Aetna, CVS Caremark, Sign 12-year PBM Deal

CVS Caremark has signed a 12-year contract to provide pharmacy benefit management services for 9.7 million Aetna customers.

Under the deal, announced this week, Aetna will retain its PBM and manage clinical programs, protocols and oversight of its pharmacy benefits business. CVS Caremark will serve approximately 9.7 million Aetna PBM members and administer approximately $9.5 billion in annual drug spending.

CVS Caremark will also manage purchasing, inventory, and prescription fulfillment for Aetna's mail-order and specialty pharmacy operations. The contract will go into effect on Jan. 1, 2011. As part of the agreement, Aetna will transfer to CVS Caremark approximately 800 PBM employees who will work in support of the transferred functions. Aetna will retain approximately 1,000 PBM employees.

"We worked hard to construct a strategic solution that enhances our value proposition in the marketplace in a way that creates a durable competitive advantage for Aetna and long-term value for our shareholders," says Ronald A. Williams, Aetna chairman/CEO. "Through this strategic agreement, we retain our PBM and our ability to integrate medical care with clinical and pharmacy programs and actionable data. We will add CVS Caremark's best-in-class clinical capabilities and broad market reach, enabling us to deliver better drug discounts and improved pricing and service to our customers."

CVS Caremark says its PBM platform capabilities include:

• Broad access across multiple channels;
• Face-to-face counseling at retail pharmacies and MinuteClinic locations, online, by phone and through specialty and mail service pharmacy support;
• A Pharmacy Advisor program, powered by CVS? Consumer Engagement Engine;
• Procurement, fulfillment, contracting;
• Physician engagement through e.prescribing, real-time physician support, and pharmacist support.

Aetna will maintain and manage its core pharmacy benefits business, including:

• Medical and pharmacy policy, including formulary and benefit design and network configuration;
• Clinical integration of pharmacy and medical benefits, including integrated care management and utilization management programs;
• Clinical program development, protocols and oversight;
• Sales and marketing activities;

• Management of member appeals and grievances;
• Rebate contracting and administration;
• Ownership and management of its mail order and specialty pharmacies.

CVS Chairman/CEO Thomas M. Ryan says his company?s integrated, multichannel platform will improve outcomes and save money for Aetna customers. "Aetna's selection of CVS Caremark is a testament to our integrated pharmacy care model as well as our reputation for service excellence," Ryan says.

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John Commins is the news editor for HealthLeaders.