The Power Of

a dsn special report

n 2012, DSN presented an in-depth report on CVS Caremark’s integrated pharmacy business model — part big retail pharmacy chain, part big PBM, part big retail clinic operator — and the innovative products and solutions that were coming out of the organization, particularly where the three parts of theI business came together, its “integration sweet spots,” as company executives referred to them. It was clear at the time that the company had emerged as a “category of one,” which was the cover theme of that special issue. Now, a year later, as the company completes its 50th year in business and the country awaits a period of change in health care unlike anything seen in at least that time, CVS Caremark executives are quite confident that its unique hybrid structure and its ability to leverage the three core parts of its business — either individually or together, in varying combinations to serve a multitude of needs — aligns more effectively with the long-term trends in health care and puts the company in a unique position at a singular moment in history. In an exclusive interview with DSN, CVS Caremark president and CEO Larry Merlo talked about what that means, why it’s important to both public and private payers of all sizes, health plans, patients and providers, as well as how the company is using behavioral economics and predictive analytics to more effectively engage clients and customers and how they are building new clinical capabilities to address the new models of care, new customers and new quality standards that will guide the new payment models that will emerge through health reform. “We’re going to see more change in the healthcare industry over the next 10 years than we will have seen in the past several decades,” Merlo said. Continued on page 20 The Power of

By Rob Eder

18O • december 16, 2013 nedrugStoreNews.com Power of One

Continued from page 18 Call it the New New Math: One plus one plus one equals one. That’s more or less the formula behind CVS Caremark’s channel-agnostic, enterprise-driven growth strategy. That’s the power of one. Its Maintenance Choice program is a prime example. A traditional standalone PBM with a mail-order business would typically work hard to keep patients bound to mail. But for CVS Caremark, even if the PBM loses some mail- order scripts, it still captures those lives to manage, and CVS/pharmacy gets the scripts; CVS Caremark the enterprise wins. Meanwhile, its PBM customers — and their members — save money and maintain access to retail pharmacy. In today’s market, with the headwinds currently facing the nation’s healthcare system and the massive changes to come, that’s a powerful message. It is no newsflash that America is facing a massive shift in health care, changing the way care is delivered, who gets it, how it is paid for and who pays for it as a result of health reform and other forces. With or without the Patient Protection and Affordable Care Act, health care had already been on a trajectory of mass retail- ization, driven by the economics of consumer- directed health care. This is only expected to intensify under health reform; with the growth that is expected in the individual plan market, millions more people will have a lot more skin the system. in the game. And this will sharply influence the Specialty pharmacy spending continues “We believe our enterprise model choices they make. to climb. By 2016, it is projected that 8-of-the- can deliver services and capabili- Consider some of the changes that will occur top-10 branded drugs will be in the specialty ties that would be very difficult for in health care in the years ahead. class — up from 3-of-10 in 2010. Currently, spe- a standalone PBM or standalone re- America is aging rapidly — 15 million more cialty drugs represent about 20% of the total tail pharmacy to offer on its own,” seniors will enter Medicare by 2020, with Medi- drug spend, and it is expected to reach more Merlo said in late November. “When care drug spending expected to rise more than than 30% by 2016, growing at 13% a year. you think about the new customer 8% in that time. The average senior, ages 65 Health reform will result in newly covered groups emerging, … obviously the years to 74 years old takes about 27 prescrip- lives, new sources of funding and massive government becomes a growing tions a year; those 75 years and older average shifts between patient segments that will play customer segment with the growth more than 31 prescriptions a year. out over the next few years. By 2016, it is ex- in Medicare and the expansion of Obesity and chronic disease continue to spike pected that 17 million of the previously unin- Medicaid. We’re well positioned. ” out of control. By 2015, it is estimated that 149 sured will enter the healthcare system either Larry Merlo, president and CEO million people — roughly half the country — through the private exchanges or Medicaid, will suffer from one or more chronic conditions. which is expected to grow 24% in that time, in the next few years to 52 million — and re- Patients with chronic disease spend five times adding 11 million more lives. sulting in a huge spike in the individual payer as much as the average person, with chronic It also is expected that a number of employ- market, expected to grow 150%, adding 21 mil- disease accounting for more than 84% of total ers will begin to shift retirees into Medicare and lion lives by 2016. healthcare costs. move current employees into the private ex- New care and payment models already are And the $300 billion a year adherence changes, further contributing to the rise in the emerging. More than 4-of-10 physicians believe problem continues to leak avoidable costs from Medicare population — expected to grow 18% Continued on page 22

20 • december 16, 2013 DrugStoreNews.com Power of One

Channel-agnostic Approach: Enhances Patient Access 4 And Drives Enterprise Share

Continued from page 20 CVS/pharmacy share of retail network claims and U.S. retail market they will be reimbursed under a pay-for-perfor- CVS/pharmacy share of Caremark retail network claims 31% mance model in the next few years — some of 30%30% 31% 28%28% them already are being compensated that way CVS/pharmacy share of U.S. retail market to some degree. Both government and private 23%23% 21% payers are pushing the development of such 19% 19% 19% 20% 18% 19% 18% 19% 19% new delivery systems as patient-centered medi- 16% cal homes and accountable care organizations. These models also require providers to assume more risk. In a frank and wide-ranging discussion, Merlo explained why he likes his company’s chances to be able to pivot against each of these 2007 2008 2009 2010 2011 2012E 2007 2008 2009 2010 2011 2012E challenges, levering and ratcheting up and Source: CVS Caremark down its offerings in varying configurations as CVS/pharmacy Share Of Caremark Retail Network Claims needed to serve the changing needs of payers plan clients, as well as on a carve-out basis as of a client’s pharmacy volume, the client’s per- CVS/pharmacy Share Of U.S. Retail Market and health plans. a standalone PBM where we have direct pre- member costs tend to go down. The company “We believe our enterprise model can deliver scription benefit offerings on the exchange uses the example of two PBM clients — both services and capabilities that would be very dif- products,” Merlo told analysts, duringCVS/pharmacy the are using share CVS of CaremarkCaremark’s bookspecialty of businessoffering, ficult for a standalone PBM or standalone re- Nov. 5 earnings call. growing fasterbut only than one, overall Client A,retail also marketis using Mainteshare - tail pharmacy to offer on its own,” Merlo said Notes:Additionally, its PBM will “participate in nance Choice and Pharmacy Advisor. Client A in late November. “When you think about the the1. 2011andpublic 2012E exchanges for CVS/pharmacy through share ofour Caremark health retail plan network claimsachieves excludes a Aetna generic and CCRx dispensing claims. rate of 77%, an 2. Includes all 90-day claims filled at retail under the Maintenance Choice program. 17 new customer groups emerging, … obviously clients on a carve-in basis, where the health average medication possession ratio (i.e., the the government becomes a growing customer plan offers integrated medical and pharmacy key metric used to measure patient adherence) segment with the growth in Medicare and the benefits and we provide the PBM services,” of 83.5% and gross costs per member of $2,305. expansion of Medicaid. We’re well positioned. he added. By comparison, Client B achieves a generic rate We currently have the No. 1 share in the man- But there is another very good reason that of 68.4%, an MPR of 80.3% and spends $2,697 aged Medicaid space — with about 30% market Merlo is so bullish about the company’s future: gross per member as a result. In these scenar- share — and we expect that segment to grow its recent past. ios, CVS Caremark manages 86% of Client A’s [about] 40% between now and 2016. We’re in The fact is its unique, integrated structure total prescription volume versus just 55% for a very good place when you look at the assets and the offerings that have come out of it thus Client B. that we have to manage the Medicare popula- far, particularly Pharmacy Advisor — the What’s more, CVS Caremark still has a lot tion; we have our own SilverScript Med D plan, company’s clinical program, which is designed of runway to grow those numbers even higher, but also we manage the pharmacy benefit for to alert its pharmacists, both in its mail facilities as it continues to woo payers and health plans our health plan clients with their respective and in its stores, to adherence issues and gaps in in each new selling season. For about 18% MAPD businesses.” care — and Maintenance Choice, have resonated of its PBM customers, more than 80% of total And the opportunities that will arise are powerfully with patients and payers in recent prescription volume runs through either CVS not exclusive to the PBM business, Merlo ex- years. It shows up in the amount of captive Caremark’s mail order or its retail channel. plained. “When you think about the emergence PBM business CVS Caremark has running For another 22%, it delivers 60% to 80% of all of the exchanges, whether it’s public or private through its retail pharmacy division — the prescriptions in-house. exchanges, we will participate in those seg- growth since the two companies came together In addition to the differentiated offerings and ments,” he said. “And our participation is not has been staggering. In 2007, CVS/pharmacy’s services that the company is able to develop limited to our PBM. It spans across the entire total share of the retail pharmacy market stood as a result of its unique model and enterprise enterprise, including our retail pharmacies at 16%, and its stores processed about 18% of growth strategy, there is another very basic and MinuteClinic.” all Caremark retail pharmacy network claims. economic edge its model affords: purchasing The exchanges will provide an interesting By 2012, its share of the pharmacy market had power. Between its retail pharmacies and its opportunity for CVS Caremark to again prove grown to 21%, but it controlled 31% of all retail PBM, CVS Caremark is the largest purchaser its value at the patient level, as an estimated scripts processed by its PBM business. That is of pharmaceuticals in the United States, filling 17 million “active selectors” hit the market in another very strong testament to its “power of more than 1 billion scripts a year. According to the next two years alone — this group will be one” enterprise growth strategy. CVS Caremark, this is about 25% more than its voting with their wallets. CVS Caremark plans And there is a very good reason why its PBM biggest retail competitor and twice that of its to participate in the private exchanges both clients are engaging with a greater number of biggest PBM competitor. through “a carve-in basis through our health its services. As CVS Caremark grows its share Continued on page 24

