CVS Health Corporation

CVS Health Corporation

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Medical - Healthcare Plans

CVS Health Corporation (CVS) Q3 2018 Earnings Call Transcript

Published at 2018-11-06 17:00:00
Operator
And our first question comes from the line of Ricky Goldwasser with Morgan Stanley. Please proceed. Your line is open. Ricky R. Goldwasser: Yeah, hi, good morning. Thank you for all the details, and Eva, welcome, I'm looking forward to working with you in the future. A couple of questions here. I appreciate it's a little bit early to talk about 2019 and 2020, but when you announced the deal you gave us some idea also of how we should think about the accretion in year two. Do you have any updated thoughts for us or give us some context of how we should be thinking about that or any changes from what you disclosed in the past? Eva C. Boratto: So, hi, Ricky. This is Eva. I look forward to meeting you or working with you in the future. We have not changed our point of view on the value being created by the transaction. As you know, and as Larry stated earlier on the call, we have increased our synergy target to more than $750 million in year two and feel very comfortable with that. So overall, we're comfortable with our previous comments. Ricky R. Goldwasser: Okay. And when we think about the pilot program, the potential opportunity there, is the pilot really going to be focused on Aetna members? Or do you have early health plan customers that are – early adopters that are interested in participating as well? And if you can give us some more color on how we should think about the opportunity that relates both to your commercial customers but also to the faster-growing Medicare population that you manage? Larry J. Merlo: Sure. Ricky, good morning. It's Larry. Ricky, we will start obviously with the Aetna members where, as we mentioned in our prepared remarks, where the integration and innovation teams are working closely around that. But as you've heard us state many times, our goal is to create an open platform model that we can partner broadly. Today, we've got more than 70 health plan clients, and I do believe that there'll be elements of innovation that will apply broadly in the marketplace. But to be clear, we'll be starting first with our Aetna members. Michael P. McGuire: Next question, operator.
Operator
Thank you. Our next question comes from the line of Ralph Giacobbe with Citi. Please proceed. Your line is open.
Ralph Giacobbe
Thanks. Good morning. I just want to go back to the – to exceeding the $750 million. Any way you can sort of help frame the size of that or how meaningful above the $750 million where that incremental savings is coming from, and maybe the visibility that you have on that? And then the last piece is just the pacing of it. Obviously, it's a two-year target. Is it half and half? Is the bulk of it front-end loaded? Just any consideration of timing around that capture (31:20). Larry J. Merlo: Yeah, Ralph, it's Larry. Listen, we will talk more about that as we get into next year and talk more about 2019 and beyond. Obviously, the integration teams are doing a terrific job, as we mentioned in our prepared remarks. And listen, we're continuing to push the teams. I don't want to say that we're done yet. And again, we've talked about the areas of opportunity as part of the initial integration work. There's really nothing that has changed beyond that. We've talked about some expense and operating savings as well as some elements of medical cost savings that are – I'll put it under the heading of low-hanging fruit from the two companies coming together. So again, we'll talk more about that as we get into next year in terms of quantifying the cadence of it as well as the dollar value.
Ralph Giacobbe
Okay. All right. Fair enough. And then just to follow up, can you give any more details around the new economic models you're discussing with consultants and customers? Is that largely fee-based with risk sharing? Any detail there? And then, maybe also what the reception has been to this point in going back to those customers and consultants? Thanks. Jonathan C. Roberts: Yeah. Ralph, this is Jon. So yeah, today the model that is in the marketplace is based on unit discounts off of AWP, and we feel there's an opportunity to create better alignment and reduce the complexity. So when we talk about alignment, today we align around not only unit discounts, but we think there's an opportunity to align around drug mix, which also drives overall cost to our clients. And that's not in the pricing model today. And when we think about complexity, there's 14 pricing levers, approximately, that consultants use to evaluate and compare price points. But again, there's no net cost to the client based on changes to drug mix that are driven by formularies that we have in the marketplace. So we feel like there's an opportunity to greatly simplify the model and create alignment. I would say the clients are very interested and I think the market is ripe for this type of change, and we'll have more to say about this next year.
Ralph Giacobbe
Okay. Thank you.
Operator
Thank you. Our next question comes from the line of Michael Cherny with Bank of America Merrill Lynch. Your line is open. Please proceed.
