Help patients remain engaged while socially distant

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A global health pandemic comes with tremendous uncertainty and anxiety. Patients deserve stability and peace of mind when it comes to their health care — the last thing that should create additional concern is whether they can access the medicines or care they need while staying socially distant.

Recognizing our responsibility to provide patients with additional support at the onset of the COVID-19 pandemic, we tapped into our solutions to ensure that all patients continue to get their medications and care without leaving the home — and at a price they can afford. 

Avoiding potential exposure without avoiding care

When the pandemic spread, routine and preventive medical care plummeted. In fact, Health Care Cost Institute estimates that millions of Americans continue to forego this type of care.https://www.nytimes.com/2020/09/11/upshot/pandemic-decline-preventive-care.html

Avoiding health care needs can have serious consequences that come at a cost to individual health — and the system as a whole — in the future. Similarly, avoiding care for chronic conditions, such as diabetes and high blood pressure, can cause more problems down the road. Patients who stop taking needed medications, or don’t get started on them, also face the risk of complications.

Our digital and remote pharmacy touchpoints help to keep patients safe, healthy, and at home as much as possible. To help prevent potential gaps in care and keep people safe at home, CVS Health led an early effort with local agencies to change regulations and enable greater remote pharmacy care management. Additionally, we made changes to our business to help minimize trips to the pharmacy, including early refill prescriptions, expanded access to 90-day supplies of maintenance medications by mail and free prescription delivery from retail stores.

Specialty members warrant added attention

We are working with hospitals and providers across the country to continue to support solutions that create much-needed hospital bed capacity and ensure streamlined care for many specialty patients. Through Coram, clinicians can deliver a clinically appropriate in-home care setting for patients recovering from a range of illnesses, which can help minimize their risk of contracting COVID-19 during treatment.

Alan Lotvin
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Secure the supply of medicines

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For patients, especially those living with complex or chronic illnesses, ensuring an uninterrupted supply of needed medications is crucial to their care. In the face of the enormous pressure the COVID-19 pandemic has placed on the U.S. health care system, our responsibility to ensure members have affordable access to the medications they need – when they need them – is critical.

From the onset of the pandemic, we’ve adapted our business practices to maintain the services that our clients and more than 100 million Americans depend on. We recognize that for someone living with a condition, such as lupus or asthma, going without a medication can create negative and costly consequences. 

Monitoring prescription supply to meet member needs

The current landscape has required the drug supply chain to be more responsive and effective. We work across the supply chain to carefully monitor prescription availability, potential shortages and spikes in demand. This way, we can stay one step ahead of utilization trends to help ensure that people have access to the medicines needed to manage their health and avoid costly complications down the road.

Using predictive analytics, we can monitor prescription usage trends and adapt drug supplies as needed. 

Moving forward, it will be important to use these analytics not only to understand supply and demand trends but analyze where pharmaceutical ingredients are coming from. Early in the pandemic, we shifted our practices to account for COVID-19 spikes in locations like Northern Italy, India and China, which are central to the pharmaceutical supply chain.

Alan Lotvin
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Ensure pharmacy benefits meet patients’ needs

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Because no two clients’ needs are the same, we customize our services, tools and programs to deliver the greatest value to both clients and their unique member populations. As our clients face the economic realities as a result of  the COVID-19 pandemic, we’re working in a consultative role to ensure they can continue to keep their populations and workforces adherent to their medicines and care, which in turn creates positive health outcomes and drives longer-term health savings. 

The pharmacy is the location where patients most frequently interact with their health care. By expanding health capabilities and services within our pharmacy benefits, we can have a positive impact on patient and member health. Beyond securing the lowest possible cost for medicines, we also work with clients to design benefits that include digital touchpoints and personalized support so that every member can start and stay on their medicines.

As telemedicine and digital health remain paramount, these digital touchpoints are critical in keeping our 100 million members engaged in their health. 

Benefits that meet patients where they are

COVID-19 has underscored how important it is for us to maintain and enhance our services for clients and members in our physically distant world.

For example, members with chronic conditions have access to specially trained clinicians at their fingertips through our Pharmacy Advisor program. The program offers personalized support over the phone – or in person if preferred – for questions on managing a chronic condition, how different medicines may affect each other and how to handle side effects.

