CVS Retains Blue Plan’s Specialty Pharmacy Business And That’s Where The Money And Costs Are

News CVS Health is losing a regional health plan’s pharmacy benefit account to Amazon and Mark Cuban’s Cost Plus Drugs isn’t all that bad for the large drugstore chain and its Caremark PBM.

Blue Shield of California Thursday said it was working with several companies to manage the prescriptions of its nearly 5 million health plan members, including Amazon Pharmacy, Cuban’s company and a fast-growing PBM known as Abarca, which will “pay prescription drug claims.” Financial terms of the arrangement were not disclosed.

But CVS Caremark will “provide specialty pharmacy services for members with complex conditions, including education and high-touch patient support,” Blue Shield said.

As more expensive specialty drugs from Alzheimer treatments to new drugs for cancer hit the U.S. market, those handling prescriptions and their claims are bracing for an even larger focus on these costly medicines.

Health plans and pharmacy benefit managers (PBMs) that manage drug costs say specialty drugs now account for 50% or greater of the total prescription spending they manage. In some cases, employer clients are seeing specialty costs account for 60% or even greater of their total drug spending.

“We believe Blue Shield’s decision to keep the most critical piece of the business with CVS demonstrates the value legacy PBMs bring to the table,” Lisa Gill, managing director at J.P. Morgan Securities wrote in a report Thursday.

Stocks of companies that operate large PBMs, including CVS Health, UnitedHealth Group, which runs OptumRx, and Cigna, which runs the Express Scripts, PBM, were hit hard Thursday.

But the story is a bit more complex.

Long gone are the days when health plans and PBMs had to worry about the launch of a new cholesterol pill or prescription antidepressant that would cost $4 each and be taken by millions of Americans. These days, it’s specialty drugs derived from biotechnology that may only be 1% to 2% of the claims health plans process for an employer or government client but are becoming a more dominant part of what they have to administer and manage.

“Based on nearly 20 years of success, we have retained the specialty business for Blue Shield of California,” CVS Health said in a statement Thursday afternoon. “Specialty pharmacy spend now represents over 50% of pharmacy benefit spend in the marketplace.”

To be sure, the Blue Shield move might even carry more risk than reward, analysts say.

“Blue Shield’s new model essentially carves out various PBM functions; Amazon will offer home delivery, Cost Plus Drug Company will provide access to generics, Abarca will process claims, Prime (Therapeutics) will negotiate with manufacturers to move towards a value-based model, and CVS will provide specialty pharmacy services,” Gill wrote in a report Thursday. “Historically, the driving force behind carve-outs has been to secure better discounts and improve transparency. However, we think the decision to carve out so many different offerings carries potential executive risk that could result in a less coordinated offering for patients.”