Michael Cherny
Good morning, and thanks for all the details as well. Thinking about the quarter, and I know, again, not trying to get to 2019 guidance, but if you think about the performance on the Retail/LTC side, you've seen the strong script growth come in over the course of the year thanks to your payer partnerships and PBMs. How do you think, especially in a future world where you own Aetna, some of those preferred or narrower networks start to develop for other payers that are not Aetna? And what is the appetite, as you've seen yourself setting up for 2019 network access, for either expansion or potentially even reductions of preferred networks? Eva C. Boratto: Hi, Mike. This is Eva. Let me try to break apart your question. Overall, from a script performance, we're very – extremely pleased with the progress that we've made achieving nearly 9% script comp growth this year. That growth came from three different key areas: our clinical program, our network arrangements beyond Caremark as a PBM with other payers, and including our strong position in Med D. So we continue to see substantial opportunity here to continue to outpace the market and continue to grow our retail share. Jonathan C. Roberts: And Michael, this is Jon. I think as CVS and Aetna comes together and with our programs, we can demonstrate the activities that pharmacies can drive around improving health and lowering overall healthcare costs. We think there's an opportunity to move the market to more performance-based networks where part of the pharmacies' reimbursement will be based on their ability to execute against clinical programs that do lower costs for our clients. So I think there's lots of opportunity here.
Michael Cherny
Great. Thanks. Just one quick housekeeping question. The five states that are left, I believe New York and California are two. Can you just update us on where the other three are? Larry J. Merlo: Sure. Mike, it's Larry. Let me just talk about where we're at with the remaining states broadly. You mentioned New York, we're pretty far down the road in our engagement with the Department of Financial Services. We're in active and productive discussions. We look forward to bringing those conversations to a successful close in the very near term. California, I am pleased that after productive discussions and engagement, we have reached agreement on all the material terms with the state. And we're in the process of finalizing the form of agreement and all the appropriate paperwork. We expect that that will be done over the next couple days. As far as the remaining couple of states, what I can add is that New Jersey was the very last state to have a hearing. That took place yesterday. So the other couple of states are in the process of finalizing their orders and all of that's reflected in our earlier comments that we expect to close before Thanksgiving.
Michael Cherny
Perfect. Thanks, Larry. Larry J. Merlo: All right. Thanks, Mike.
Operator
Thank you. Our next question comes from the line of Lisa Gill with JPMorgan. Your line is open. Please proceed. Lisa C. Gill: Great. Thanks very much. Eva, when we look at where current consensus is for 2019, I know that some people have the transaction included, some don't have it included. When we think about core CVS in 2019, is there a way to maybe think about some of the headwinds and tailwinds for the core business, so that everybody can get aligned? And then Aetna is going to be what it's going to be when you add that on top of it? Eva C. Boratto: Yes. Thanks, Lisa, for the question. Obviously, we're going to have much more to say in February, but let me try to outline for you some of the moving pieces. As I think about tailwinds we just spoke about one of them, continued strength in our retail script growth and outpacing the market due to the programs I mentioned previously. As you heard on the call, PBM had a net positive selling season albeit lower than the last few years still net positive and we continue to see specialty as a growth driver. Streamlining continues – our expectations continue to accelerate there to deliver the long term savings Dave outlined a couple of years ago. From a headwind's perspective, I would say it's going to be a lighter year from a break-open generics perspective. You can think about pricing and reimbursement pressures at comparable levels to what we've seen the last few years. And obviously we'll have the wrap of the tax reform investment that started about mid-year this year. The other thing is, there are also some unknowns with the regulatory changes. And some of those what HHS is talking about could be positive or negative. So we're going to continue to evaluate that and have our clarity on our call in February. Lisa C. Gill: Okay. That's helpful. And then, Larry, looking back at the slides where you talk about the building blocks of multiple levers being medical cost, membership, et cetera. As we think about the health plan business and growth in membership, there really hasn't been a lot of growth in membership for Aetna over the last several years. Can you talk about philosophically how you think about trading off membership growth for price in the market? Larry J. Merlo: Well, Lisa, as you've heard us mention since we announced the transaction, actually it's coming up on a year, that we really view the opportunity of the two companies coming together as a growth story. And obviously, there's – continues to be tremendous opportunity in the Medicare space. And I do believe for the reasons that we've begun to talk about, to be clear we have a lot of work ahead of us. But you look at the billions of dollars that are being spent unnecessarily they could be prevented, avoided in just the management of chronic disease. And the opportunity through this new model to meaningfully help people achieve a better health outcome at a lower cost or reduced cost we believe can create a new model that will allow for membership growth in the marketplace. So, again, we've got a lot of work ahead of us, but that's the trajectory that we're working towards. Lisa C. Gill: I appreciate the comments. Larry J. Merlo: Thanks, Lisa.