22 • december 16, 2013 DrugStoreNews.com Power of One

Uniquely Positioned To Drive Better Health Outcomes Continued from page 22 And Lower CostsDriving better health outcomes and lowering costs And with its new 50/50 joint venture with Cardinal Health, announced Dec. 10, which will ClientClient AA ClientClient B B source and negotiate generic drug supply con- tracts for both companies, CVS Caremark picks Maintenance Choice Choice up even more scale in the thick of the generic wave. In the next two years, it is expected that Pharmacy Advisor Advisor nearly $30 billion worth of blockbuster drugs Exclusive Specialty Specialty will go generic, including Nexium, Copaxone and Celebrex in 2014 and Abilify, Namenda, Generic dispensing dispensing rate rate 77.0%77% 68.4%68.4% Lovaza and Androgel in 2015. Pembroke Con- sulting president Adam Fein estimates the CVS Medication adherence adherence (MPR) (MPR) 83.5%83.5% 80.3%80.3% Caremark-Cardinal Health generic drug joint venture has combined purchasing power of Gross cost cost per per eligible eligible member member $2,305$2,305 $2,697$2,697 about $10 billion. Another area in which the company recently CVS CaremarkCaremark enterprise enterprise share share of Rx ofvolume 86%86% 55% added some heft is in its specialty pharmacy Rx volume Source: CVS Caremark business, with its $2.1 billion acquisition of the Coram specialty infusion services and enteral hospital can be twice as expensive as delivering Store banner in Hawaii — through the HMSA Note: Client’s A & B shown above reflect retiree populations. nutrition business from Apria Healthcare, in the service in the home or the physician’s office. information network. 22 late November. While specialty pharmacy al- Prior to the deal, CVS Caremark had been a In addition to its retail pharmacies, the ready had been a large and growing business relatively small player in the infusion services partnership also leverages MinuteClinic in for the company — estimated to reach more business, Merlo said. a new way. CVS Caremark opened its first than $20 billion in revenue in 2013, and grow- As it continues to make each of its busi- clinics in Hawaii this summer, and its seven ing over the last several years at about 23% — nesses stronger, the truest demonstration of MinuteClinics on the island of Oahu are the Coram deal lands CVS Caremark squarely the power of its enterprise-driven, integrated linked to HMSA’s medical homes, helping to in the center of one of the fastest-growing seg- model is in the areas where the three busi- coordinate acute and chronic care. All patient ments within specialty pharmacy. The $11 bil- nesses come together — the integration sweet interactions are captured and shared through lion home infusion services market is growing spots — and where CVS Caremark is able to the HMSA provider information network. at about 10% a year, with infusion-based drugs seize on its clinical capabilities and strong in- Executives have stated that the company will accounting for the majority of new drugs in the sights, both at the PBM client and the retail cus- look to create more of these types of collabora- pharmaceutical pipeline in the years to come, tomer levels, to deliver innovative solutions. tions, leveraging multiple parts of its business Merlo told DSN. Meanwhile, the changes in health care also are to help providers better manage risk and meet “So the acquisition is consistent with the CVS leading to new customer relationships with their quality measurement goals. “From our Caremark strategy of core businesses that will healthcare providers. viewpoint, provider risk should turbocharge help direct growth,” he explained. “But if you As health reform evolves, providers will not our efforts to ensure patients are getting and dig a little deeper, this becomes another compo- only move more to a pay-for-performance mod- taking the right medications, and none of our nent to being a full-service specialty provider.” el, they will be required to assume more risk. competitors in the PBM space or the retail What does that mean, exactly? “Specialty Some of the lowest hanging fruit for them lies worlds can match these programs,” CVS Care- pharmacy today can be covered through the in improved patient adherence, which strikes at mark chief medical officer Dr. Troyen Brennan medical benefit, or it can be covered through the heart of the CVS Caremark operation. has stated. the pharmacy benefit, depending on the site of One strong example is the work CVS Care- While the design and construction of some care, whether the patient chooses to have in- mark currently has underway in Hawaii in of its offerings can be quite complicated, Merlo fusion [therapy] performed in the physician’s partnership with HMSA, the state’s Blue Cross brings the conversation back to the patient level. office, a hospital or perhaps at home. Our ap- Blue Shield program. HMSA is moving to a pa- Consider again the aging of America — the av- proach is to bring the most complete set of ser- tient-centered medical home model. CVS Care- erage senior with chronic conditions takes any- vices to clients and patients, … and we want to mark, which became the PBM for HMSA about where from 13 to 19 prescriptions daily. Fewer bring new approaches to the market that im- a year ago, is working with providers and than 50% of seniors are up to date on preventive prove the management of specialty pharmacy case managers that are affiliated with HMSA’s health services. And each year, the average se- costs across the entire spectrum of care.” medical home system to share adherence and nior sees seven doctors across four practices. Site of care management is a critical cost-sav- gaps in therapy data captured via Pharmacy Merlo talks about a patient the company ings strategy in the specialty pharmacy busi- Advisor by Longs retail pharmacists — CVS/ calls “Maria.” ness. Getting an infusion-based therapy at the pharmacy still operates under the Longs Drug Continued on page 32

24 • december 16, 2013 DrugStoreNews.com Power of One

Changing the game: PBM boosts revenue

By Antoinette Alexander

With a successful 2014 selling season under its belt, the promise of health reform ahead and its late November acquisition of home infusion company Coram, the pharmacy benefit management side of the business continues to be a game- changer for CVS Caremark. The company’s integrated pharmacy care model — which generated revenues of $57 billion for the nine months ended Sept. 30 — provides CVS Caremark a major competitive advantage, creating a channel-agnostic suite of services that it can tailor to meet a broad group of payer and patient needs. With the rise of such new models of care as accountable care organizations and patient- centered medical homes, and as new outcomes-based payment models begin to emerge, CVS Caremark executives are confident not only in the company’s ability to bend costs, but also in its ability to offer something traditional PBM models can’t — the local access to patients that only a network of 7,700-plus stores can deliver. This local access is especially critical in terms of the ability to serve the government-funded Medicare and Medicaid markets. Apparently, it is a message that is resonating with payers and health CVS Caremark’s integrated pharmacy model continues to resonate in the PBM marketplace. During the 2014 selling season, the PBM racked up plans, as the company continues gross sales wins of $5.1 billion — up from $4.4 billion for 2013. to rack up wins in the PBM marketplace. During the 2014 selling success across all payer segments — begins to shift. This will lead to new solutions that CVS Caremark is season, the PBM business secured employers, Medicare and Medicaid, partnership opportunities and risk- leveraging to improve adherence, gross sales wins of $5.1 billion as of and private health plans. Executives sharing arrangements as the focus identify gaps in care, increase ac- the end of the third quarter, with net are confident its broad range of shifts away from just the near-term cess to preventive care and wellness new business of about $1.8 billion, distinctive products and services cost of filling a script to the bigger services, and ultimately, drive down the company reported — up from will help retain and grow its share of costs associated with managing the healthcare costs — as well as how $4.4 billion gross, $1.1 billion net business in each of these segments total health outcome of the patient. it is leveraging the total enterprise during the 2013 selling season. as health reform unfolds in the years In the next few pages, DSN ex- and the many touch points of the The company continues to garner ahead, and the payer landscape amines some key products and company to do it all.

26 • december 16, 2013 drugStoreNews.com Power of One

On a mission to transform primary care By Antoinette Alexander

Given the ongoing challenges of a national physician shortage that doesn’t figure to get any better in the decades to come, the sharp rise in chronic disease and obesity, an aging population and the promise of tens of millions of newly insured Americans under health reform, CVS Caremark is on a mission to help transform primary care. And MinuteClinic is core to that mission. “Our long-term goal is to create a platform that supports primary care by providing integrated, high- quality care that is convenient, accessible and affordable,” Larry Merlo, CVS Caremark president and CEO, told analysts during the company’s quarterly conference call in November. Amid this tsunami of change, the company continues to ramp up MinuteClinic revenue has grown 39% CAGR from 2007 to 2012, and has delivered high double-digit increases in each of the first three fiscal its retail clinic business, expand- quarters of 2013. ing not only its physical footprint and suite of services, but also the Northern California, coastal North sible treatment options for payers Healthcare, match health system unique array of solutions it can Carolina and New Hampshire. It — both private and public. Beyond physicians as MinuteClinic medi- present to large payers and health also opened seven clinics inside chronic care and disease state man- cal directors in these areas, help- plans through MinuteClinic. select Longs Drug stores on the agement, MinuteClinic continues to ing set important groundwork for Clinic revenue had grown at a Hawaiian island of Oahu, which deliver innovative new solutions for its participation in such emerging compound annual rate of 39% from will help support a unique Medical insurers and large payers, including models of care as accountable care 2007 to 2012, and MinuteClinic con- Home-based program operated by reduced co-pays, biometric screen- organizations and other integrated tinued the momentum in 2013 with Blue Cross Blue Shield of Hawaii. ings, such wellness programs as networks of care. high double-digit sales increases in Along the way, MinuteClinic weight-loss and smoking-cessation, Opportunities will continue to each of the last three earnings peri- continues to expand beyond the and onsite employer clinics. expand as healthcare reform un- ods — 18% in the third quarter, 32% basic acute-care array of services “We expect these valuable pro- folds in the years ahead, coverage in the second quarter and 50% in that originally defined the model. grams to grow over the next five expands and MinuteClinic begins the first quarter, according to com- At the end of 2012, non-acute/ years, as the need for low-cost, to participate more in the public pany executives. Comparable clinic non-flu vaccine-related visits ac- accessible care intensifies,” associ- and private exchanges, company sales increases were running in the counted for 16% of total patient ate chief medical officer for CVS executives have noted. “low 20s,” CFO David Denton not- visits and had grown 41% over Caremark and MinuteClinic pres- This will lead to even greater col- ed in November. the previous three years. ident Andrew Sussman has noted. laboration with Caremark clients, as With 726 clinics in operation at This expansion of scope of prac- Helping to transform its role MinuteClinic expands to help meet the end of the third quarter, the plan tice will continue in the years to within the healthcare landscape is clients’ unique healthcare needs. is to more than double that number come, driven both by the expansion MinuteClinic’s growing number In 2012, among its top 100 PBM by 2017 to more than 1,500 locations of practitioner guidelines for nurse of health system affiliations, which clients, 42% of covered lives lived in 35 states, adding more than 150 practitioners and physician assis- at press time stood at 30. These within 10 miles of a MinuteClinic. new clinics a year. MinuteClinic tants across the states, as well as relationships, such as the ones By 2017, that number is expected to recently entered new markets in the greater need for low-cost, acces- with Cleveland Clinic and Emory reach 67%.

