HARTFORD, Conn – CVS Health announced key milestones in its ongoing effort to make health care simpler and more affordable for American consumers.
"Our ambition is to be America's most trusted health care company," said David Joyner, president and CEO. "We are partnering with the Administration and Congress to deliver common-sense solutions that make health care more affordable and improve outcomes for the people we serve. We continue to decrease prior authorizations, reduce hospital readmissions and emergency room visits, and bring down the costs of prescription drugs. The underlying costs of health care — primarily hospitals and new pharmaceuticals — continue to push up insurance premiums in the United States. We welcome policymakers' assistance in driving out provider fraud and combatting drugmaker price gouging."
Simplification
Part of CVS Health, Aetna continues to make good on significant commitments to remove friction in the health care system and improve the experience for health care professionals and their patients. The prior authorization process has been hindered by incomplete data provided by clinicians, as well as the lack of technology interoperability across the health care system, but it has made significant strides in making the process simpler.
• Across the insurance industry, Aetna has the fewest medical services subject to prior authorization — about half as many as its nearest competitor. They approve more than 95% of all eligible prior authorizations within 24 hours, with many completed instantaneously. It currently approves 77% of electronic prior authorizations in real-time, and it will exceed 80% by the end of this year.
• They have met their commitments to enhance cross-payer interoperability to ensure continuity of care when patients switch health plans. By the end of this year, the 5-10 prior authorizations that represent 40% of the volume will adhere to consistent cross-payer clinical and technology standards. Furthermore, they are expanding this alignment effort to 50 of the most common prior authorization procedures in Medicare.
• Last year, CVS began bundling prior authorizations for certain conditions into a single request that would provide approval for a series of future tests and interventions consistent with the appropriate line of care. Historically each of these additional steps would have required separate prior authorization requests. These began in lung, breast, and prostate cancer to cover whole pathways of current and future screenings. CVS then built on this streamlining momentum to expand its prior authorization bundles to certain musculoskeletal procedures, where a single request authorizes a series of future procedures that can include X-rays, knee arthroplasty (THA/TKA) surgical procedure, anti-nausea and non-opioid pain medications, inpatient admission, infection control, and durable medical equipment. The company has also begun bundling prior authorizations across pharmacy prescriptions and medical procedures for in vitro fertilization (IVF).
• Aetna is now embedding nurses within 17 major health systems to facilitate the necessary care and follow-up support patients need to transition successfully out of the hospital, remain healthy, and reduce future readmissions. The company projects this program will reduce year-over-year 30-day readmissions and hospital length of stay by 5 percent.
Affordability
CVS Health works across their businesses to ensure each of the 185 million Americans we serve are receiving the right care at the right cost. The company is expanding low-cost primary care, covering preventive care at no cost to patients, and offering free virtual care to eliminate barriers to access.
• CVS is expanding access to coverage that rewards providers for keeping patients healthy, not just treating illness. To date, they have made this shift for 80% of Medicare spending. This approach costs less, keep patients safer and healthier, and improves overall satisfaction. For multiple years running, the Centers for Medicare and Medicaid Services (CMS) have recognized their Medicare Advantage plans with industry-leading Star Ratings, measures of member satisfaction and health outcomes.
• The company is driving competition to lower drug costs. They are aggressively promoting the use of biosimilars, introducing alternatives for popular expensive branded drugs like Humira and Stelara. Their alternative to Humira has generated $1.3 billion in savings for our clients, and we introduced a biosimilar for Stelara at 86% less than the brand list price.
• In addition, the company shares these savings with consumers directly. Since 2019, Aetna has been sharing its negotiated pharmaceutical rebates directly with members when they fill their prescriptions at the pharmacy counter. Today, their pharmacy benefit manager CVS Caremark delivers rebate savings at the pharmacy counter for 25 million of their 87 million members, and Caremark's TrueCost solution enables our clients to transparently deliver direct-to-consumer value from the discounts we negotiate from drugmakers.
Community impact
In 2024, CVS Health delivered $474 billion in positive contributions to the United States economy. The company employ more than 300,000 United States citizens, and indirectly create an additional one million jobs through the partners and vendors who work with us.
In an era when other major retail pharmacies have declared bankruptcy or turned to private equity, more than 85% of Americans live within 10 miles of one of their 9,000 community pharmacies. They continue to put the people of the United States first in the work we do to simplify health care. One patient, one family, and one community at a time.
