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Michigan healthcare freedom community forum
CVS Health is America’s largest drugstore chain by number of locations and second largest (after Walgreen's) by sales. It also writes health insurance policies through its Aetna subsidiary. CVS has a gigantic pharmacy benefit management (PBM) business that delivers prescription drugs for big clients like health care insurers and employers.
CVS Pharmacy will adopt a new prescription drug pricing model claimed to make prices more consistent and transparent to customers. The company will offer CVS CostVantage next year through some cash discount prescription card administrators (e.g. Good Rx). CVS Pharmacy plans to extend CVS CostVantage as CVS Caremark TrueCost to pharmacy benefit managers in 2025:
- Introduces CVS CostVantageTM and CVS Caremark TrueCostTM to drive aligned incentives and deliver a more transparent and sustainable reimbursement model
- Launches CVS HealthspireTM brand for Health Services segment that simplifies access to multi-payor capabilities, better aligns client service, and drives better outcomes and greater lifetime member value
- Demonstrates ability to unlock value across superior assets including CVS Caremark®, Aetna®, and CVS Pharmacy® businesses
- Announces quarterly dividend of sixty-six and a half cents ($0.665 cents) per share, an approximate 10% increase
- Reiterates 2023 financial guidance and initiates 2024 projections, outlining achievable long-term growth expectations with clear opportunities to outperform
WOONSOCKET, R.I., Dec. 5, 2023 /PRNewswire/ -- Today at its 2023 Investor Day, CVS Health® (NYSE: CVS) will share how its strategy and combination of assets drives reliable, diversified, and accelerating earnings growth, while also delivering superior care and value to millions of Americans.
In addition, the company will introduce a new pharmacy reimbursement model, announce a new brand for its Health Services segment, and showcase continued growth opportunities for its businesses.
"We are successfully executing on our strategy to advance the future of health care while unlocking new value for consumers," said CVS Health President and CEO Karen S. Lynch. "The combination of our businesses, and the key growth areas we have invested in, drive our ability to lower the total cost of care, improve health outcomes, and deliver on our commitments to our customers, consumers, and shareholders."
Introducing CVS CostVantage, a more transparent and sustainable model for retail pharmacy
CVS Pharmacy today announced CVS CostVantage, a new approach that evolves the traditional pharmacy reimbursement model and brings greater transparency and simplicity to the system. CVS CostVantage will define the drug cost and related reimbursement with contracted pharmacy benefit managers (PBMs) and payors, using a transparent formula built on the cost of the drug, a set markup, and a fee that reflects the care and value of pharmacy services. These changes will also help ensure that CVS Pharmacy locations will continue to be a critical touchpoint for consumers to access affordable health care in their communities.
"We are leading with an approach that will shift how our retail pharmacy is compensated by implementing a more transparent and sustainable model that fairly aligns pharmacy reimbursement to the quality services we provide," said Prem Shah, PharmD, executive vice president, Chief Pharmacy Officer and President, Pharmacy and Consumer Wellness, CVS Health. "It provides our PBM and payor clients a foundational step towards more pricing clarity for consumers."
CVS Pharmacy plans to launch CVS CostVantage with PBMs for their commercial payors in 2025, working together to ensure a smooth transition.
Following on from the launch of its Choice Formulary program earlier this year, CVS Caremark today introduces TrueCost, a model innovation that offers client pricing reflecting the true net cost of prescription drugs, with visibility into administrative fees. Simplified pricing will help consumers be confident that their pharmacy benefit is providing the best possible price and will allow members to have stable access to our national pharmacy network. Through this approach, clients will have the flexibility to choose a pharmacy benefit model that works best for the unique needs of their members and plan, and CVS Caremark TrueCost provides another valuable option for them. CVS Caremark plans to launch CVS Caremark TrueCost in 2025.
Launching CVS Healthspire to define Health Services segment
To help demonstrate the connection and convenience CVS Health uniquely delivers, CVS Healthspire will be the new branded name for the company's Health Services segment, including Caremark, CordavisTM, Oak Street Health®, Signify Health®, and MinuteClinic®. The groups within CVS Healthspire will continue to focus on integration across the company's assets to deliver connected patient care, pharmacy benefits, and innovative provider support solutions in communities across the country, making expert care simple, more accessible, and more affordable.
The CVS Healthspire brand will begin to roll out publicly this month and advance throughout 2024. Consumers will initially see "Part of CVS Healthspire" appear on select CVS Health care delivery offerings across digital and physical assets as the company continues to create an integrated ecosystem for patients.