28 • december 16, 2013 DrugStoreNews.com Power of One

Pharmacy Advisor boosts adherence By Antoinette Alexander CVS Caremark patients’ monthly supply of oral medications to treat diabetes

Designed to improve adherence and iden- 40 tify gaps in care, CVS Caremark’s Pharmacy Program period Intervention group Advisor clinical program is a pharmacy- 38 Control group based approach to condition management that is proving to be a powerful differentiator 36 for the company. Launched in 2011, the program is available to CVS Caremark members who are 34 diagnosed with certain chronic conditions and provides them with key information Days’ supply per month 32 about their prescribed therapy when they are most receptive to these messages — face- 30 to-face when filling a prescription at CVS/ 1 4 7 10 13 16 pharmacy or by phone from the URAC-accredited Pharmacy Advisor Call Center for Months mail-order and non-CVS retail pharmacy Source: Health Affairs, Jan. 10, 2012 customers. This approach to pharmacy care is a prime example of how CVS Caremark is Pharmacy Advisor programs are gaining rapid adoption reinventing pharmacy. The program initially focused on patients There were approximately 16 million lives enrolled in Pharmacy Advisor programs in 2013. with diabetes and, in 2012, Pharmacy Advi- sor was expanded to four more conditions condition focus expansion: — high blood pressure, high cholesterol, 2012 2013 coronary artery disease and congestive heart • Diabetes • Asthma failure. The program was expanded again in • Hypertension • COPD 2013 to include asthma, breast cancer, chronic • Dyslipidemia • Depression obstructive pulmonary disease, depression • Coronary artery disease • Osteoporosis • Congestive heart failure • Breast Cancer and osteoporosis. The company expected to have 16 million lives on the Pharmacy Advisor platform Source: CVS Caremark in 2013. The results? The customized counseling to patients has been shown to increase adher- increases of 3.9%. Results of Pharmacy Advisor program ence rates up to 3.9% and return $3 in savings The company also expanded the program Percent change in optimally adherent users for every $1 spent on counseling. in 2013 to serve Medicare patients, and ex- of diabetes medications For example, research published in Health ecutives expect Pharmacy Advisor to be a Non-Pharmacy Advisor 0% Affairs about the Pharmacy Advisor program key differentiator in the market given the users (control) for diabetes has shown that pharmacist in- massive increase in this patient population in Pharmacy Advisor 4% teraction with patients and their doctors the coming years and the shift to outcomes- users increased both medication adherence rates based payment models. “This expansion [of and physician initiation of prescriptions to Pharmacy Advisor] in Medicare will help our Percent change in members with diabetes with gaps (no blood-pressure-lowering medications) close gaps in care. Therapy initiation rates in- health plan clients achieve their star ratings,” creased by as much as 39% for the population said CVS Caremark EVP Jon Roberts, presi- Non-Pharmacy Advisor 0.4% studied, with an even higher increase of 68% dent of the PBM division. It is expected that users (control) for the group counseled at retail stores. Over- 15 million more people will enter Medicare Pharmacy Advisor -17.2% all medication adherence rates increased by by 2020, with Medicare drug spending an- users 2.1%, with face-to-face interventions by retail ticipated to grow at a compound annual rate store pharmacists resulting in adherence rate of 8.5%. Source: CVS Caremark

30 • december 16, 2013 DrugStoreNews.com Power of One

Maintenance Choice options create loyalty By Antoinette Alexander Maintenance choice 2.0 plan design differs from 1.0

Since the merger in 2007, CVS Caremark has set maintenance choice 1.0: maintenance choice 2.0: its sights on developing innovative products and • Mandatory plan design required • No plan design changes growing the overall enterprise. Its channel-agnostic to drive 90-day utilization required to gain 90-day approach is working, and perhaps there’s no better • Mail-order pharmacy distinct economics for patient and payor from CVS/pharmacy • Mail-order pharmacy integrated example of that than Maintenance Choice. • Binary choice for consumer with CVS/pharmacy Introduced in 2009, Maintenance Choice is the (i.e., mail or CVS/pharmacy) • Complete flexibility for company’s integrated offering that extends the mail- consumers to alternate order benefit for Caremark members who participate Source: CVS Caremark in qualifying plans, enabling them to pick up their maintenance medications at any CVS retail pharmacy Maintenance choice adoption (in millions of members) with no increase in co-pay or payer pricing. In 2012, the company introduced a less restrictive version of 34 the program, which enables clients with either a man- Maintenance Choice 2.0 datory or a voluntary mail plan design to participate Maintenance Choice 1.0 in Maintenance Choice. Between the two versions of the program, CVS Care- mark is able to provide payers with a range of 30-day and 90-day offerings that offer a continuum of options balanced between access and cost savings. 14.5 Given the plan design of the expanded Mainte- 10.8 nance Choice offering, the pharmacy benefit manager 8.4 has the opportunity to gain more lives, and the retail 6.3 business benefits from those members choosing CVS/ 2.9 pharmacy for their 90-day maintenance medications. The end result: More clients sign on with the PBM and 2009 2010 2011 2012 2013E Runway use CVS/pharmacy locations, thus benefiting the en- Source: CVS Caremark tire enterprise.

message when she’s due for a refill; she can CVS Caremark captures all of that patient Power of one then choose whether she wants to pick it up at information and shares it with Maria’s primary Continued from page 24 her local pharmacy or have it mailed to her for physician via the new health information ex- “She’s 68 years old,” he explained. “She the same co-pay. Either way, the CVS Caremark changes. Maria’s physician sees CVS Caremark suffers from three chronic conditions: diabe- pharmacist, in the store or at the mail facility, as a care partner in the virtual medical home. tes, high cholesterol and rheumatoid arthritis. will use Pharmacy Advisor to receive alerts That is the power of one, and that is how When you [think about it], you’re going to say, about Maria. In this case, the pharmacist gets CVS Caremark sees its future. ‘You know what? I know a Maria.’” a message to counsel Maria about an adher- In a series of exclusive interviews with Merlo Merlo explained the range of challenges Ma- ence issue with one of her medications. Phar- and key members of its leadership team — in- ria has managing her medications. She forgets macy Advisor also prompts a referral for Enbrel cluding SVP merchandising Judy Sansone, to refill her medications. She is unsure when counseling and a cholesterol test. chief marketing officer Rob Price and newly there is a change in her therapy. She doesn’t al- Maria goes from the pharmacy counter to appointed president of CVS/pharmacy Helena ways remember to get the lab tests she needs. MinuteClinic, where she gets a cholesterol test, Foulkes, who officially assumes leadership of She uses multiple pharmacies. And when she and in 20 minutes, the nurse practitioner is re- the company’s retail business on Jan. 1 — DSN does see each of her doctors, she has a hard time viewing her results with her and providing examines the core parts of CVS Caremark’s describing any changes or updates in therapy counseling on diet and self-care. Since Maria’s business, including an in-depth look at its front- that any of her other doctors may have made. test results are elevated, the NP also writes a store business and a series of new personaliza- How does CVS Caremark leverage the total prescription for a higher dose statin. Maria tion initiatives that is reshaping every aspect of enterprise to help Maria? First, she gets a text picks up her new prescription 15 minutes later. its retail business.

