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Aetna Commits to CVS With 12 Year Contract for Pharmacy Benefit Management Services To Serve Almost 10 Million Members

Posted Jul 27 2010 6:45pm

This will bring more patients under the hood for the combination of using the availability of software that CVS Caremark has in place to fill member prescriptions.  Aetna has their own PBM which from what I read here, part of it will be combined with sending 800 Aetna employees over to Caremark, image and Aetna will keep 1000 of their own.  The overall end result appears to be cost effective with having less employees on the Aetna payroll and using more technology services from Caremark.  With Caremark incorporating 13 drugs into their recently announced “genetic benefit” service, the brings a lab connection into the picture too with selected genetic tests available.

Insurance companies cannot discriminate due to genetic tests per the laws of GINA so shift this off to a pharmacy benefit manager to use their algorithms for decisions with creating the best route for the patient to go with medications.  Being that so many aspects of pharmacy benefit management data bases are sold I wonder how this all plays into privacy role, not only for Caremark but for other pharmacy benefit managers.  Obviously Caremark in this instance would know and perhaps with internal correspondence with claim settlements does some of this get exposed back to Aetna, who can’t violate GINA laws with discriminating, but in fact might just have “data” for the files for “viewing” capabilities.  If this were perhaps the case is there anything to stop the process with this information to run additional algorithms to find additional information, just some gray areas out there not spoken of often enough.

You could also see through pharmacy benefit management devices using biometrics come into play as that is facilitated easier through a PBM than an insurance company.  In addition this might stand to push forward the use of in store Minute Clinics too, which of course are all on electronic medical record systems.  Aetna will maintain their network of specialty pharmacies and their own mail order business and I am guessing this might be relative to certain contracts held with employers to where they are the paid administrators of company paid plans, a money maker for insurers with self insured employers.  BD  image

HARTFORD, Conn. and WOONSOCKET, R.I., July 27 /PRNewswire-FirstCall/ -- Aetna (NYSE: AET ) and CVS Caremark (NYSE: CVS ) today announced they have entered into a 12-year contract to provide Pharmacy Benefit Management (PBM) services that will further enhance value and service for Aetna's customers and members. 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 spend as it applies its unique, integrated pharmacy care delivery model to the administration of Aetna's retail pharmacy network and management of pharmacy customer and member service functions. In addition, CVS Caremark will manage purchasing, inventory management and prescription fulfillment for Aetna's mail-order and specialty pharmacy operations. Through this strategic agreement, Aetna will retain its position as a premier provider of PBM services while delivering enhanced service capabilities, innovative product offerings and greater value to its customers and members.

"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."

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.

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