Through our nurse-led chronic care management program, Accordant, patients with rare, chronic diseases can get virtual support and remote monitoring to help with managing their benefits and conditions.

Our Point Solutions Management offering helps employers and health plans augment their pharmacy benefits with carefully vetted digital solutions that address key aspects of health care costs. These tools guide members in strategies to reduce worry and anxiety, improve heart health, get better sleep and make smarter nutritional choices. They are easy to use and come at no additional cost to members enrolled in a participating health plan.

We’re bringing these practical solutions to our clients and members through an integrated model that draws upon our deep knowledge, longstanding partnerships and industry expertise.

Alan Lotvin
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Help members access the most cost-effective drug through clinical expertise

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Prescription medicines are the most cost-effective part of our health care ecosystem, but they’re only clinically effective if patients can afford them. The amount that patients pay out-of-pocket has long been a point of contention in our health care system. Further underscoring this point, a recent CVS Health survey found that more than 70% of patients are concerned about the cost of their prescriptions.

The COVID-19 pandemic continues to create financial hardship in virtually every community. Recognizing this reality, solutions that help ensure that patients have access to prescriptions will be mission critical.

Clinical strategies to manage drug costs

Utilization management strategies are a cornerstone of our pharmacy benefit strategies. They enable appropriate use of medicines and help to mitigate the impact of high-cost drugs that do not demonstrate a clear clinical benefit.

We are closely monitoring trends in utilization, particularly high-cost specialty drugs, to stay ahead of the curve and ensure that patients can access clinically appropriate new therapies, while reducing wasteful spend.

We use innovative strategies to encourage the use of lower cost and clinically equivalent generic options when appropriate. Through these strategies, we continue to blunt the impact of price inflation, prioritize lower-cost generic options when clinically appropriate, and keep members’ out-of-pocket costs in check.

Prioritizing member savings and adherence

We also know that patients want to know whether their drug is covered, what it will cost out-of-pocket and have the ability to discuss with their provider. Just because a drug is expensive, doesn’t mean it’s the best option for every patient. That’s why we utilize patient-centric programs to make sure patients can access medicines that will create the best clinical outcome at the lowest possible cost.

Our approximately 100 million members, their prescribing physicians and pharmacists provides have immediate access to real-time prescription benefit information, including how much a drug will cost. With this information at hand, physicians and pharmacists can identify an alternative, clinically appropriate option, when possible.

We also offer a robust set of consumer-friendly tools to help members better understand how to access the most effective medicine at the lowest cost. With the digital tool Savings Advisor, members can view costs readily, enabling them to make more informed decisions about medicines choices.

Alan Lotvin
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Helping patients access the right medicine at the right price

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Serving as a trusted partner to many of America’s leading employers, health plans and government programs, we value our role in keeping their members – totaling approximately 100 million people – on their prescription drug therapies as prescribed by their doctors. Every day, we’re able to accomplish this with tools and solutions that empower patients to access the most effective treatment at the lowest possible cost.

At a time when our health care system is facing many strains, including increased financial and economic pressures for our clients, delivering drug costs savings is critical. Without access to medicines, we know this: Patients get sicker, they need more care – and ultimately – health care costs increase for everyone. That’s why we remain laser-focused on getting patients their medicines and care in a way that is personalized, convenient and – above all – affordable.

Since the COVID-19 pandemic began, and as we continue to navigate it together for the foreseeable future, we’re working as a consultative partner to our clients in helping ensure that their drug benefit plans keep their members adherent and healthy.

What we do every day – and accomplish for our clients – doesn’t change in the face of this pandemic, but its importance is now greater than ever.

We’ll remain focused on four key areas as we deliver drug cost savings:

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Help patients access the most cost-effective medicine through clinical expertise

Prescription medicines are the most cost-effective part of our health care ecosystem, but they’re only clinically effective if patients can access them. We keep patients adherent and healthy by ensuring they can access the medicine that will deliver the best outcome at the most efficient cost. 

Read this article

Unknown subject holds and inspects an empty prescription medication bottle in one hand, while accessing a smartphone with the other hand.