32 • december 16, 2013 DrugStoreNews.com Power of One

Initial Pilot Results: Understanding specialtyNew Therapy Starts Uppharmacy 112% Over Four Months spending By Antoinette Alexander Average new scripts per store per week during pilot Average New Scripts Per Store Per Week During Pilot With specialty drug spending expected n Control stores n Integrated specialty pilot stores to continue to grow rapidly — 15% to 20% Up annually — for the next several years, and ex- 143% pected to represent half of total drug spend by 2018, perhaps nowhere else are payers more fo- Up Up cused than on reducing costs and better manag- 197% Up 47% ing specialty pharmacy spending trends. And 79% this is another area in which CVS Caremark is creating unique solutions that leverage its integrated pharmacy care innovation structure. Generally speaking, the PBM part of the business focuses on three core areas to reduce specialty pharmacy costs: First month Second month Third month Fourth month • Unit cost: Optimizing discounts for manu- 1st Month 2nd Month 3rd Month 4th Month Source: CVS Caremark facturers and pharmacies, managing re- Notes: 1. Non-pilot control based Controlon data from Stores 63 stores, whichIntegrated was normalized Specialty to match the Pilot number Stores of stores used for each test and imbursement schedules, site of care and indexed to pre-test fills. channel management; 2. Third and fourth months for pilot only include data from mini-test. 3. Notes:Analysis excludes any patient and NDC combination, which shows RX Fill Nbr 0 but has been presented within pilot market • Utilization: Maximizing clinical quality 1.during Non-Pilot fiscal Control year based 2012. on data from 63 stores which was normalized to match the number of stores used for each test and indexed to Pre-Test Fills. while addressing waste, overuse and re- 2. 3rd and 4th months for pilot only include data from mini-test. imbursement; and 3. Analysis excludes any patient and NDC combination which shows Rx Fill Nbr 0 but has been presented within pilot market during FY12. 26 • Drug mix: Aligning incentives to en- “INfusion will be a sure the lowest cost, most clinically valuable component of effective option. our specialty pharmacy “When patients implement all of our pro- offering going forward. grams, they can save 12% to 16% of their spe- Our comprehensive cialty spend,” Jon Roberts, president of CVS services will enable Caremark’s PBM business, has noted. us to streamline care Roberts illustrates the power of its holis- management for patients, tic approach to managing specialty pharmacy ... leading to better health spending, using the example of a rheumatoid outcomes while avoiding arthritis patient. First, utilizing clinical guide- unneccessary costs. ” lines, CVS Caremark employs step therapy to CVS Caremark utilizes tools and strategies — such as step therapy, site — Jon Roberts, President, start the patient with the lowest cost, clinically of care and channel managment and optimizing utilization — to lower CVS’ PBM business costs as much as 16% for PBM clients. appropriate therapy available — in this case, the oral generic drug methotrexate — before moving a patient to a more expensive biologic. of its business that has been vastly expanded leading to better health outcomes while avoid- “In our data, we see that about 20% of patients by its $2.1 billion acquisition of Coram from ing unnecessary costs.” [who] have a prescription written for an expen- Apria Healthcare Group in November. Coram Another example of how CVS Caremark sive biologic and have not tried methotrexate provides infusion therapy and enteral nutrition leverages its total enterprise is its Specialty first,” Roberts explained. services to more than 20,000 patients a month, Connect program. Patients have the choice of Second, if a biologic must be used, CVS Care- primarily through home infusion, as well as via dropping off and picking up their specialty mark reviews whether or not there is a preferred a national network of more than 85 locations, medications in a CVS/pharmacy store or re- drug available — for instance, Humira or Enbrel. including 65 ambulatory infusion suites. ceiving them via mail. A four-month test of the Last, CVS Caremark looks at site of care. For “Infusion will be a valuable component of program led to a significant increase in new instance, getting an infused drug delivered in a our specialty pharmacy offering going for- specialty therapy starts at retail, Roberts noted. hospital setting is twice as expensive than in the ward,” Roberts said. “Our comprehensive ser- About half of patients want to be able to pick home or in the physician’s office. vices will enable us to streamline care manage- up their specialty prescriptions at its stores, Thus, managing infusion therapy is an area ment for patients, as well as their physicians, he said.

38 • december 16, 2013 DrugStoreNews.com Power of One

MinuteClinic programs help reduce co-pays

By Antoinette Alexander “This is the kind of collaboration we expect to reproduce throughout the As healthcare reform unfolds, the opportu- country, taking advantage of the changes in financial incentives for providers nities for CVS Caremark extend beyond the and applying a greater connectivity that they will need to manage care.” PBM part of its business. One area in which — Troyen Brennan, EVP, Chief Medical Officer, this is becoming increasingly apparent is in CVS Caremark MinuteClinic, which — apart from just the massive expansion of its physical footprint and its scope of services — continues to transform primary care and further demonstrate to health plans what it can do to bend costs. In 2012, MinuteClinic began adding a reduced co-pay pilot program for PBM clients to utilize its clinics for more preventive care and wellness services, physicals and biometric screenings. By 2013, it had more than 8 million lives enrolled in these types of programs. Meanwhile, as health reform evolves, pressure from government and private payers has given rise to two new healthcare delivery models — the patient-centered medical home and the Accountable Care Organization — each representing significant opportunities for MinuteClinic. One strong example is the work Minute- Clinic has done with HMSA, the Hawaii Blue Cross Blue Shield Program; about a year ago, CVS Caremark became the PBM for HMSA. Under the partnership, Longs Drug Stores in Hawaii — CVS Caremark, which acquired Longs in 2008, continues to operate the Ha- waiian stores under the Longs banner — will share adherence and gaps-in-care messaging gathered through the Pharmacy Advisor plat- MinuteClinic Co-pay Reduction With Marriott: MinuteClinic’s reduced co-pay program for PBM clients, which enables them to utilize clinics for preventive care and wellness form with doctors and case managers through Programscreenings, has Yielding more than 8 million Promising lives enrolled. Results the health information network HMSA has designed for its medical homes. Additionally, minuteclinic co-pay reduction with marriott the seven MinuteClinic locations that opened this summer in Hawaii are linked into HMSA’s medical home structure and coordinate acute 80% and chronic care for HMSA patients. These Member out-of-pocket cost patient interventions will be shared through HMSA’s health information network. “This is the kind of collaboration we expect Visits vs. baseline 3x to reproduce throughout the country, taking advantage of the changes in financial incentives for providers and applying a greater connectivity that they will need to manage care,” First-time users 67% said Troyen A. Brennan, CVS Caremark EVP Source: CVS Caremark and chief medical officer.

40 • december 16, 2013 DrugStoreNews.com

29 Power of One

Key architect of ExtraCare, Pharmacy Advisor and Maintenance Choice, Foulkes takes helm of retail biz

By Rob Eder retail business, including its more than 7,600 retail stores and 19 dis- Personalization is shaping ev- tribution centers, as well as its re- ery major initiative occurring in tail merchandising, supply chain, CVS Caremark’s retail business marketing, real estate, front store today. And although she is new and pharmacy operations. In ad- to the job, the new president of dition, Foulkes also will maintain CVS/pharmacy, effective Jan. 1, responsibility for the company’s Helena Foulkes knows an awful enterprise digital, brand and lot about it. After all, Foulkes was communications functions. the original architect of Extra- She will lead an organization Care — the engine that is driving that has worked hard to drive all efforts to personalize its stores pharmacy innovation, deep con- and the shopping experience, and sumer insights, exceptional cus- better engage customers at every tomer reach and engagement — a touchpoint they have with CVS/ good deal of which she has had pharmacy — and led the launch a hand in. DSN caught up with of the program back in 1997. new head of CVS/pharmacy in Since then, Foulkes has worn an exclusive Dec. 3 interview, to a multitude of hats for the com- get a better sense of her vision pany, having held leadership po- for the retail business and what sitions in many core areas of the makes her excited about taking business during her 22-year ca- on responsibility for one of the reer with the company, including most critical assets in CVS Care- merchandising, marketing and mark’s integrated business mod- operations; most recently, she el, its stores. served as chief health care strat- “My experiences have taught egy and marketing officer, with me how to design programs for responsibility for corporate strat- the consumer, and I think if you egy and enterprise marketing, design with the consumer in government relations and com- mind, you tend to produce bet- building products and programs including Maintenance Choice munications. As health care con- ter outcomes,” Foulkes told DSN. with the consumer in mind, and and Pharmacy Advisor. These tinues to evolve and CVS Care- “The single most important thing the goal of forging a closer rela- programs are strong examples of mark as a company looks to drive I have learned, whether it’s been tionship with its customers. And how the company’s enterprise- further differentiation through its in merchandising, marketing, while she has received a good wide focus on personalization integrated pharmacy model, the store operations or product de- deal of credit for ExtraCare and extends beyond just the front- company believes its retail busi- velopment in the PBM, is that we for her role in developing the end of the store or retail division. ness needs a leader who truly have a tendency in this industry program — which now boasts By definition, Pharmacy Advisor, understands the healthcare con- to focus on the processes or the more than 70 million active card- which identifies gaps in therapy sumer and the opportunities it prescriptions, and we forget that holders and is tied to 68% of all and adherence at the patient lev- can deploy to attract and retain we’re supposed to be design- front-store transactions — what el, relies on a personalized inter- customers and generate strong ing all of this for the customer. is lesser known is the key role vention with the patient. long-term growth. Certainly, When you design with the con- she has played in the company’s Both programs also are indica- Foulkes has built her career on sumer in mind, you can achieve work to transform the digital ex- tive of how the personalization just that. great things. That’s what gets perience for healthcare consum- efforts extend beyond just retail As president of CVS/pharma- me excited.” ers and the development of some customers — Pharmacy Advisor cy, Foulkes will have responsibili- Indeed, Foulkes has demon- of the company’s most innova- also is used by CVS Caremark ty for all aspects of the company’s strated quite a bit of expertise tive healthcare programs today, Continued on page 44

