Market Dynamics Driving Up Drug Costs 1.  High launch prices for branded products 2.  Price increases for older drugs Pricing Dynamics: •  Sales and marketing outpace R&D •  Slow drug approval timeline •  More ‘me-too’ drugs, less innovation •  High deductible health plans Causes of High Cost Drugs: $ 4
  • 5. Reducing Preventable Hospital Readmissions Source: 2013 CVS Caremark Enterprise Analytics. Projections based on CVS Caremark data. Individual results will vary based on plan design, formulary status, demographic characteristics, and other factors 1 in 7 patients are readmitted within 30 days 2/3 of hospital readmissions are due to medication issues (non-adherence and adverse drug reactions) Up to ¾ readmissions are preventable 65% savings, totaling $3,324 per patient, from reduced readmissions as a result of pharmacist interventions 5
  • 6. Improved Medical Adherence is Essential •  Prescription drugs are ”first, logical choice for medical intervention” for nearly 90% of people with chronic and complex diseases. •  In-person interventions are 2-3X more effective at increasing medication adherence. •  Improved medication adherence could save nearly $300 billion in unnecessary medical costs each year. Source: Medco 2011; CVS Health Insights, “adherence,” Fall 2014 6
  • 7. Prioritizing Affordable Medicines for Consumers Adrenaclick $109.99 Cash Price EpiPen $649.00 Brand $339.99 Authorized Generic 7
  • 8. Zero-Copay Preventive Drug List Improves Adherence and Reduces Costs •  Consumers are less likely to pick up scripts with more expensive co-pays. •  As an employer, our high deductible health plan includes preventive drug list, where plan pays the full cost of preventive generics and brand insulins. •  A model for other employers and health care plans to improve health outcomes and reduce costs. 8 Patient OOP Cost on Prescription Pharmacy return to stock rate increases steadily as patient out of pocket costs rise
  • 9. 9 Integrated Delivery Models to Improve Access, Cost and Outcomes 25% market share 12,000+ long term care facilities served 25% market share 1,100 MinuteClinics in 33 states and DC with more than 27 million patient visits 34,000 pharmacists, nurses, nurse practitioners and physician assistants 9,700 retail pharmacies 27 Specialty pharmacies 12 mail-order pharmacies
  • 10. 10 MinuteClinic as Low Cost Site for Quality Care •  Address gaps in care with providers, payors and PBMs •  Provide health risk assessments/biometric screenings •  Electronic record integration with health systems Investing in: •  Scheduling tools and walk-in options •  Expansion of primary care services •  Telehealth •  Up to 80% less expensive than other sites of care •  MinuteClinic Savings Strategy can further reduce costs Low-Cost Care Population Health Patient Engagement and Access More than 50% of U.S. population is within 10 miles of a MinuteClinic
  • 11. Market-Oriented Reforms Promote Competition, Curb Rising Costs 1.  Increase the flow of generics and biosimilars to market. Promote policies that do not delay generic and biosimilar entry. 2.  Empower pharmacists to support patient care. 3.  Acknowledge the role of PBMs in keeping drug costs down. 11