Operator
Our next question comes from the line of Robert Jones with Goldman Sachs. Your line is open. Please proceed.
Robert Patrick Jones
Great. Thanks for the questions. And it sounds like, we'll obviously get a lot more detail not only in February but in June. But Larry you guys did share a few more examples of kind of the longer-term goal of bringing these two companies together. You mentioned medical adherence, infusion, generally expanding the scope of care within the MinuteClinic the concept stores. So, I guess, it seems like we'll get more details and it's a little bit maybe down the road. But I was wondering, if you could maybe just share directionally how we should be thinking about the necessary infrastructure relative to kind of the current CVS footprint in order to accomplish some of these examples that you've laid out today? Larry J. Merlo: Yeah, Bob, it's Larry. Maybe I'll start, and then I'll ask Eva to jump in as well. But Bob, I think you've probably heard us talk a little bit about that. You look at the CVS community assets today. We've got 10,000 points of distribution in communities all across the country. And we envision a hub-and-spoke concept where as we've talked about the concept stores or some have referred to them as health hubs we don't know what we'll call them yet, okay. But think about those as the hubs, okay? And we would have those in a set number of stores within a given market and the balance of the stores would have a core set of offerings that would serve as a referral source to those hub stores. So from a bricks-and-mortar perspective, I think we have the assets to create that local presence in communities again across the country. And let's not forget about the role that digital plays or the fact that we're going to have almost 40,000 healthcare professionals that not just work within those bricks-and-mortar assets, but – or within a few miles of where people live. So there's the concept of, we can come to them at their doorsteps as well. Maybe I'll flip it over to Eva to talk more about how we're thinking about the CapEx component of that. Eva C. Boratto: Yeah. Hi, Bob. If you think about our capital allocations, between the two companies our CapEx is about $2.5 billion to $2.8 billion. As Larry said, what we'll be changing in the stores, think about that as a shifting of investment from our normal refreshes to investing in some of these health hub changes for which we will need. So largely, we expect to be able to do this within what you would consider normal CapEx spend.
Robert Patrick Jones
Got it. And then, I guess, just one quick follow-up. If I look at the performance in the Retail gross margin, Eva you mentioned the strong script growth and how some of those programs could help carry that through to next year. The margin decline in the quarter seemed to be a little bit worse than what we saw in the first half. So I was just wondering was there anything worth calling out there? And then relative, again not looking for guidance, but just directionally relative to how script trends are going in the Retail Pharmacy segment. Anything you can share to help us think about how we should be modeling those margins going forward? Eva C. Boratto: Sure. In terms of the quarter-to-quarter impact, Bob, I would say there was really nothing unique in the third quarter. As CIR (44:23) has become an increasing component and that's performance-based, relative Q2 versus Q3, you had some timing differences there year-over-year. As we look at overall margin, things that will pressure our margins are success in Medicare Part D. We've spoken many times that those are at lower margins. Additionally, as we increase our 90-day penetration that carries a slightly lower margin as well.
Robert Patrick Jones
Okay. Got it. Thanks so much. Larry J. Merlo: Thanks, Bob.
Operator
Thank you. Our next question comes from George Hill with RBC. Your line is open. Please proceed.
George Hill
Good morning, guys. Thanks for taking the question. And Eva, welcome to the call. I guess my question is two parts is, I guess, Larry and Eva, number one, can you talk about how you think about synergy delivery gross versus net? So, I guess, how much gets generated by the end of year two versus how much flows to the bottom line? And then typically when you see transactions of this size, there's a significant level of investment spend that comes with executing the deal. I don't know if you've contemplated that as we think about 2019 and if there's any color that you can provide around that. Like is there either a big charge or a big investment spend number coming forward that investors should be looking towards? Larry J. Merlo: Yeah, George, it's Larry. I'll start. George, in terms of what we talked about in our prepared remarks around the synergies, those are net synergy numbers reflecting investments that we would need to make, I'll say, ongoing investments that would be tied to achieving those synergy dollars.
George Hill
Okay. That's all I have. Thank you.
Operator
Thank you. Our next question comes from the line of Eric Percher with Nephron Research. Please proceed. Your line is open.