42 • december 16, 2013 DrugStoreNews.com Power of One

Continued from page 42 But what really gets Foulkes excited are the plained — an advantage the company has pharmacists in the company’s mail facilities. new opportunities to further innovate phar- over its competitors that have launched loyal- The two programs also are examples of how macy care that will emerge in the years to ty programs of their own in the last few years. CVS Caremark can work with payers and come, as new systems of care develop, new “It’s one thing to have a program with a lot of health plans to tailor plan design. payment models emerge, providers take on people enrolled; it’s another thing to have the “As health care continues to evolve and we more risk and payers demand to see — and analytical expertise to make deep insights.” drive further differentiation through our in- pay for — results. But also it takes time for a loyalty card to tegrated pharmacy model, we need a leader “I also believe the ACA is going to gener- evolve from a marketing platform to being who truly understands the healthcare con- ate different forms of payment structures that an integral part of a company’s DNA. That sumer and the opportunities we can deploy will be much more outcomes-based,” Foulkes takes buy-in. to attract and retain customers and gener- said. “In an outcomes-based world, pharma- “When we started ExtraCare, there were ate strong, longer-term growth,” noted CVS cy will always be a winner because pharmacy a couple of category managers who got on Caremark president and CEO Larry Merlo. produces a great return on investment. Every board early,” Foulkes recalled. “But once oth- “Helena has been laser-focused on our dollar spent to get someone more adherent to ers started to see the really cool things they enterprise strategy for the past three years,” their medications, produces real savings in were doing with ExtraCare, more jumped in. Merlo told DSN. “And I know she will do an reduced hospitalizations and other upstream Over time, it just became a part of our mer- outstanding job in this role and the role that costs. Building the capabilities at CVS where chandising culture. Today, our merchandis- CVS/pharmacy plays in our enterprise goal we can really differentiate the pharmacy ex- ing organization feels an intense ownership of helping people on the path to better health perience and deliver improved patient out- of ExtraCare. They’re using it not just to drive by reinventing pharmacy.” comes … that, to me, is exciting.” offers, but they’re also making business de- Foulkes has already given some serious cisions about products to carry and how to thought to the important role CVS/pharmacy “I think if you design with the price items. It’s an important part of their and its pharmacists can play as health reform consumer in mind, you tend to toolbox, and I don’t think you can get that in unfolds — beyond just filling scripts. “All of produce better outcomes. ... We a year or two.” the experiences that I have had have really forget that we’re supposed to Today, the insights from ExtraCare are given me a great appreciation for the oppor- be designing all of this for the driving a lot more than assortment, pricing tunity we have as a company to really help customer. When you design with the and promotion. It is informing nearly every the consumer navigate a very complicated customer in mind, you achieve great aspect of its retail business, and it is the unde- healthcare landscape,” Foulkes said. things. That’s what gets me excited.” niable engine behind the company’s massive “Pharmacy is such an accessible part of personalization efforts. To a large extent, that — Helena Foulkes, President, the healthcare system, seeing as many people is what the company was hoping for when it CVS/Pharmacy (effective Jan. 1) as we do every day. I am incredibly excited created ExtraCare in 1997. about the role that a pharmacist can play. I But if you ask Foulkes, she’ll tell you that was at a store earlier today,” Foulkes said in No doubt, Foulkes will continue to find in- the one thing she never expected was the im- early December, “[and] one of the relatively spiration by designing with the consumer in pact it has had on the culture of the company. young pharmacists in the store said, ‘We’re mind. Going forward, that means bringing a “It’s not just the business results that you starting to get lots of questions from custom- greater degree of personalization to its com- get from a loyalty program, it’s the cultural ers about the [Patient Protection and] Afford- munications with its best customers. shift it creates within the company,” she said. able Care Act, and I want to make sure I am Certainly, 15 years worth of ExtraCare data “That’s the really interesting thing I would giving them the best information I can. [But] has delivered tremendous insight over the never have expected.” it’s complicated.’” years, and the company continues to mine Given the role she has had in helping “We don’t expect our pharmacists to be that information to segment its customers, to plant the seeds for that culture in her fully expert in every aspect of the ACA, but design and merchandise its stores and per- career with the company, it is indeed fit- we think we can be there for the consumer to sonalize its promotions. But what has been a ting that Foulkes takes the helm of its retail help her navigate the changing landscape,” big surprise, Foulkes explained, has been the business now. she continued. “The rollout of Medicare Part impact it has had on the company’s culture. In the pages that follow, DSN examines in D clearly demonstrated that our pharma- “ExtraCare allowed us to build a culture greater depths how CVS/pharmacy is lever- cists played the role of trusted advisers that of experimentation and learning beyond the aging ExtraCare to drive several important helped build relationships with consumers pure business results. It’s part of our DNA,” front-end initiatives, including customer seg- when they gained coverage and started filling she said. “I think what’s most exciting is that mentation, store clustering and a new digital prescriptions. And I expect that as 25 million it has produced an environment where we circular program that creates a personalized Americans become newly insured over time, can test and learn.” page one of offers based on the actual items they will come to see us as a resource.” But that didn’t happen overnight, she ex- an ExtraCare member historically purchases.

44 • december 16, 2013 DrugStoreNews.com Power of One

Leveraging ExtraCare: Conversion and My Weekly Ad

By Rob Eder

Fifteen years worth of ExtraCare learnings also have dramatically influenced the way CVS Caremark markets and merchandises to its best customers. These learnings have in- formed a critical part of its overall retail strategy, SVP merchandising Judy Sansone told DSN — conversion. “What we found was we had a lot of up- side with existing customers,” Sansone explained. “Conversion is the way we bring personalization to existing customers; by giving them offers that are highly relevant to them, we can really engage them across the store.” Prior research had shown the company that customers tend to shop a limited number of categories. For example, the data revealed that pain relief customers bought hair care products 42% of the time, and oral care customers bought vitamins 36% of the time. The early results have been “a tremendous success,” Sansone noted in a late-September interview. “Just in the last month, we’ve converted [more than] 2 million people to buy in categories they’ve never bought in.” Accord- ing to Sansone, who was reticent to point to any single vendor success story, the big wins have been in the “health, beauty and personal care categories.” Conversion will continue to be a major ting, but also in the delivery mechanisms to component of the company’s retail growth engage the customer.” “ExtraCare allows the ability for strategy going forward, she said. At the heart Enter the most recent example of how CVS brands to develop loyalty and of conversion is CVS Caremark’s broader re- Caremark is personalizing the conversation long-term value to the brands, and tail mission to personalize its relationship with its best customers through ExtraCare: … for suppliers it is so much more and its communications with its best cus- My Weekly Ad. The new digitized circu- efficient to build long-term value tomers. “We have worked to innovate in a lar initiative, which launched in September, with a customer than it is to con- number of different ways to engage with the enables CVS to personalize its weekly pro- stantly have to acquire [new cus- customer,” Sansone said. “In the past, it’s motions down to the user based on past tomers]. Constantly acquiring new been really traditional methods — most peo- purchasing behavior. customers is expensive. So… they ple are familiar with coupons at the register “Last week, we had one circular,” Sansone continue to work with us very ag- or [printing] coupons from the kiosk; those said, during the Sept. 20 interview. “This gressively to grow the program.” are fairly traditional. But we have [made] week we have a different versions for each of Judy Sansone, SVP merchandising huge innovations in our digital strategy our customers.” around email and around social media — … My Weekly Ad is enabling CVS Care- the number of tools and channels we have mark to engage in more meaningful and rel- mass media vehicles have had a very good today to reach customers, pre-shop, during evant communication with customers, SVP/ run, and they will continue to be a very big shop and post-shop is tremendous. It’s so- chief marketing officer Rob Price explained. part of what we do,” Price said. “But we’re phistication in the kind of offers they’re get- “Newspaper and television, and all of the Continued on page 48

46 • december 16, 2013 DrugStoreNews.com Power of One

Continued from page 46 mindful of the challenges of mass media — declining newspaper circulations, etc. And also we’re mindful of big changes in consumer behavior; whether it’s digital commerce or personalizing your sneakers, playlist or ted- dy bear, there is a sea of change occurring out there, and we want to participate in that. … I think from a media and marketing and pro- motional standpoint, My Weekly Ad is about moving toward that convergence. Registered ExtraCare members get their own personalized front page customized with offers “based on the items they buy at CVS,” Sansone said. The offers are specific to the SKU and store level, and the ads can even instruct the customer on where to find the items on the shelves of their local store. The app also allows users to create a customized shopping list from items featured in My Weekly Ad. The ability to create this kind of personally curated, geo-mapped shopping list is unprec- edented in loyalty programs, Price added. Notably, none of this important work or the insights that drives it all could exist without the commitment of CVS Caremark’s vendors, Sansone said. “Our vendors have engine for insight, whether its new product been great partners in both the develop- “Conversion is the way we bring launches or new product design, or commu- ment of ExtraCare and our growth in terms personalization to existing nications, etc.” of how we have delivered personalization customers; by giving them offers And just as CVS Caremark can personal- through ExtraCare.” that are highly relevant to them, ize its communication to the customer level, it Again, while she is reluctant to single out we can really engage them across also has the ability to target efforts at the store any one of its vendors or a single program the store. ... Just in the last month, level. That means a vendor doesn’t have to be it has partnered on, Sansone told DSN why we’ve converted [more than] 2 in all 7,700 stores to have meaningful partici- so many of its suppliers have invested in the million people to buy in categories pation in ExtraCare — an important consid- program over the years. “They get a great they’ve never bought in. eration for smaller companies who may not ROI from working on personalization by the Judy Sansone, SVP merchandising think they have the bandwidth to commit to very nature of personalization — it’s very rel- the program. evant to the individual customer,” she said. “By it’s nature, ExtraCare is about person- “ExtraCare allows the ability for brands to understand how to use it,” she said. To help alization,” Sansone said. “We can personalize develop loyalty and long-term value to the foster closer collaboration with its vendors, it to customers, and we can personalize it to brands, and … for suppliers it is so much CVS Caremark this fall unveiled a new infor- stores,” she said. “So, for limited distribution more efficient to build long-term value with mation gateway, which it developed in con- products, we can deliver offers in stores that a customer than it is to constantly have to ac- junction with IRI. The information gateway carry those products specifically. There are quire [new customers]. Constantly acquiring enables its vendors to use and plan from the large and small suppliers that see tremendous new customers is expensive. So… they con- same data used by CVS’ own category man- benefit — in fact, many small suppliers have tinue to work with us very aggressively to ager and buying teams. actually shifted most of what they do with us grow the program.” These kinds of customer insights cre- into the personalization vehicles because mass Of course, all of this is pretty sophisticated ate an added incentive beyond just selling [media] isn’t necessarily the best way for them work, Sansone told DSN. “Our suppliers re- more merchandise, for suppliers to invest to deliver their messages. By doing it in this ally need the kind of tools and resources to in ExtraCare, Price added. “It’s not just an personalized way, they are actually building first understand the information and then engine for efficient promotion; it’s also an loyalty for their small brands in our stores.”

