Wednesday, May 31, 2023

Caremark's President Speaks at 'Forum 2023'

David Joyner is President & EVP of CVS' Caremark PBM business. Caremark refers to a recent event and business as "Payor Solutions" whose website is at Truth be told, CVS Caremark would rather patients whose insurance use Caremark as their PBM do not know what the PBM's executives say or do behind their veil of secrecy. Caremark is a business used to operating while serving itself first and everyone else as an afterthought.

On May 5, 2023, the Caremark PBM business of CVS Health hosted an event it called "Forum 2023", and Mr. Joyner gave a presentation on "What' next for payors". It was rather amusing that CVS Health said: "though the [PBM] system is working – from claim adjudication to drug dispensing, it's important that payors understand what's on the horizon". 

For example, David Joyner blames insulin manufacturers for continually raising prices, while ignoring the rebates his own industry and his company in particular work to "aggregate". 

He also talks only of how Caremark offers clients low "net" prices, while ignoring that the back-end rebate discounts are the very reason drug manufacturers are forced to raise drug prices so they can pay ever larger rebates to PBMs. 

Mr. Joyner addresses the recent developments in the insulin market and how that no longer appears to be a way for insurance companies (including one in his own company Aetna) use to bankroll premium offsets given to their employer clients and those rebates lower premiums for all at the expense of patients. He cites the spread between retail and list prices, while ignoring that his company is one of the only reasons those disparities exist. He also laments the PBM industry's weakness for lobbying advocacy in the states and how that could adversely impact the PBM business. He warns the audience that there are "over 900 bills" in states across the country targeting the PBM industry. In particular, he warns the states are targeting ERISA preemption, but recall that the Supreme Court essentially gutted ERISA preemption when it ruled unanimously on Rutledge v PCMA back in 2020 as far as PBMs are concerned. But remember: PBMs are notorious for lying with straight faces. Nothing the industry says or does should be presumed as true.

But because of wrongdoing of entities like Caremark, spread pricing exists. For example, I blogged about the insanity of my experience with Aetna/CVS Health/Caremark in getting a cheap generic statin drug made in India. 

Ultimately, because CVS Caremark was so aggressive in its spread pricing on that generic drug, that I as a patient covered by sister company Aetna actually noticed the games they were playing and initially, I simply patronized their biggest competitor: United Healthcare Group's OptumRx (catch my coverage of that experience HERE) saving myself 56%.

However, more recently, Optum has sold its Optum Store to a third-party entity known as RVO Health, LLC (see more about how Optum Store is getting out of the direct-to-consumer mail order pharmacy with limited exceptions HERE). Anyway, when they raised the price of generic Crestor 40%, I found a new supplier which was even cheaper: Mark Cuban Cost Plus Drug Company.  In fact, it was so cheap that I didn't even bother letting Caremark pay for it after I satisfied my deductible because it wasn't worth the temporary savings to do so.

In fact, "the system" as David Joyner describes it is working great for vertically-integrated insurance company payors like Aetna (whose sister business units include Caremark), rival Cigna (which owns Express Scripts) and the other rival United Healthcare (which owns OptumRx), but for every other payor including employers and patients, thanks to PBM financial gamesmanship, there are legitimate questions as to whether the system is really working. 

Prescription drug prices continue to go up and up and up, coverage complaints are endemic, and PBM's use cumbersome tools designed to reduce drug spending such as step therapy whereby a patient must fail first on a preferred formulary drug before the PBM will even cover alternative medicines their doctors actually prescribe, and runaway prices on commoditized prescriptions like insulin have forced manufacturers to launch unbranded, unrebated versions which are frequently even less costly for patients than to even use their insurance company's PBM formulary brands, all while PBM's contribute more to their parent companies' bottom lines than insurance premiums now do (if you believe healthcare industry whistle-blower Wendell Potter who wrote about that HERE). In his article, Mr. Potter opined:

"I've decided it's time to stop calling UnitedHealth and two of its biggest competitors–Cigna and CVS/Aetna–insurance companies. All three are now getting or making more money as drug supply chain middlemen than providing health insurance in the United States."

So, in Caremark's view "the [PBM] system is working – from claim adjudication to drug dispensing" when the data on everything else suggests otherwise. Still, David Joyner (President & EVP of CVS' Caremark PBM business unit) comments are worth a listen. The company disables sharing their videos, but anyone with rudimentary knowledge of html can figure out how to share it with a little work. Catch them at or see the video below. Other presentations made at that event can be viewed at

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