Clayton Meyers
Hi. Good morning. This is actually Clayton Meyers on the line for Eric this morning. Eva, welcome to the team. Looking forward to working with you going forward. I know people have been kind of asking about the 2020 EPS number, and I want to try to come at it from a different direction. And when the time the deal was announced, it's expected to be accretive relative to consensus at that point. Is the way that we should think about it is to take that consensus number and then kind of adjust it for tax reform and then adjust it for the lines of the business that's happening, the increased operating investment that's happening in the business? Do you think that logic is kind of roughly sound as you think about where to base the accretion number as we go forward to 2020? Eva C. Boratto: So Eric (sic) [Clayton], this is Eva. Obviously you're on the mark in terms of tax reform has occurred since we jumped off of that consensus number. So that's one of the biggest things that have happened. The base is no longer valid, so it's difficult with all of the moving pieces for us at this point to update that. But what I can say is as it pertains to the transaction, there have been no changes.
Clayton Meyers
Okay. Very cool. It helps. Thanks for the color. That's helpful. Then just one other question just going back to the Part B mechanisms that's coming through with step therapy. Is that an area that you think CVS's asset in Coram Infusion particularly could benefit as it comes to CVS? And how have the payers been responsive to CVS' PBM capabilities within the space, given that Part B hasn't really been a space that PBMs have played with – with in the past. And then finally, just a follow-up to that. With the new advance notice for the Part B IPI, would that impact CVS' business in any way? And how should we think about the role that CVS could potentially play as a vendor for that proposal? Larry J. Merlo: Yeah, it's Larry. Let me just talk broadly about the proposals that we've seen in terms of [Part] B to [Part] D. And obviously we see a tremendous opportunity to be an important part of that solution for the reasons that I think have been well quantified in terms of there is more competition today in Part B with the various therapies from where the reimbursement model started with Part B many years ago when there were single source products and very little competition. We would sit here today and say the Part B mimicking the role that the private sector plays as part of Part D is the answer. I would sit here and say it's highly unlikely that an international price index, the other proposal, would result in net prices that are lower than what the private sector can negotiate through competition and innovation as part of the processes that exist with Part D. And we're excited by the opportunity to play a bigger role there. Michael P. McGuire: Melanie?
Operator
Thank you. Our next question comes from the line of Justin Lake with Wolfe Research. Your line is open. Please proceed.
Justin Lake
Thanks. Good morning. My first question is just on your segment guidance. It appears the Retail business for the fourth quarter would be down mid-teens on an EBIT perspective with the PBM up high-single digits. So just with that divergence, if my math is correct in the first place, I was hoping you can share what is driving that seasonality and divergence versus the year-to-date results, and how we should think about that as informing our view into 2019, if at all? Eva C. Boratto: Hi, Justin. This is Eva. As it pertains to our guidance, I think your math is – we said for the year down low-single digit, so in the quarter, obviously given our year-to-date performance, you would be down in the mid- to high-single digits, depending on what point you picked. In terms of any context for 2019, it's really too early to provide as I earlier discussed some of the headwinds and tailwinds.
Justin Lake
Okay. And then just a follow-up on the debt side. Is there anything you could share with us in terms of where you expect your gross and net debt to look like at year end post the deal close? Eva C. Boratto: Let me get back to you on that, Justin, if I could.
Justin Lake
Okay. Thank you very much.
Operator
Our next question comes from the line of Charles Rhyee with Cowen. Please proceed. Your line is open.
James Auh
Hi. It's actually James on for Charles. So, on Teladoc, recently you talked about the soft rollout of the telehealth capabilities in about 18 states and Washington D.C. Can you talk about how Teladoc affects your clinic strategy and when we should expect a full-blown rollout? Larry J. Merlo: Yeah, James, it's Larry. As you mentioned, we've been rolling it out state-by-state. There are some state processes that we're going through to turn them on. And once we get more of a critical mass, we will begin broader marketing of that. As you look at the complementary strategy to the clinics, it has the opportunity to expand our reach as well as expand our scope of practice. And those were the use cases that we've been piloting. We're pleased with how it's going and we see more opportunities there, especially with the role that it can play after-hours, the role that it can play as part of what the announcement that you saw in terms of the role that telemedicine can play with Medicare, and more to come.
James Auh
Okay. Great. And so synergies are now expected to exceed $750 million by year two, which is ahead of the original expectations. Can you elaborate for us where the upside in synergies is coming from? Is it more corporate expenses, reduction in medical costs? Also can you maybe touch on the revenue synergy opportunities a little bit more? Thank you. Larry J. Merlo: Yeah, James. It's really – we're not going to break those out at this point. It's really the areas that we broadly talked about. And as I mentioned earlier, the teams are continuing to work hard in those areas. And we'll talk about the opportunities for revenue synergies as we work through our longer-term plans. And we'll get into more details around that next year. So Melanie, we'll take – I think we have time for two more questions.