48 • december 16, 2013 DrugStoreNews.com Power of One

Leveraging ExtraCare: Customer segmentation

By Rob Eder

From here on, it’s personal. Sixteen years since CVS Caremark first introduced its ExtraCare loyalty card program, the company has vowed to take the program — and its relationship with its best customers — to a new, more personalized level. That commitment to personalization is playing out in a number of key marketing initiatives, including a consumer segmentation program that is helping it identify and communicate with its best customers. It is no news flash that after many years of being the only loyalty program in the drug channel, CVS Caremark has seen competition emerge to ExtraCare in recent years, as both Rite Aid and Walgreens have introduced programs of their own. “We have seen a greater saturation of conventional loyalty programs,” noted CVS/pharmacy SVP/chief marketing officer Rob Price. “What it has told us is that we need to be unconventional.” But it’s not just being different for the sake of it. “The card itself — and even the basics of a loyalty card program — is not the heart and soul of customer engagement,” he explained. “The easy part is distributing cards — we’ve distributed 327 million cards. The disbursement of plastic is not the hard part. The hard part is the personalization, the access and viding more personalized service to our top ease of use, and the insights and relevance customers based on their healthy habits,” “The card itself — and even the that you build over time.” Price said. basics of a loyalty card program And that is an area in which CVS Caremark CVS’ best customers are concentrated in — is not the heart and soul of is quite confident that its 16-year head start one of three areas, he explained, which the customer engagement ... The easy gives it a significant advantage. “We think company has identified as: part is distributing cards — we’ve that relevance is an advantage that is very • Health seekers — Customers who tend distributed 327 million cards. The hard to catch up with,” Price said. “We think to over-index in terms of managing disbursement of plastic is not the of ourselves as a matchmaker, or a personal chronic conditions and who are enthu- hard part. The hard part is the per- shopper, between a customer and their very siastic and curious about how they can sonalization, the access and ease of best deal — that’s something you can only take personal control of their health; use, and the insights and relevance earn over time.” • Health strugglers — Similarly strug- that you build over time.” As CVS Caremark has discovered over the gling with chronic conditions, but these Rob Price, SVP/chief marketing officer years, the true beauty of its ExtraCare loyalty customers tend to be more uncertain program — used in about 84% of total front- about how to take control; and they grow older, become caregivers and store sales, according to the company — is the • Quality actives — Valuing convenience perhaps develop chronic disease them- data that helps CVS identify segments of cus- and ease of use when taking care of selves, and begin to fall into that ‘Seek- tomers in order to deliver relevant rewards to their acute needs. “They may not have ing’ or ‘Struggling’ phase, we are going each segment. as much presence of chronic disease to be their preferred destination.” “What has become more important is pro- in the house,” Price explained, “but as Continued on page 52

50 • december 16, 2013 DrugStoreNews.com Power of One

ExtraCare, which is up to 70 million active cardholders, has spun off opt-in niche programs like ExtraCare Pharmacy and Health Rewards and ExtraCare Advantage for Diabetes.

Continued from page 50 For the “Actives” part of its strategy, Ex- reaching specific health-related goals — think Why health? Because it enables a pow- traCare has spun off fun, hip programs like quitting smoking, losing weight or reaching erful alignment between its best custom- Beauty Club. some fitness-related goal. ers’ core interests and CVS Caremark’s core While executives are reticent to discuss “We have partners that are very interested strengths as a dominant force in pharmacy how these opt-in niche programs would con- in creating incentives as part of some collabo- healthcare innovation, and its broader mis- tinue to evolve through ExtraCare, it is clear ration to putting people on the path to better sion to leverage its unique three-pronged, that CVS will continue to work closely with health,” Price said. “In some cases, it’s specifi- integrated structure to help fix health care its best vendor partners to leverage the pro- cally about ExtraCare opportunities woven — lowering costs, increasing access and gram and its full digital, mobile and in-store into some part of plan design — particularly, improving outcomes. platform to further personalize down to the the health plans we are working with on ex- ExtraCare has evolved in design in re- needs and preferences and purchasing behav- change products.” “We see enormous enthu- cent years, with a growing range of opt-in ior of its best customers. siasm in plan benefit design meetings and programs that aim at the sweet spot of its While still in the early stages, the company strategy discussions about how we bring that “Seekers/Strugglers” strategy, including the also is talking with payers and health plans expertise to create ideas to enrolling custom- addition of ExtraCare Pharmacy and Health about leveraging ExtraCare to incentivize ers, engaging customers, measuring results Rewards and the ExtraCare Advantage for better outcomes by rewarding plan members and unleashing those assets that are closest to Diabetes program. and employees for healthier behaviors and the customer,” he added.

52 • december 16, 2013 DrugStoreNews.com Power of One

Building an armada of manageable clusters

By Rob Eder

Another key area, in which the learnings of ExtraCare are helping to inform the overall CVS Caremark retail strategy and personalize the shopping experience is in the way CVS Caremark designs and merchandises its stores. Further leveraging the insights from ExtraCare, CVS Caremark continues to evolve its myCVS store clustering initiatives, which began in 2011 with the rollout of a special store format designed for its urban cluster stores. The urban cluster stores are designed to serve as “general stores” in dense trade areas with limited supermarket competition and feature vastly expanded consumables offerings, among other key features. By the end of 2012, the company operated 450 urban cluster stores, with plans to have more than 500 by the end of 2013. Currently, the company also is piloting a suburban cluster format that features an “amplified health and beauty presence,” SVP/chief marketing officer Rob Price told DSN. These PATH stores, as the company has identified them — short for “Personalized Access to Health” — offer “a more complete assortment and a more elevated experience, with a more shop-able and better integrated healthcare quadrant, … both in terms of physical access and naviga- tion, and also how it integrates into pharmacy,” he said. CVS Caremark also is applying the insights from its store-clustering initiatives to refreshes and remodels of its existing stores, as well into its regular planogram reviews, resets and new product introductions on an ongoing basis. And along the way, it also is learning that some of the insights that come out of one cluster or another are not neces- Continued on page 56

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Continued from page 54 sarily exclusive to those stores. “Many of these insights are generalizable — or ‘cluster-agnostic,’ as we call it,” Price added. “We see a lot of promise with some of these insights being weaved into our day-to-day business.” One key example of how CVS Caremark has been able to take learnings from its store clustering initiatives and apply them more broadly to larger swath of stores is the healthcare resets it began about a year ago. Studies from its suburban cluster pilot program indicated that vitamins needed to have a bigger presence in the healthcare quadrant of the store. The reset repositioned the vitamin and nutrition categories opposite the pharmacy counter, replacing magazines and As Seen on TV, with wider-set aisles and the addition of aisle breaks to allow customers easier navi- gation of the vitamin assortment. According to CVS executives, the move has resulted in double-digit increases in vitamin category sales and a 3% to 5% increase in the entire healthcare quadrant in the reset stores. The plan was to roll the reset into 600 stores in 2013. “You’re going to see these insights come to life in a number of ways. So, as we understand our clusters, we can modify our planograms — that’s a very standard pro- cess, … [but] now we can do it in a richer way,” Price said. “When we open a new store, we have the analytical sophis- tication to [know] which cluster that store is, so we design the store around those particular requirements. But then … we [also] know what customers are in which stores. So then, [we also] highlight those elements in targeted communications and promotions to [those customers] that best amplify the things we know they are going to be interested in. [That] is where all of our customer insights and all of our clustering insights come together — where we have these customer touchpoints.” While the overarching strategy of store clustering might be personalization, the real goal is not to create 7,600 different variations on the store prototype. “If we had our Continued on page 58

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Continued from page 56 druthers, we would individualize the stores based on visit,” Price said. “But what you can do is leverage the information, not to individualized stores, but to personalized stores, and tailor those stores into manageable groups that create an affirmative answer to the question: ‘Is this store for me?’” The goal, Price explained, is a perfect balance of “trying to create customer delight at the broadest customer level, [while also] achieving scalable results,” he said. “The objective is not a handful of flagships — it’s a whole armada across 7,600 stores to make sure that we can harvest the insights from our cluster work … and weave those insights into [more] of our stores. The objective is to have the most clusters that we can that are substantially different enough from one another, but the fewest that we can have to make it actionable and scalable [because] our partnership with our vendors is about results.” No doubt, 15 years worth of ExtraCare data acquisition and the degree of engagement it has had with customers, “gives us an incredibly rich pool of insights to build stores that customers are going to love,” Price added, “but it’s a journey.”