"Delivering care in a more integrated way - especially for complex patients with chronic health conditions - improves health outcomes and the patient experience," said Mike Pykosz, CEO of Oak Street Health and interim president of Health Care Delivery. "We are already seeing the benefits of our value-based model to lower the total cost of care for customers, clients, and patients, and we believe we will build on these results as we more fully integrate with our core businesses."
Accelerating momentum through combined strength and innovation of leading businesses
While CVS Health's business segments continue to be successful and profitable on their own, there is a sizable opportunity to continue strengthening these connections and create incremental value for the overall company.
A notable example was the recent improvement of Aetna's Medicare Advantage Star Ratings. In just a year, by leveraging the power of the company's cross-enterprise assets and executional excellence, Aetna was able to achieve 87% of their members in four star plans or better for the 2025 plan year, a recovery from 21% in the previous year.
"This achievement was due to the work across our Aetna, CVS Pharmacy, and CVS Caremark colleagues. Even more important than our ratings, these teams worked together to help members improve medication adherence and overcome barriers such as costs and transportation," said Lynch. "Our strong performance in this area shows how we can quickly unite our businesses to achieve important common goals."
Reiterating 2023 financial guidance, announcing 2024 full-year projections
CVS Health interim CFO Tom Cowhey will detail the company's 2024 financial outlook, capital deployment strategy, and long-term outlook and growth targets. The company's unique combination of assets provides CVS Health with clear opportunities for long-term outperformance, including through Medicare Advantage margin recovery, incorporating Star Ratings, starting in 2025; CVS CostVantage, the company's new retail pharmacy pricing model; increased patient enrollment in Oak Street Health; expanded product offerings through Signify Health; and enhanced growth in core businesses from new offerings in health care delivery.
"By broadening our portfolio of integrated products and services, we expect to create a path to sustainable, profitable growth," Cowhey said. "Our powerful cash generation capabilities will support our strategic goals, prudent capital deployment, and attractive return profile – while also providing opportunities for meaningful long-term outperformance."
2023 Guidance
Today, the company is reiterating its 2023 guidance as shared on its November 1, 2023 earnings call:
- Total revenues: $351.5 to $357.3 billion
- Operating income: $13.6 to $14.0 billion
- Adjusted operating income: $17.2 to $17.6 billion
- GAAP diluted earnings per share ("EPS"): $6.37 to $6.61
- Adjusted EPS: $8.50 to $8.70
- Cash flow from operations: Upper-end of $12.5 to $13.5 billion
2024 Guidance
The company is initiating its 2024 full-year projections:
- Total revenues: At least $366.0 billion
- Operating income: At least $15.0 billion
- Adjusted operating income: At least $17.2 billion
- GAAP diluted EPS: At least $7.26
- Adjusted EPS: At least $8.50
- Cash flow from operations: At least $12.5 billion
Announcement of increased quarterly dividend
CVS Health has announced that its board of directors has approved a quarterly dividend of sixty-six and a half cents ($0.665 cents) per share, an approximate 10% increase from sixty and a half cents ($0.605 cents) per share. The dividend is payable on February 1, 2024, to holders of record on January 22, 2023.
About CVS Health
CVS Health® is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues — including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health — whether that's managing chronic diseases, staying compliant with their medications or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system — and their personal health care — by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day. Follow @CVSHealth on social media.
Cautionary Statement Concerning Forward-Looking Statements
The Private Securities Litigation Reform Act of 1995 provides a safe harbor for forward-looking statements made by or on behalf of CVS Health. Statements in this press release that are forward-looking include, but are not limited to, references to CVS Health Corporation's priority areas for strategic growth, financial outlook, long-term growth targets, capital deployment, Ms. Lynch's quotations, Mr. Cowhey's quotation, Mr. Shah's quotation, Mr. Pykosz's quotation, the information under the headings "Reiterating 2023 financial guidance, announcing 2024 full-year projections", including "2023 Guidance" and 2024 Guidance", "Introducing CVS CostVantage, a more transparent and sustainable model for retail pharmacy", "Launching CVS Healthspire Services to define Health Services segment", "Accelerating momentum through combined strength and innovation of leading businesses" and the information included in the endnotes and reconciliations. By their nature, all forward-looking statements are not guarantees of future performance or results and are subject to risks and uncertainties that are difficult to predict and/or quantify. Actual results may differ materially from those contemplated by the forward-looking statements due to the risks and uncertainties as described in our Securities and Exchange Commission ("SEC") filings, including those set forth in the Risk Factors section and under the heading "Cautionary Statement Concerning Forward-Looking Statements" in our most recently filed Annual Report on Form 10-K, our Quarterly Reports on Form 10-Q for the quarterly periods ended March 31, 2023, June 30, 2023, and September 30, 2023 and our Current Reports on Form 8-K.