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Ensure pharmacy benefits meet patients’ needs

Because no two clients’ needs are the same, we customize our services to deliver the greatest value to both clients and their unique member populations. As our clients face the economic realities of the COVID-19 pandemic, we’re providing solutions that better support adherence.

Read this article

 

A fashionable young woman sits in on a beige-coloured, modern sofa in a living room while holding and browsing content on a smartphone.

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Secure the supply of medicines

For patients, especially those living with complex or chronic illnesses, ensuring an uninterrupted supply of medicines is crucial to their overall health and well-being. We’re staying one step ahead to ensure patients who rely on medicines will always have an adequate supply.

Read this article

A middle-aged woman sits at a kitchen table while holding a prescription bottle and reading a tablet computer.

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Help patients remain engaged while socially distant

Patients now require health care solutions at the palm of their hand and in their home. We’re leveraging our tools and services to ensure that patients can continue to get their medicines and care without leaving the comfort and safety of their homes.

Read this article

 

A CVS Pharmacy customer collects a delivery from a Nuro autonomous vehicle outside of a CVS Pharmacy location in Texas.
An older female, wearing bright and comfortable clothing, stands in a very modern kitchen with a prominent brick wall, holding a mug in her right hand while using her mobile phone with her left hand.
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CVS Caremark earns Health Information Products Certification

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CVS Caremark received Health Information Products (HIP) Certification from the National Committee on Quality Assurance (NCQA), for providing comprehensive pharmacy benefits information to its members. The certification was implemented on July 15, 2020, and will go through July 15, 2022. This marks the second consecutive two-year HIP Certification from the NCQA.
  
This helps affirm that CVS Caremark, through our Caremark website and customer call center, provides members with the information they need to understand and optimize their pharmacy benefits. NCQA's HIP Certification is a quality assessment program that health plans can use to help evaluate health care organizations that develop and provide content, tools and services to plan members.

This certification further underscores our ability to provide accessible and accurate pharmacy benefit information to the members we serve on behalf of our clients. 

“Earning NCQA’s HIP Certification demonstrates that an organization has expertise in gathering and disseminating health care information for members,” said Lisa Slattery, Vice President, Accreditation and Recognition Operations, NCQA.”

CVS Caremark provides pharmacy benefit information to members by mail, digitally and telephonically. This can include information about a member's prescriptions, drug coverage and plan design, such as in-network pharmacy locations and mail-order options.

HIP Certification is a voluntary review process in which NCQA evaluated CVS Caremark’s management of various aspects of its data collection and systems operation, and the process the company uses to continuously improve the services it provides. The HIP review includes rigorous evaluations conducted by a team of health care professionals. A national oversight committee of physicians analyzes the team's findings and determine certification based on the HIP organization's compliance with NCQA standards.

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website contains information to help consumers, employers and others make more informed health care choices.

Learn more about the pursuit of higher quality through third-party accreditations.

NCQA Health Certification
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Helping members stay well, at home

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In the wake of the COVID-19 pandemic, employers and other benefit plan sponsors are searching for more ways to support members’ health. People are experiencing both physical and mental challenges as they cope with isolation, economic hardship, disruptions to normal work and school routines, and the virus itself.

CVS Health is making it easier for employers and health plans to meet these growing challenges with the expansion of our Point Solutions Management offering. This program enables plan sponsors to more efficiently administer apps, online trackers and other digital point solutions that support their members’ self-care routines at home.

“Digital point solutions can help people manage important wellness areas like mental wellbeing, fitness and weight loss from the safety and convenience of their own homes,” said Sree Chaguturu, MD, Chief Medical Officer at CVS Caremark. “Employers and other plan sponsors increasingly are looking for better ways to include these kinds of tools in their benefits packages — especially in light of the COVID-19 pandemic.”

The recently added solutions have passed CVS Health’s rigorous vendor evaluation process to ensure that they support health outcomes while helping to reduce costs. The five new point solutions available to CVS Caremark clients through Point Solutions Management include:

  • Daylight: A fully automated and highly personalized mobile app to tackle worry and anxiety, based on cognitive behavioral techniques. 

  • Naturally Slim: An online program that uses informative videos and learning tools to teach individuals how to lose weight and improve their overall health.

