The proliferation of new health and wellness tools on the market have left healthcare purchasers overwhelmed in how exactly to integrate these solutions into their benefit offerings.
CVS Health is launching a service for clients of its Caremark pharmacy benefits business to overcome that barrier by making it easier to contract, implement and manage both digital and non-digital third-party products.
The company’s Vendor Benefit Management platform helps to standardize logistics like member eligibility verification, billing and payment processing and results measurement and reporting to streamline the process for plan sponsors.
CVS said part of the goal with the Vendor Benefit Management platform is to be vendor-agnostic and give clients multiple products to choose from. The company said they perform an assessment on potential solutions to ensure they have a high quality member experience, adhere to to clinical guidelines and have adequate data security infrastructure.
“As health care continues to evolve, plan sponsors have begun looking beyond the standard medical, pharmacy, dental and vision health benefit offerings, and are increasingly considering supplemental benefits to help improve health outcomes and reduce overall medical spend,” CVS Caremark President Derica Rice said in a statement.
“Our new proprietary service enables us to leverage the sophisticated infrastructure, technologies and processes we have honed as a leading
PBM to further benefit our clients and their members.”
The company’s first vendor partner on the system is San Francisco-based Big Health, which is offering its digital CBT-based sleep improvement program Sleepio through the service.
Big Health CEO Peter Hames said the deal helps to integrate digital therapeutics into same system traditional health products like pharmaceuticals are sold and administered.
“There’s been a lot of talk about the potential of digital therapeutics, but the challenge is really, how do you make access to those solutions as easy and widespread as drugs,” Hames said. “When you look at CVS, they are the plumbing for a huge proportion of healthcare that gets delivered in the U.S.”
Adding Sleepio into that same infrastructure helps to decrease the friction and ease the process for coverage and reimbursement of the product, he said.
Obviously, there’s the potential of scaling up as well. Sleepio is currently available to 12 million people through deals with U.S. employers and the U.K.’s UK’s National Health Service.
Compare that to roughly 90 million plan members who have their medications managed by CVS Caremark.
As the digital therapeutics space continues to grow – as evidenced by successful regulatory approvals and commercial deals for companies like Pear Therapeutics – pharmacy benefit managers are looking at more efficient ways to offer the solutions to payers.
Last month, leading PBM Express Scripts announced that it was developing a standalone digital health formulary it intends to offer starting in 2020.
Ultimately, Hames said what’s exciting to him is partnering with a company that has the retail footprint, covered patient population, resources and strategic alignment to deliver care in ways that fully integrate with emerging technologies.
“CVS has said publicly that they want to be the health innovation company and there’s a unique set of assets that I view as lego bricks to construct completely new models of care centered on delivering care where people are and that fit into their daily lives,” Hames said.
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