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CVS Health
Integrated payer, PBM and retail pharmacy network.
About
Vertically integrated health company combining the Aetna insurer, Caremark PBM and retail pharmacy with strong pharmacy-benefit management, specialty coverage, biosimilar policy and digital submission.
Deterministic scores · rules-based, not AIiHow these scores are obtained: each one is computed from this profile's listed attributes — capability checkboxes, certifications, capacity figures and coverage — by a fixed formula, recomputed on every page load. Deterministic and rules-based means the score comes from a fixed, transparent formula over listed attributes — the same inputs always produce the same score. It is not AI: there is no model, no learning, and no hidden weighting. Whether a score is relevant to you depends on your specific project: a capability that raises the number may not matter for your work, and a niche strength your project needs may barely move it. Capability scores are a directional starting point, not a verdict. A lower score does not disqualify a company or consultant, and no decision should rest on the score alone — always contact the company directly to confirm the specifics for your project.
Coverage reach iTiers reported covered lives from 6 points (any) up to 42 points (100 million or more), then adds 4 points per coverage area (capped at 22), 3 per therapeutic focus area (capped at 20), and 5 per geographic region (capped at 16). Levels: 80+ National reach | 60-79 Broad coverage | 40-59 Regional | below 40 Focused. Whether this dimension matters for you depends on your specific project.
40Regional
Formulary strength iCounts the 5 coverage categories (oncology, cell and gene therapy, rare disease, biologics, vaccines) at 9 points each, capped at 45, plus 5 points per formulary tier, capped at 25. Specialty drug coverage adds 16 and a biosimilar policy adds 14. Levels: 80+ Comprehensive | 60-79 Strong | 40-59 Solid | below 40 Basic. Whether this dimension matters for you depends on your specific project.
66Strong
Reimbursement iAdds 7 points per reimbursement code system listed, capped at 35, plus 17 each for medical and pharmacy benefit coverage, 16 for coverage determination, and 15 for appeals management. Levels: 80+ Full-spectrum | 60-79 Broad | 40-59 Established | below 40 Limited. Whether this dimension matters for you depends on your specific project.
93Full-spectrum
Value contracting iSums five capability checkboxes: value-based contracting 24 points, outcomes-based contracts 22, risk sharing 20, budget impact modeling 18, and real-world evidence 16. Levels: 80+ Innovative | 60-79 Advanced | 40-59 Emerging | below 40 Traditional. Whether this dimension matters for you depends on your specific project.
62Advanced
Access efficiency iRewards a high approval rate (up to 28 points at 100 percent), fast reviews (20 points at 5 days or less, down to 3 above 20), quick prior-auth turnaround (18 points at 1 day or less, down to 2 above 7), and a low denial rate (20 points at 5 percent or less, 0 above 20); a digital submission portal adds 14. Shows Not reported (score 0) when none of the four metrics is provided. Levels: 80+ Highly efficient | 60-79 Efficient | 40-59 Moderate | below 40 Developing. Whether this dimension matters for you depends on your specific project.
0Not reported
Compliance maturity iAdds 6 points per regulatory framework listed, capped at 45, plus 18 for appeals management and 7 per certification, capped at 22. Recent audit findings add 15 points at zero, 10 at one, 4 at up to three, and nothing above that. Levels: 80+ Exemplary | 60-79 Strong | 40-59 Solid | below 40 Developing. Whether this dimension matters for you depends on your specific project.
42Solid
Coverage & contracting capabilities
Prior authorizationStep therapyCoverage determinationValue-based contractingOutcomes-based contractsSpecialty drug coverageBiosimilar policyAppeals managementMedical benefitPharmacy benefitReal-world evidenceDigital submission portal
Therapeutic focus
SpecialtyOncologyImmunologyCardiometabolicInfectious disease
Locations
Woonsocket, RI, USACorporate HQHartford, CT, USAInsurer operations
Live record · illustrative seed data · scores deterministic, rules-based — not AI.