  • Vida: A weight loss program with an app that pairs individuals one-on-one with a health coach, helping members achieve their health goals through phone and video conversations.

  • WW: Weight Watchers reimagined — A weight loss app providing access to food and fitness trackers, thousands of delicious recipes, and community support.

  • Kurbo: A digital program for children and teens ages 8 to 17 that teaches users how to make healthier choices and lifestyle changes through weekly video coaching, in-app chat, messaging, games, and educational videos.

These solutions join Hello Heart, Hinge Health, Sleepio, Torchlight, and Whil that are available to CVS Caremark clients through our Point Solutions Management program.

Point Solutions Management is a full-service offering that leverages the CVS Caremark pharmacy benefit management (PBM) infrastructure to help clients evaluate solutions, streamline vendor contracting, billing, eligibility verification and reporting. In total, ten solutions are now included as part of the program — addressing a broad range of health care concerns including chronic condition management, musculoskeletal health, stress reduction, mental health management, weight loss, and caregiver support.

This expansion is the latest in CVS Health’s ongoing innovation strategy, focused on meeting emerging client and member needs — while responding to acute concerns arising during the COVID-19 pandemic. We will continue to regularly evaluate and update the offering to include additional vendors that support improved outcomes and help lower costs across key areas of health, including fertility, financial wellness and the social determinants of health.

For plan sponsors interested in learning more about Point Solutions Management, please visit the Point Solutions Management page on our Payor Solutions website.

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Heart At Work: Jackie DeJesus

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Jackie DeJesus, wearing a headset and working on a laptop computer in her home office.

Undaunted by COVID-19, Jackie used the reach of CVS to get our member the medication he needed. 

When the COVID-19 pandemic hit, LorenName changed for privacy purposes. thought he would be OK if he just followed the CDC guidelines and stayed home. Even though Loren never contracted COVID-19, his health was eventually impacted by the pandemic. Luckily, his case manager, Jackie, came to his rescue and quickly worked across CVS Health to provide a solution.

Loren has a history of psoriatic arthritis, among other health concerns, and was taking hydroxychloroquine to control his painful symptoms. He had been using his local pharmacy to fill his medications. But after hydroxychloroquine was named as a potential treatment for COVID-19, his pharmacy told him that they had exhausted their supply and couldn’t get any more. Not knowing what else to do, Loren began rationing his medication and eventually ran out too.

Jackie DeJesus, a registered nurse case manager on the Clinical Services Care Management team reached out to Loren because she saw he was prescribed hydroxychloroquine and heard there were shortages. “He was so happy to hear from us. He was very worried that his arthritis and skin conditions would quickly worsen and, because of the pandemic, didn’t feel like he had any choices,” said Jackie. “Loren didn’t feel safe shopping around for his medication since he was following quarantine protocols, and even if he located the medication at another pharmacy, he was concerned about the safety of leaving his community.”

Jackie explained to Loren that we had dedicated CVS pharmacists who can help. She worked with Caremark customer service to not only locate the medication, but also set up a 90-day mail order delivery right to his home.

Within 48 hours, Loren started taking his prescribed dosage and was better able to control his painful symptoms. He’s now aware of the Caremark mail order option and is excited to use it for all his medications during the pandemic and beyond. He is also thrilled to have Jackie as his personal contact.

Karen Lynch said, “The Aetna case managers provide a tremendous opportunity to connect with our members and identify solutions even when they don’t know those options exist. In this case, we not only helped a member overcome physical pain, we worked across CVS Health to simplify his access to care.”

Thank you, Jackie, for bringing your heart to work to help your patients when they need it most.

Jackie DeJesus, wearing a headset and working on a laptop computer in her home office.
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CVS Health helping protect supply of medicines potentially useful for COVID-19 treatment

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CVS Caremark, the pharmacy benefit management business of CVS Health, is working with clients to implement new measures to balance the burgeoning interest in off-label use of certain medicines to treat COVID-19 pneumonia with the ongoing needs of members who use these drugs for chronic conditions. These medicines include hydroxychloroquine, azithromycin, one protease inhibitor and albuterol inhalers, which are approved for treatment of lupus, bacterial infections, HIV, rheumatoid arthritis and asthma.

