CVS Caremark Drug-Benefit Pitches Missed The Mark For Some

CVS Caremark Corp.'s (CVS) effort to sell potential clients on the advantages of using a pharmacy benefits manager linked to a retail drug-store chain apparently missed the mark in several cases this year.

This may help explain why rival Medco Health Solutions Inc. (MHS) has collected far more new business for 2010 as of midyear - $2.8 billion gross compared with $1.1 billion for CVS - and why CVS Caremark's chief executive last month acknowledged disappointments in the competition for contracts.

A number of companies choosing among finalists this year for their upcoming pharmacy-benefit contracts felt CVS Caremark representatives at the bid presentations talked too much about the CVS drug-store chain and not enough about the Caremark PBM offering, according to two benefits consultants, who said they relayed the criticism to CVS Caremark. One consultant said CVS Caremark later revised its presentation.

John Malley, national practice leader, pharmacy benefits consulting, at Watson Wyatt Worldwide Inc. (WW), estimated CVS won only 10% of his roughly 30 clients with new PBM business up for bid, even though CVS typically offered the best pricing. He noted that Medco won the bulk of the accounts.

He said that CVS asked him a few months ago why it wasn't winning more business from his clients. The gist of the client feedback was, "You didn't utilize your time properly...to talk about anything you do as a PBM. We are not hiring a retail pharmacy to manage our drug benefits, we're looking for a pharmacy benefits manager," Malley said.

This isn't to say Caremark isn't a strong PBM, he said. "There's a disconnect between what they offer, what they're capable of, and what they're communicating to the marketplace," Malley said. He noted that "I have some very, very large clients that have CVS Caremark, always have had CVS Caremark, and they love them." Watson Wyatt has no financial relationships with the PBMs, is paid on a fee basis by clients and has no stake in bid outcomes, he said.

CVS Caremark plans to update investors on its 2010 selling season during its next earnings conference call and has no comment beyond remarks on the second-quarter call last month, said spokeswoman Carolyn Castel on Thursday.

CVS Caremark, Medco and Express Scripts Inc. (ESRX) are the three largest PBMs. PBMs handle prescription-drug benefits for employers and other groups, selling their ability to reduce health-care costs through discounts and programs to help patients adhere to treatments. They also operate large mail-order pharmacies.

David Dross, national managed pharmacy practice leader at Marsh & McLennan Cos. (MMC) consulting business Mercer, said that this year "Medco and Express Scripts, among others, had very good years from the standpoint of picking up new business. CVS Caremark won some new business, but from a relative increase in new clients perspective, they did not do as well as Medco or Express Scripts."

Dross said it's difficult to pin down one reason for clients' contract decisions. He did share client feedback with CVS Caremark about the presentations' emphasis on retail stores and said the company has revised its message.

Benefits consultants say employers now are looking beyond deal price and weighing PBMs' programs and performance guarantees to help lasso medical costs, in large part by keeping patients with chronic conditions on track with their treatments.

A perception by some employers that CVS Caremark overemphasized its retail pharmacies could be a problem, considering the company's promise that the 2007 landmark merger of the CVS pharmacy chain and the Caremark Rx PBM would provide industry-changing advantages for customers and shareholders. Some industry watchers say the jury is out, even though the deal gave CVS enormous buying and pricing power, the retail business is doing very well and CVS recently raised guidance.

Analysts point out, though, that CVS Caremark's PBM contract losses for 2010 have been outstripping new-business wins, and Chief Executive Thomas Ryan, noting successes and disappointments during the company's earnings conference call last month, said that "the remaining opportunities are probably not sizable enough to offset the losses." CVS is retaining about 96% of its renewing clients for 2010, while Medco is keeping more than 98%.

Jefferies & Co. analyst Scott Mushkin, who considers CVS one of the world's best retailers, said he doesn't understand why the PBM is having trouble winning accounts without offering pricing discounts. "I search...for a smoking gun and I don't have one," he said.

CVS this year lost its $1 billion Coventry Health Care Inc. (CVH) account to Medco, and recently New Jersey awarded a state employee and retiree contract to Medco, which also won the Chrysler-UAW union retiree account that Caremark had served.

Medco Chief Financial Officer Richard Rubino said Thursday, "We're winning significantly and we're retaining the material amount of our accounts...From a pricing perspective all the players out there in our space are rational, so I don't see pricing as a differentiator."

-By Dinah Wisenberg Brin, Dow Jones Newswires; 215-656-8285; [e-mail]