Operator
Thank you. Our next question comes from the line of Steven Valiquette with Barclays. Please proceed. Your line is open.
Steven Valiquette
Thanks. Good morning, everyone. So during the quarter, there was obviously a large expanded store-within-a-store deal announced away from you for greater lab services in the retail pharmacy setting. So I'm just curious if you can maybe just remind investors what your general preferences are in relation to that type of opportunity, or are you just kind of looking past that event in the marketplace and just focusing on the other concepts that you're talking about for your retail footprint? Thanks. Larry J. Merlo: Yeah, Steve, there are certainly opportunities in front of us as we think about the companies coming together. And you think about whether it's through integration and absolutely having aligned incentives, the value that can be created, that can't necessarily be achieved through partnerships. At the same time, I want to be clear, we are certainly not opposed to partnerships. And as I mentioned earlier, as we build out these new programs and service offerings, we intend to create an open platform for others to participate in and we'll go from there.
Steven Valiquette
Okay. All right. Thanks.
Operator
And our final question comes from the line of David Larsen with Leerink Partners. Please proceed, your line is open.
David Larsen
Hi. Can you talk a bit about the PBM selling season? It looks like there was a pretty good increase there, the retention rate looks pretty high, Express Scripts reported a very high retention rate and pretty good core claims growth expectations for 2019. Just how is that shaping up? And what does that leave you to think preliminarily about 2019 growth expectations and operating income? Thanks. Jonathan C. Roberts: Yeah, David, this is Jon. So, we saw less movement of business from one PBM to another this year, I think that has a lot to do with the mergers that are happening in healthcare. And yeah, our retention as Eva talked about was 98%, so very happy and a little higher than we've historically had. As far as 2020, it's too early for us to really comment on the RFP activity, it's just starting to gear up. And then, as we mentioned, we do have the Anthem contract that's coming onboard for 1/1/2020, which is a very large health plan obviously. Eva C. Boratto: And as we think about that Anthem contract, you can think about it in terms of a net accounting contract given the terms of that business.
David Larsen
Okay. Has there been any sort of shift in the sort of profitability or nature of the PBM contracts that are going to roll on in 2019 and 2020, like any general thoughts there? Has it been a highly competitive selling season? Has pricing been aggressive? Or any comments there would be helpful. Jonathan C. Roberts: This is Jon. The pricing environment, it's a very competitive industry as we all know, and it typically gets a little more competitive as you go through the season. I would say it's consistent with what we've seen over the last several years, so not really a step change. We do, from time-to-time, see some PBMs get very aggressive on certain accounts based on their own strategies, and I think this year is no different than what we've seen in years past.
David Larsen
Okay. And then just one more quick one for Eva. Can you talk a little bit about your streamlining effort there? And operating income sort of growth expectations in retail, retail's obviously been under a lot of pressure. Just any thoughts around cost reduction efforts and initiatives and when can that streamlining gross benefit turn into a net benefit? Any thoughts around that at a high level would be great Eva? Thanks. Eva C. Boratto: Yeah. So overall as it pertains to the streamlining, we're extremely pleased with the results we've rolled out numerous programs, we highlighted the one in specialty today. We're also looking to reduce overall call volume that comes into the retail channels through better sharing of data between the PBMs not in the Caremark, but other PBMs, not only to reduce our cost but to make the customer experience better as well. We continue to expect to see these benefits ramp in 2019 to give broader color than that we'll provide more in February. Larry J. Merlo: And Dave, listen, we have – I think you know – we have always had a cost focus in terms of how can we do things better while continuing to enhance levels of service. So it's not just about cost cutting, okay, but it's about doing things faster, better and cheaper. And that's – we believe that that's in our DNA and that work never stops. Before we round out the call we're going to – let's go back to I think Justin had asked the question about the debt, so... Eva C. Boratto: Justin, you'd asked the question about the total debt on the balance sheet post closure. It would be around $75 billion when you look at our existing debt plus bringing on Aetna steps. Larry J. Merlo: So with that, everyone, thanks again for your time this morning. And as always, if there are any follow-up questions, Mike's available. And we'll see many of you soon, and have a great Thanksgiving.
Operator
Ladies and gentlemen, that does conclude today's conference call. We thank you for your participation and ask that you please disconnect your lines.