“Pharmacy benefit managers play an important role at the center of the pharmaceutical supply chain,” said CVS Caremark President Alan Lotvin, M.D. “Our advanced analytics allowed us to quickly identify changes in prescribing patterns and enabled us to take proactive steps to help ensure the integrity of the supply chain. We are taking additional steps today to limit stockpiling that could result in future shortages and gaps in care. We will continue to anticipate and support the needs of our clients, who collectively provide prescription drug coverage for more than 90 million members.”

With client consent, CVS Caremark is setting appropriate limits on the quantity of each of these medicines for potential use in treating COVID-19. Members who already take these medicines for approved uses will be able to bypass the new quantity limits.

“We continue to proactively study the latest clinical literature and consider what additional measures may be needed to help facilitate access to any other newly identified treatments as they emerge during this extraordinary public health situation,” said CVS Caremark Chief Medical Officer Sree Chaguturu, M.D.

Understanding that it may be harder for members to see their health care providers during the COVID-19 outbreak, CVS Caremark is extending previously-approved prior authorizations for most medications set to expire before June 30. For example, if a current prior authorization is set to expire on May 15, the expiration date will be extended to August 15. This step will enable members to refill most medications without renewing an existing prior authorization — not only providing them peace of mind, but also helping to reduce the volume of phone calls and other administrative burdens on physicians’ offices and pharmacies.

Measures already in place to help ensure ongoing access

These additional steps build on actions previously taken by CVS Caremark to protect the drug supply and enhance members’ ability to refill and access their prescriptions from the comfort and safety of their own homes.

For example, CVS Caremark recently worked with clients to make it easier for members to refill most 30-day prescription maintenance medications earlier than usual — by waiving commonly used early refill limits, which require members to use most of the medication on hand before obtaining a refill. Since CVS Caremark announced this new policy on March 10, it has assisted more than 239,000 members in refilling their 30-day prescription maintenance medications.

In addition, most plan members have the ability to obtain 90-day prescriptions of maintenance medications delivered to their homes, or another location of their choice, at no extra charge. CVS Caremark and plan sponsors have been proactively reminding members of this plan option since the COVID-19 outbreak began. CVS Caremark expects to see a 20 percent increase in members receiving a 90-day prescription supply of prescription medicines in the coming weeks.

CVS Caremark also continues to closely monitor the global manufacturing environment. At this time, CVS Caremark does not see any disruptions to the supply chain, as a result of COVID-19, that will affect our ability to fill prescriptions.

CVS Caremark clients and other payors can access information about steps CVS Caremark has taken to support their plans and members during the outbreak, as well as useful turnkey resources for member communications, at the PBM’s COVID-19 PBM Partner Resource Center.

More information on steps that the CVS Health enterprise is taking to address the COVID-19 pandemic is available at the company’s frequently updated COVID-19 resource center.

About CVS Health

CVS Health employees are united around a common goal of becoming the most consumer-centric health company in the world. We're evolving based on changing consumer needs and meeting people where they are, whether that's in the community at one of our nearly 10,000 local touchpoints, in the home, or in the palm of their hand. Our newest offerings from HealthHUB® locations that are redefining what a pharmacy can be, to innovative programs that help manage chronic conditions are designed to create a higher-quality, simpler and more affordable experience. Learn more about how we're transforming health at https://www.cvshealth.com.

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CVS Health expands Point Solutions Management with new health and well-being benefits and comprehensive evaluation process

CVS Health expands Point Solutions Management with new health and well-being benefits and comprehensive evaluation process
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Five new point solution vendors added following rigorous evaluation to ensure high clinical, security and business standards

Simplified contracting, lowest price and performance monitoring helps PBM clients maximize benefits and minimize spend

WOONSOCKET, R.I. — CVS Health (NYSE: CVS) today added five new health and well-being point solution vendors to its Point Solutions Management service following a comprehensive clinical, security and business evaluation process. Point Solutions Management is a full-service offering that enables CVS Caremark pharmacy benefit management (PBM) clients to simplify contracting, secure lowest price and monitor ongoing performance of third-party health care point solutions, which can help maximize their benefits program while minimizing associated spend. Newly added point solutions address health care costs and support clinical outcomes in key areas, including chronic condition management, musculoskeletal health, stress reduction and mental health management, and caregiver support.

