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INSIGHTS
2012
ADVANCING THE SCIENCE OF PHARMACY CARE
connected
2012
Tremendous shifts are underway in health care. We’re midway between passage of the
Affordable Care Act (ACA) and the implementation of its major provisions, but the market
is moving now, and not only to accommodate reform. Regardless of what happens on the
national front, all of us in health care recognize the need for new solutions.
Health care stakeholders are evaluating options, next steps, and new models. In many cases,
those next steps involve forming new alliances. Plans and providers are joining together to
explore new ways to expand capabilities and improve quality while reducing cost.
Collaboration is at the base of many of these new solutions, whether they involve a new
care delivery model like an ACO or determining how to build a formulary that will meet
member needs and manage health con
INSIGHTS 2012 ADVANCING THE SCIENCE OF PHARMACY
2012 Tremendous shifts are underway in health car
INSIGHTS Editorial Direction Per Lofberg, MS Tro
Table of Contents One Overwhelming Concern—Cost
One cost Overwhelming Concern INSIGHTS U.S. hea
Resurgence of utilization is inevitable and neces
2.5 M More young adults now have coverage 2.65 M
i m p r o v i n g a c c e s s The Affordable C
help them buy insurance. Many of those seeking in
employers are likely to move from a defined benef
INSIGHTS
i n c r e a s i n g q u a l i t y Health Care R
(continued from page 10) The PCMH model and conce
on the Exchanges to tracking performance data for
INSIGHTS trend 2011 Prescription Drug
Managing Pharmacy Trend: New Challenges Price wa
$5.8B (continued from
26 are not heavy users of prescription therapy •
34% between generics and preferred brands
Figure 4 54.4% OF EMPLOYER CLIENTS HAVE A GROSS
GDR Forecast 2012: Twenty-five percent of plan
CVS Caremark Drug Trend Forecasts UTILIZATION RA
INSIGHTS Specialty Drugs Will Soon
Three specialty drugs were among the 2010 top 10
63% HEALTH PLAN SURVEY of
2011 APPROVALS AND 2012 POTENTIAL NEW PRODUCT APP
Rapid advances in technology and better understan
Restricted annual limits will continue to be impo
50% orthopedic surgeries, such as hip or
New, more effective regimens are reviving interes
• Among privately-insured individuals under a
Health plans value the extensive patient manageme
Managing New Cost Dynamics Future specialty provi
coordinated specialty pharmacy care: hemophilia
(continued on page 32) Rigorous clinical, safety
Reinventing Pharmacy The health care landscape
INSIGHTS helping people on their path to better
CVS Caremark: reinventing pharmacy Being connec
INSIGHTS advancing the science of pharmacy care
(continued from page 36) for all CVS pharmacy pat
7days/wk INSIGHTS Projected shortage of
by Column Five Infographic PBM 70 Million Pharm
20% of Medicare patients are readmitted to the
Figure 2 PHARMACY-RELATED QUALITY MEASURES Mea
References One Overwhelming Concern—Cost INSIGH
24. International Journal of MS Care, “Comorbidit
Figures 4: 54.4% of Employer Clients Have a Tren
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