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Engaging with pharmacy patients

By Antoinette Alexander

As the healthcare industry rapidly evolves, CVS/pharmacy is reinventing pharmacy and taking its patient care programs to new heights. A shift toward pharmacists providing more clinical services and a government push through Medicare star ratings to improve outcomes are among the key elements shaping today’s fast-changing pharmacy landscape. To ensure greater ef- ficiency and improved patient outcomes, CVS/pharmacy implemented its new WeCARE workflow initiative. Rolled out chainwide by the end of 2012, the new WeCARE system integrates all prescriptions into one workflow for improved management and integrates patient care intervention programs directly into the pharmacy workflow. It also clearly defines the role of each member of the pharmacy. After several years of testing, CVS/ pharmacy executives have been encour- aged by the results. The biggest benefit has been a massive decrease — more than 50% — in the number of instances of patients not having prescriptions ready when expected. The workflow initiative enables teams to better prioritize their work and achieve optimal outcomes, resulting in a 5% boost in customer outreach, according to company executives. The pharmacy retailer also has been able to cut down by about 6% the time it takes to fill prescriptions, which means that pharmacists have more time to spend with patients. And to directly address the issue of improving outcomes through medication adherence, the pharmacy retailer has several patient care programs in place, including new script outreach, first-fill counseling, ReadyFill and Pharmacy Advisor. Since 2008, the company has conducted more than 230 million pharmacy interventions, and its 18,000 immunization-certified pharmacists deliver more than 3 million flu shots a year.

60 • December 16, 2013 drugStoreNews.com Power of One

Catering to individual healthcare needs

By Michael Johnsen

CVS/pharmacy has been one of the more forward- thinking retailers in front-end merchandising, and that’s certainly the case across the OTC aisles as much as any- where else in the store. CVS/pharmacy was one of the first retail pharmacy operations to change the signage in the store from not- easily-understood industry jargon, such as “analgesics” or “digestives,” to everyday terms that everyday folks can better understand, such as “pain relief” or “heartburn relief.” And CVS/pharmacy was the first to deploy pull-box displays across their diagnostics and diabetes meter sets. With those displays, customers for the first time could Continued on page 64

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Continued from page 62 handle a blood-pressure monitor or blood-glucose meter before their purchase. Now CVS/pharmacy is working to leverage its Ex- traCare loyalty program to personalize the shopping experience for mom with her own special deals. If she has shopped for pediatric allergy remedies in the past, for example, and CVS/pharmacy has an offer on an item in that category, that deal will be highlighted. That personalization is enabled through CVS’ myWeek- ly Ad, a first-of-its-kind digital circular powered by the company’s ExtraCare loyalty program. “What has become more important is providing more personalized service to our top customers based on their healthy habits,” Rob Price, CVS’ chief marketing officer, recently told DSN. CVS has segmented its health-savvy consumers into 1-of-3 segments: health seekers, health strugglers and quality actives. Health seekers either suffer from a chronic health condition, or they take care of someone with chronic health needs. They are constantly on the look- out for new disease-management solutions and actively seek education on how to better take personal control of their health. Health strugglers also have chronic conditions, but they’re less confident in their purchasing decisions. Meanwhile, quality actives turn to CVS/pharmacy first for their acute care needs, such as a cold or a headache, and value convenience and ease of shopping the most. It’s important to cater to those customers as well, Price noted, because one day they will fall into one of the other two segments, and CVS/pharmacy wants to already be their preferred health destination.

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Bolstering beauty with exclusive programs

By Antoinette Alexander

A beauty trailblazer in many respects, CVS/pharmacy is working to further lift the front end and drive loyalty in beauty through its ExtraCare Beauty Club program and exclusive offerings. Beauty has been — and continues to be — an important front-end business for the retailer. It made waves in 2003 when it opened its first Healthy Skincare Center, a beauty boutique that sells European brands. The centers are staffed with trained beauty advisers who provide customers with a personal consultation, skin analysis and product recommendations. Another pillar in its beauty offerings is its ExtraCare Beauty Club, the first-ever beauty club program for the Continued on page 68

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Continued from page 66 retail pharmacy industry. The ExtraCare Beauty Club provides cardholders who opt in the program with ad- ditional rewards on beauty purchases and other beauty-specific benefits. Today, the Beauty Club has about 12 million members. Meanwhile, CVS continues to bolster its exclusive product offerings. The retailer partnered with actress Salma Hayek to offer the exclusive beauty collection Nuance Salma Hayek — marking the first complete beauty line developed by an A-list actress in partnership with a drug store. For spring 2014, the Nuance Salma Hayek line will offer new products for hair and skin, such as the new Age Affirm skin care collection that is designed for mature skin. Looking to further strengthen its relationship with beauty shoppers — both inside and outside of the store — CVS/ pharmacy also launched on Aug. 2 a new website and mobile site dedicated to its growing Essence of Beauty brand, available exclusively at CVS/pharmacy. Since its launch in 2002, Essence of Beauty has consistently been one of CVS’ top-selling brands. Last year it was the No. 1 fragrance and body care line at CVS/pharmacy, selling twice as many units as the second-most popular brand, George Coleman, VP merchandising for store brands at CVS/pharmacy, told Drug Store News in a recent interview. CVS has adjusted its merchandising strategy for the brand, and for the first time, all of the Essence of Beauty Fine Fragrance body mists will be merchandised together in store, with ancillary products grouped by scents throughout the display, Coleman said. These displays will highlight the new packaging design and enable testing. Moving forward, all stores will have tester products available so shoppers can try the new Fine Fragrance body mists, and an Essence of Beauty Tester Bar will be available in more than 2,000 locations. The recently expanded Essence of Beauty Fine Fragrance Collection now consists of 14 scent offerings, including four new scents, and the Shea Indulgence treatment line.

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Tailoring GM/consumables to market needs

By Antoinette Alexander

Customization. That’s the one word that sum- marizes CVS/pharmacy’s approach to food and general merchandise. With its store clustering initiative, CVS/pharmacy is creating store designs that match the needs of customers within each type of market area — designs that are heavily influencing the treatment of food and GM in stores. For example, the “general store-like” urban cluster con- cept has expanded grocery, fresh on-the-go foods and self- service checkouts. There’s also an expanded pantry offering with a greater assortment of household and baby products, as well as an expanded travel-size section and a larger selec- tion of wines. Bolstering its store brands across the store is a major focus for the retailer, with a goal of moving toward 20% store-brand penetration. Among the more recent GM and consumables developments are the revamping of its Gold Emblem consumables brand and the 2013 launch of its Total Home brand, a line of home care-related items.

70 • December 16, 2013 drugStoreNews.com Power of One

Serving the local communities

By Antoinette Alexander Trust teamed up with the National Asso- ciation of Community Health Centers for CVS Caremark is reinventing pharmacy a $3 million multi-year partnership called Key moments in history and, by leveraging its vast PBM, retail and “Innovations in Community Health.” 1963 clinic network, is taking an innovative ap- The initiative supports the develop- The first “Consumer Value Store” store, selling proach to drive down healthcare costs, en- ment of innovative community-based health and beauty products, opens in Lowell, hance access to care and improve patient programs to manage such chronic dis- Mass., founded by brothers Stanley and Sidney outcomes. But playing out largely under eases as diabetes, heart disease, asthma Goldstein and partner Ralph Hoagland. the radar are its outreach efforts and the and hypertension. 1964 significant impact that CVS Caremark has Hitting the ground running, the trust The chain grows to 17 stores. The original “Con- on the communities in which it serves. awarded 21 grants in 2012 totaling more sumer Value Stores” logo unveiled. As CVS Caremark strengthens its foot- than $1 million to community health cen- 1967 hold along the front lines of U.S. health care, ters across the country. Opens first stores with pharmacy departments in behind the scenes the retailer continues to “The programs will use a variety of Warwick and Cumberland, R.I. forge ahead on its long-standing commit- methods to help people manage their 1969 ment to serve the community. In fact, last chronic disease and improve health CVS is sold to Melville Corp. year alone, CVS Caremark and its founda- outcomes — including the use of tele- 1970 tion, the CVS Caremark Charitable Trust, Continued on page 74 Chains grows to 100 stores in the Northeast. contributed more than $81 million in dona- 1972 tions, volunteer hours and gifts-in-kind. Acquires 84 Clinton Drug and Discount Stores. As a pharmacy innovation company, 1974 CVS Caremark has set its sights on sup- Tops $100 million in annual sales for the first time. porting organizations focused on advanc- 1977 ing community health, including those Acquires the 36-store New Jersey-based Mack that reduce barriers and increase access Drug chain. to health care services, develop wellness 1978 and prevention programs or provide Differentiates itself by opening mall-based small health education and awareness for the health and beauty aids stores. local communities that it serves. 1981 Breaks ground on current company headquarters Battling chronic conditions via in Woonsocket, R.I. community programs 1984 In July 2012, CVS Caremark Charitable Harvey Rosenthal named president and CEO of CVS, succeeding Stanley Goldstein. 1985 Reaches $1 billion in annual sales for the first time. As a division of Baxter, Caremark launches Mail Service Pharmacy, IGIV Home Care Services and Growth Hormone Distribution and Services. 1988 CVS/pharmacy celebrates its 25th anniversary, finishes the year with nearly 750 stores and sales of about $1.6 billion. 1990 Acquires 500 stores from People’s Drug, entering new markets, including Washington, D.C., Penn- sylvania, Maryland and Virginia. Continued on page 74

