CVS Caremark 2020 Drug Trend at 2.9%

New starts fell off sharply last spring and the flu season "all but disappeared," according a summary of CVS Caremark's 2020 drug spend report.

CVS Caremark’s overall drug spend trend was 2.9% in 2020 and about one-third of its clients had a negative trend, the PBM announced today. Utilization increased just 1.7% and price growth was 1.2%, according to its 2020 Drug Trend Report.

The report from the PBM unit of CVS Health includes a graph that shows the steep drop in healthcare utilization in April 2020 as the COVID-19 pandemic took off and lockdowns ensued had a similar effect on patients starting new drugs. The number of CVS Caremark prescriptions for a new drug for depression, diabetes, dyslipidemia (high cholesterol) and heart failure fell precipitously in April, the graph shows. By September, new starts for depression, diabetes, and dyslipidemia had recovered somewhat so they were roughly 10% higher than new starts in 2019. But for heart failure, the new starts continued to lag behind 2019 and were about 10% lower in September 2020 than in September 2019.

Here is the graph from the report:

The drug trend report also updates the long-term trend in the growth of the specialty drug spend as a share of the overall pharmacy spend. In 2020, specialty drugs accounted for 52% of the CVS Caremark drug spend, according to this report. Five therapeutic area — autoimmune, oncology, cystic fibrosis, atopic dermatitis, HIV — accounted for 90% of that spend.

The summary from the PBM also has data on the 2020 flu season and states that it “all but disappeared” from a drug spend perspective. Flu-related prescriptions decreased 45% in the first quarter of 2021 for CVS Caremark relative to the first quarter of 2020, according to the report. Meanwhile, flu vaccinations at CVS retail pharmacies increased by 56% during the 2020-2021 flu season compared with the 2019-2020 season. The report mentions COVID-19-related social distancing, mask wearing, and the vaccinations as contributing factors to the relative scarcity of flu cases and prescriptions to treat them.

The report says that the pandemic accelerated digital connections and tools for the PBM. CVS Caremark now as “visibility” into the EHRs of more than 70% of specialty drug patients and 85% of members have signed up to receive digital communications, according to the report. CVS Caremark says that half of prior authorizations are approved without additional prescriber outreach.

The report acknowledges the specialty trend but touts CVS Caremark’s ability to manage it. “Ensuring appropriate utilization, avoiding waste and maximizing cost reduction programs helped us keep specialty trend in check for clients who used our services,” the report says, citing figures that show that more than 40% of clients had single-digit specialty trend and 18% had a negative trend.