CVS Launches New PBM Pharmacy Network, NCPA Responds

CVS Health announced that it will launch a new performance-based pharmacy network early next year. The NCPA says that this new network could be good for pharmacists, but the group has reservations about how the network might reward or punish its pharmacies.

According to CVS Health, the network will consist of 30,000 stores, “anchored” by CVS Pharmacy and Walgreens. It will also feature up to 10,000 independent pharmacies across the United States.

The performance-based part of the network will include performance measurements such as medication adherence for chronic conditions including hypertension, diabetes, respiratory conditions, and behavioral health. The network will, according to CVS, help to deliver cost savings through its PBM CVS Caremark, but also improve patient outcomes that will in turn further reduce costs.

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"Steadily increasing drug costs, and the current transition in health care from volume to value, require us to continually develop and implement innovative solutions to help our clients manage pharmacy costs while improving health outcomes," said Jon Roberts, Chief Operating Officer of CVS Health, in statement. "This partnership with Walgreens, CVS Pharmacy, and independent pharmacies enables us to offer a new kind of pharmacy network that provides our clients with opportunities to improve health outcomes and lower overall health-care costs, along with comprehensive, nationwide access to medications for their patients."

Pharmacies participating in the network will be encouraged to develop their strategies and programs to enable to them to increase the performance of their patients.

"This network,” said Alex Gourlay, Co-Chief Operating Officer of Walgreens Boots Alliance and President of Walgreens, “recognizes that pharmacists do more than dispense medications [and that] they are key members of the patient-care teams and add value by helping and encouraging patients to take their medications as instructed, improving overall health and wellness while lowering costs for patients and payers. Tracking performance provides additional accountability and incentive to achieve measurable outcomes."

The network will be available to PBM clients for implementation staring in March 2018.

John Norton, NCPA Director of Public Relations, said that independent community pharmacists have been dealing with performance-based programs for some time now, but the NCPA has concerns about how the network might play out. The NCPA favors payment models that reward quality and performance, he said.

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“However,” he added, “we believe such programs should clearly separate the incentives for improved performance from the ingredient cost of the drug. Additionally, any pharmacy incentives for good performance should be just that, positive incentives, not retroactive pharmacy payment deductions that are reduced from payments for good pharmacy performance as we often see under Medicare Part D. Otherwise, the line between payment for true quality and fees assessed on independent pharmacies by PBMs will continue to be blurred.”

Norton added that the NCPA is looking into the new CVS network, but has “limited details at this time on which to evaluate its structure.” A CVS spokesperson did not have any additional details to share about reporting and tracking performance measurements, or other logistics related to the network.