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Continued from page 72 clusive CVS Caremark All Kids Can Bat- medicine, nurse practitioners to moni- ting Camps, including one during spring Continued from page 72 tor at-risk patients and wellness circles training in Florida. 1991 that bring people together who are living Caremark purchases Prescription Health Services. with and working to manage the same Stepping up in times of disaster 1992 chronic disease,” said Eileen Howard Beyond its healthcare-related initia- Caremark spins off from Baxter. Boone, president of CVS Caremark Char- tives, CVS Caremark’s support of first re- 1993 itable Trust. sponders and community organizations Caremark sets up offices in Redlands, Calif. in times of disaster has always played a 1994 Supporting inclusion through All key role in its outreach initiatives. Tom Ryan named president and CEO of CVS/ Kids Can Whether supporting relief efforts in pharmacy. Ryan began his career with CVS/phar- One of its more notable endeavors is typhoon-stricken Philippines, tornado macy in 1974 as a pharmacy intern. CVS Caremark All Kids Can, which is relief efforts in Oklahoma and Texas or CVS launches PharmaCare, a PBM company. committed to helping all kids on their stepping up to assist those impacted by Caremark expands product lines and sets up ad- path to better health. To date, All Kids Hurricane Sandy, the company is unwav- ditional offices in Northbrook, Ill. Can has committed more than $60 mil- ering in providing financial support and 1996 lion in support of nonprofit organizations in-kind donations of water, snacks and Following the restructuring of Melville Corp., CVS that provide innovative programs and other products to help those impacted by Corp. becomes a stand-alone company. Stanley services focused on helping kids to be the devastating events. Goldstein named first company chairman. best they can be, and has helped make a And when the Boston Marathon bomb- 1997 positive impact in the lives of nearly 20 ing rocked the nation in April, the retailer, Acquires more than 2,500 stores from Revco million people. which has deep New England roots and — the largest acquisition in the history of the Among the recent initiatives under stores just blocks from the finish line, U.S. retail pharmacy industry — in the Midwest this program: A $50,000 grant to Special swiftly rose to the occasion, expressing and Southeast. Olympics to help expand the organiza- its sadness over the tragic events and Caremark merges its PBM and biotech businesses. tion’s Healthy Young Athletes program announcing that it was coming together 1998 and the ninth consecutive season of part- with the Boston business community to Acquires 200 stores from Arbor Drugs of Michigan nering with the Boston Red Sox on the in- Continued on page 76 to bring store total to 4,100 in 24 states. 1999 Tom Ryan is named chairman of CVS Corp., succeeding company co-founder Stanley Goldstein. Company enters Florida, with stores initially planned for the Tampa market. CVS/pharmacy launches CVS.com, the first fully integrated online pharmacy in the United States. Caremark launches online prescription refills. 2000 CVS/pharmacy enters the Chicago market and continues expansion in Florida, entering Fort Lau- derdale and Orlando. CVS Corp. acquires Stadtlander pharmacy, making CVS ProCare the largest specialty pharmacy in the United States at the time. Rick Krieger; Douglas Smith, M.D.; Steve Pon- tius; and Kevin Smith, RN, FNP founded Quick- Medx, the original name of MinuteClinic. 2001 Introduces ExtraCare, becoming first national pharmacy retailer with a loyalty card program. 2002 CVS/pharmacy enters Texas in Dallas and Continued on page 76

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Continued from page 74 mark is the largest corporate donor for support The One Fund Boston. ALS research in the United States. Continued from page 74 Houston. Company also enters Phoenix and Advancing medical research CVS Caremark Charity Classic: Las Vegas. For the past 11 years, CVS Caremark A world-class charitable sporting event QuickMedx is renamed MinuteClinic in December. has made a significant impact in advanc- Then there’s the CVS Caremark Char- 2003 ing amyotrophic lateral sclerosis, or ALS, ity Classic. The tournament, Rhode Is- CVS celebrates its 40th anniversary, and enters research with support from colleagues and land’s largest charitable sporting event, the Minneapolis/St. Paul, Minn., market. customers, raising more than $30 million. has raised more than $17 million since its Extra Care loyalty card program ends the year ALS, also known as Lou Gehrig’s dis- inception in 1999. with more than 44 million cardholders. ease, is a neurodegenerative disorder The appeal of this event is twofold; it Caremark Rx and AdvancePCS announce a $23 typically leading to paralysis and death provides world-class entertainment for billion merger. within four to six years. There is no avid golf fans, and it provides funding 2004 known cause or cure for ALS. for a variety of programs serving children Acquires 1,268 Eckerd Stores and Eckerd Aside from holding its annual in-store and families throughout Southeastern Health Services, Eckerd’s mail order and Advancing Medical Research fundrais- New England. PBM business. ing campaign to benefit the ALS Therapy As part of its philanthropic mission, CVS ProCare becomes part of PharmaCare. Alliance, the pharmacy retailer was a key the CVS Caremark Charity Classic ex- 2005 funder of recent research whereby scien- panded its reach through a series of golf CVS/pharmacy partners with MinuteClinic, an- tists from Belgium made a rare discovery: clinics for veterans of all abilities in part- nouncing three clinics in CVS stores. a new gene that influences survival time nership with the nonprofit organization 2006 of ALS. The findings could help acceler- Golf For All, a program of the Northeast Acquires 700 stand-alone Sav-On and Osco ate efforts to find a treatment. CVS Care- Accessible Golf Association. drugstores from Albertsons, growing presence in southern California and Midwest. MinuteClinic becomes the first retail clinic to be accredited by the Joint Commission. CVS Corporation acquires MinuteClinic. 2007 CVS Corp. and Caremark Rx merge, creating CVS Caremark, nation’s first integrated pharmacy services provider. 2008 First anniversary of CVS’ transformational merger as the largest integrated provider of prescriptions and health-related services in the nation. Acquires 541 stores from Longs Drug in Califor- nia, Hawaii, Nevada and Arizona. 2009 Opens store No. 7,000 in Little Canada, Minn. MinuteClinic begins a series of affiliations to en- hance access to high-quality, affordable healthcare services. 2011 Larry Merlo succeeds Tom Ryan as president and CEO of CVS Caremark. Merlo joined CVS/ pharmacy in 1990 through the acquisition of People’s Drug. 2012 CVS Caremark tops $100 billion in revenues for first time. MinuteClinic expands to more than 600 clinics in 25 states and 14 million patient visits.

76 • December 16, 2013 drugStoreNews.com shelf surfing cvs A SPECIAL ADVERTISER SECTION FOR CVS VENDORS

+MD USA +MD USA is nationally recognized for manufacturing the finest medically correct yet affordable Diabetic and Compression socks on the market, according to the company. Recently, more and more retailers have become aware of its hi-tech Blister Control, Odor Control, FIR Inflammation Relief and Bamboo Travel Compression socks. +MD, the wellness subsidiary of one of the world’s largest sock manufacturers, has become internationally renowned for their innovative advances in producing socks and other wellness products that not only make customers feel good, but also look good, according to the company. +MD manufactures hosiery and other knitted products. In addition to total vertical manufacturing integration, they have operations in Asia that meet the strictest requirements of the many well-known retailers in the United States. Contact: Roger Roundy at (888) 430-9888 or visit PlusMD.us

Nicole by OPI Nicole by OPI announces four new Top Coats & Treatments for 2014 — essentials for a perfect at-home manicure. Devel- oped and inspired by OPI’s in-salon favorites, the line includes Oil to Go; 3-in-1 Base, Top Coat & Strengthener; Quick Dry Top Coat; and Matte Top Coat. Packaged in a leak-proof tube, Oil to Go keeps cuticles soft and smooth on the go, according to the company. 3-in-1 Base, Top Coat & Strengthener encompasses nail care must-haves in one convenient bottle. Matte Top Coat can be layered over any Nicole by OPI hue to instantly transform shiny finishes to matte. Quick Dry Top Coat reduces drying time and adds shine and protection. Nicole by OPI formulas are long-lasting, fast-drying and salon-quality, according to the company. These treatments will be available in January 2014 for $7.99 each at retailers, including select CVS, Target, Walmart, Kmart, Duane Reade, Kroger and H-E-B locations. In Canada, these treatments will be available for $10.99 each at select Shoppers Drug Mart, Walmart Canada, Jean Coutu, Loblaws and London Drug locations. Visit NicolebyOPI.com

Uniweb “What a genuine privilege this past decade has been for Uniweb working as colleagues with CVS in the evolution of pharmacy storage systems,” Uniweb stated. Uniweb continues to provide storage solutions that exceed CVS’s fixturing requirements in the pharmacy, according to Uniweb. Uniweb’s progressive culture allows it to create and build durable, cost-effective, and adaptable displays — delivering more than just shelving. Whether it’s new construction or a renovation, plenty of options to maximize space are available. Uniweb offers a complete line of American-made fixture solutions, including modular office areas, complete pharmacies, complete managers’ offices, temporary spaces, check-out systems, locking cabinets, under-counter vials, bins, shelves, doors, countertops and health clinic spaces. Discover how Uniweb’s customer-first philosophy, dedica- tion to innovation and quality provides customers with unrivaled products and support. Visit UniwebInc.com

UrgentRx UrgentRx is a line of fast-acting, portable OTC medications providing right now relief for today’s busy, on-the-go consumer. UrgentRx Fast Powders come in an innovative, fast-acting flavored powder format available in convenient, single-dose, credit card-sized packets for easier portability and accessibility, the company stated. The flavored powders can be taken without water, providing immediate relief whenever and wherever needed. Initially developed for heart attack victims, UrgentRx currently produces medications for such everyday ailments as allergy attacks, headaches, aches and pains, heartburn and upset stomach. Visit UrgentRx.com

78 • december 16, 2013 DrugStoreNews.com