As a licensed physician for 32 years, my primary focus is making sure patients receive the highest quality care. That is why I was glad to read that Mrs. Norma Smith featured in your Aug. 2 article, “Cancer patients are being denied drugs, even with doctor prescriptions and good insurance,” is doing well on her treatment regimen. However, as chief medical officer of CVS Health, I have significant concerns with inaccurate information and lack of context in The Fresno Bee’s reporting.
The article states that Mrs. Smith “was without needed medicine for nearly two months while her case was on review before receiving new medication,” and implies our company interfered with the doctor’s decision-making and, as a result, threatened Mrs. Smith’s health. That allegation is simply not true. We follow the best clinical evidence validated by external experts and provide appropriate service to our clients and members.
We asked Mrs. Smith for permission to share her patient health information as it reveals a remarkably different story than what appeared in the article. Mrs. Smith preferred not to give us consent, which we respect, and thus we cannot address the specifics of her coverage decisions due to our obligations under HIPAA. With respect to the medication referenced in the article, CVS Caremark’s treatment protocols adhere to the U.S. Food and Drug Administration-approved indication for the medication as well as the National Comprehensive Cancer Network (NCCN) guidelines. This particular drug is considered by both the FDA and NCCN to be a third or fourth line agent for use when two prior drug regimens have failed to stop disease progression.
We make decisions according to the timeframes set forth in the laws and regulations applicable to the member’s plan. Generally, for self-funded plans, the mandated timeframe is 15 days for a standard request and 72 hours for an expedited request. For fully insured plans subject to state laws, the mandated timeframes may be more stringent. We meet or exceed all mandated timeframes. In fact, on average across our book of business, we make decisions in less than 24 hours for standard requests and 12 hours for expedited requests when we have complete clinical information.
The goal of any Pharmacy Benefit Manager (PBM), including CVS Caremark, is simple: ensure people have access to medications based on the latest medical evidence while reducing costs. We do this by negotiating discounts with manufacturers, who are solely responsible for setting drug prices. We also design formularies that encourage the use of lower-cost generics and biosimilars, and create new tools to help bring escalating drug prices under control.
Every day, CVS Health helps patients in California find their path to better health, and we couldn’t do it without some of the most powerful tools in our health care system today: evidence-based medicine, PBMs and our 29,000 employees throughout the Golden State.
Over the last three years (2016-18), we have saved our clients $141 billion in drug costs. At the same time, in 2018 alone, 44 percent of our clients saw their net prescription drug prices decline and 85 percent of our members utilizing their prescription benefit spent less than $300 on their prescriptions.
We care about every patient — and the 94 million members we help serve across the country — and believe the work of the PBM industry is needed today more than ever to increase patients’ access to high-quality, cost-effective medicines.
Dr. Troyen Brennan is chief medical officer at CVS Health.
Clarification: A more detailed timeline provided by Norma Smith’s oncologist shows that while Smith did wait about two months for a cancer drug early this year during a string of denials and delays, she continued to receive some cancer medication. She was only completely without cancer drugs for over three weeks. Her doctor said the medication she continued to use while waiting for another drug was not effective, and that it needed to be used in combination with other drugs.