"Plan sponsors increasingly see the value in health care point solutions for improving workforce productivity, satisfaction and overall well-being, however with so many options on the market, it can be challenging to identify trusted solutions that best meet the needs of their members," said Sree Chaguturu, M.D., Chief Medical Officer, CVS Caremark, the pharmacy benefit management business of CVS Health. "We have analyzed pharmacy and medical claims to identify where these benefits can make a difference and employ a rigorous and transparent evaluation process to assure that any vendor included in Point Solutions Management meets high standards for safety, quality and user experience at the vendor's lowest price in the marketplace."

More solutions to meet client and member needs

Five new solutions are now available through Point Solutions Management, in addition to Sleepio, a personalized digital sleep program from Big Health, which was the first participating point solution when the service launched as Vendor Benefits Management in 2019. New point solutions available to CVS Caremark clients through the service include:

  • Hello Heart helps members understand and improve their heart health. It offers an FDA-approved blood pressure monitor coupled with an app that tracks blood pressure readings, weight and physical activity, alerts for out-of-range hypertension, and has patient-enabled medication adherence reminders.

  • Hinge Health, a coach-led digital program for members with musculoskeletal conditions such as chronic back or joint pain. Hinge Health combines wearable sensor-guided exercise therapy with behavioral change through 1-on-1 health coaching and education to reduce chronic pain, opioid use, and surgeries.

  • Livongo (Nasdaq: LVGO), an Applied Health Signals company, offers an integrated platform and includes diabetes, hypertension, weight management, and diabetes prevention solutions. Livongo provides support through personalized coaching and connected devices including weight scales, blood glucose meters, and blood pressure monitors to deliver appropriate interventions and help improve health outcomes.

  • Torchlight, a caregiver support solution that guides families through the complexities of educational, financial, social, health, and legal demands related to caring for a loved one, no matter the age, stage, or concern. With a digital platform and team of expert advisors, Torchlight helps reduce stress and enhance caregiving outcomes

  • Whil, a digital training platform for mindfulness, stress resilience, mental well-being and performance. It addresses 12 different aspects of wellbeing and performance through
    5-minute daily sessions and 250+ mini-courses. Users have access to 2,000+ video and audio sessions on demand, reinforced with ongoing tips, exercises and articles to improve employee health and happiness.

Rigorous vetting, evaluation and ongoing performance management

The CVS Health vendor evaluation and selection process starts with identifying the specific areas of health and well-being that meet the clinical and cost management priorities of CVS Caremark clients and where vendor point solutions are most likely to have a positive impact. Each selected solution then undergoes a rigorous clinical, data security, and business evaluation, which includes testing of the end-to-end consumer experience by a team of CVS Health clinicians. Once solutions are adopted by payors, the Point Solutions Management service also provides member eligibility and real-time billing verification and ongoing performance monitoring.

"As a large employer with a diverse workforce, health care point solutions are an essential component of our overall benefits package, but it can be time-consuming and costly to identify, evaluate and contract individually with each vendor," said Kristen Brown, Director of Benefits, JetBlue. "CVS Health's Point Solutions Management helps make the process easier and more efficient." CVS Caremark client JetBlue adopted Point Solutions Management in 2019 to help streamline contracting with point solution vendors and supplement their medical and pharmacy benefits.

CVS Health will continue to expand Point Solutions Management to meet growing client and member needs, including in weight loss, women's health, metabolic health, mental health and other categories that help to address social determinants of health.

For plan sponsors interested in learning more about Point Solutions Management, please visit: https://payorsolutions.cvshealth.com/point-solutions-management.

About CVS Health

CVS Health employees are united around a common goal of becoming the most consumer-centric health company in the world. We're evolving based on changing consumer needs and meeting people where they are, whether that's in the community at one of our nearly 10,000 local touchpoints, in the home, or in the palm of their hand. Our newest offerings from HealthHUB locations that are redefining what a pharmacy can be, to innovative programs that help manage chronic conditions are designed to create a higher-quality, simpler and more affordable experience. Learn more about how we're transforming health at http://www.cvshealth.com.

Media contact

Christina Beckerman
CVS Health
401-770-8868
Christina.Beckerman@cvshealth.com

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