You are cautioned not to place undue reliance on CVS Health's forward-looking statements. CVS Health's forward-looking statements are and will be based upon management's then-current views and assumptions regarding future events and operating performance, and are applicable only as of the dates of such statements. CVS Health does not assume any duty to update or revise forward-looking statements, whether as a result of new information, future events, uncertainties or otherwise.
Non-GAAP Financial Measures
This press release contains certain non-GAAP financial measures, including adjusted operating income and adjusted earnings per share. In accordance with SEC regulations, you can find the definitions of the non-GAAP items mentioned, as well as the reconciliations to the most directly comparable GAAP measures, below in this press release.
Business Insider attributes the new CVS Health prescription drug pricing model to competition from Mark Cuban's much smaller Cost Plus Drugs Company operation:
https://www.businessinsider.com/cvs-pharmacy-prescription-drug-prices-mark-cuban-2023-12
How Mark Cuban forced the biggest US pharmacy to upend its business
- CVS just announced it's changing how prescription drugs get priced at its pharmacies.
- The new program includes a set markup for medication costs, a step toward drug pricing transparency.
- The retailer has been facing pressure from new models like Mark Cuban Cost Plus Drugs.
CVS just announced plans for a major shift to how drugs are sold in its pharmacies — and it's a sign the retailer is bending to market pressures.
The retail pharmacy chain is set to launch a program that will flip how its pharmacies get reimbursed by pharmacy-benefit managers and insurers. Under that program, called CostVantage, CVS's pharmacies will get paid based on the cost of the drug plus a set markup and a service fee. It's not clear if it will always lead to lower costs for customers at the pharmacy counter.
The new program offers a far simpler model than how CVS's pharmacies have traditionally been reimbursed. At least in part, it's a response to models like billionaire Mark Cuban's online pharmacy taking hold in the market.
CVS has been facing increased pressure to provide transparent drug pricing in the past two years as consumers turn to companies like Mark Cuban Cost Plus Drugs for lower drug prices. Blue Shield of California, for example, said it's ditching a CVS unit and replacing it with Cuban's company for some prescription-drug tasks. Cuban declined to comment for this story.
The billionaire's drug-pricing model, which made waves across healthcare when the company launched at the start of 2022, looks remarkably similar to the program CVS is now adopting.
Federal lawmakers and the US Federal Trade Commission have also been scrutinizing the prescription-drug supply chain. They've been especially focused on pharmacy-benefit managers and the lack of transparency around how much drugs cost.
CVS's new model "provides our PBM and payor clients a foundational step towards more pricing clarity for consumers," said Prem Shah, executive vice president, chief pharmacy officer and president of pharmacy and consumer wellness at CVS Health, in a statement.
How Mark Cuban changed drug pricing
Cuban's pharmacy buys drugs directly from manufacturers and sells them to consumers at a 15% markup, plus pharmacy fees.
The company's patients pay for the drugs out of pocket, skirting middlemen like PBMs or insurers, and generally paying far less for their medications as a result. Cost Plus says it has more than 2 million members.
Cost Plus isn't the first company to try to revolutionize how consumers pay for pricey drugs. GoodRx has offered coupons for drug discounts for more than a decade.
Still, GoodRx works with PBMs to get those discounts rather than with the pharmacies, and has made some enemies in the process. The drug-discount startup took a revenue hit last year when an unnamed grocer, rumored to be Kroger, renegotiated a number of its drug pricing contracts at once and forced GoodRx to stop offering discounts for those drugs at the grocer.
Kroger announced in July that it's now partnering with Cost Plus.
GoodRx's stock tumbled more than 6% on Tuesday, while CVS gained 3.8%.
Other healthcare firms have been feeling the pressure to provide lower prices, too. Walgreens announced a new drug-discount app last week that helps patients find savings for their prescriptions. Cigna's pharmacy-benefits unit, Express Scripts, announced a transparent pricing option last month.
CVS is the biggest US pharmacy chain by prescription revenue, followed by Walgreens, according to Drug Channels.
It's not clear if CVS's new program will result in lower prices overall for consumers. Some drugs will cost more under CostVantage, while others will cost less, according to the Wall Street Journal. The costs could also depend on the terms of an individual's insurance plan, and whether they choose to use it.
But the announcement looks to be a step in the right direction for drug pricing transparency.
CVS said it plans to launch the program in full through contracts with commercial payers in 2025.
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