Bipartisan Policy Center “The Leaders’ Project” April 24 th , 2008 Washington DC Jonathan Roberts

1. Bipartisan Policy Center “The Leaders’ Project” April 24th, 2008 Washington DC Jonathan Roberts SVP & CIO

2. CVS Caremark • $76+ billion in revenue ~ Fortune 20 • #1 provider of prescriptions in the nation • Over 1 billion filled or managed • #1 in Store Count and #2 in Mail Order • #1 Specialty Pharmacy • #1 Retail Clinic Operator • #1 Retail Loyalty Program • #1 Retail Pharmacy Sales per Square Foot • #1 or #2 in 75% of the top 100 markets in which we operate

3. Unique industry positioning We have a large and unique presence in driving patient value through e-prescribing Physician software Retail pharmacy PBM Payor connectivity Minute Clinic Pharmacy connectivity

4. ePrescribing solves many quality and operational challenges Challenges the community faces How e-Prescribing addresses • Patient safety • Patient and payor costs • Patient health outcomes through Compliance & persistency • Physician costs • Patient convenience • Emergency preparedness • Script legibility • Automated data entry • Point-of-care interventions • Reduced phone calls • Generics • Formulary • Preferred • Proven C&P impact for several reasons • New data drives interventions • Cost and convenience drive C&P • Eases clinical administrative burden • Data capture • Time on phone • Ease of e-Refills • Script gets head start to pharmacy • Katrina example

5. While adoption is growing rapidly…

6. … Other key indicators of e-Prescribing maturity tell a mixed story Pharmacy network and regulation are maturing . . . January 2008 January 2004 July 2005 1% 36% 95% Pharmacies Receiving ERx 5 45 50 States that Allow ERx . . . but physician adoption is low January 2004 July 2005 January 2008 Have access to ERx software 1% 17%+ 29% 0% 0.7% 6.1% Actively e-prescribing

7. Is cost really a barrier to adoption? • Non-adopting Physicians cite cost as the top barrier • However, several top solutions are provided free to physicians • e.g. iScribe, Prematics, NEPSI • In our experience, only a small percentage “take” the free tool Cost is a perceived barrier; reality less clear

8. Other barriers to robust adoptions • Lack of incentives • Controlled substances • Workflow and training in the physician’s office • Confusion between EMR and standalone e-Prescribing solutions

9. PHRs could provide value-added services directly to patients that address gaps in care Many players interested in space, but no clear vision has emerged What does this mean? Multiple players playing in PHR space • Why be excited • Why be cautious • Stakeholder landscape • View on players • CVS Caremark role • Dedicated PHR Providers • Technology Vendors • Web Content Providers Pharmacy, PBM, and clinic data seen as key to driving adoption — due to availability, consolidation and value to patient • Payers • Employers

10. What can be done in Washington to promote health IT? • Create incentives for physicians to e-prescribe under Medicare • Eliminate the barrier to e-prescribe for controlled substances • Create grants and tax incentives to encourage broader adoption by assisting providers in purchasing of equipment • Ensure strong patient privacy by enforcing existing federal privacy laws (HIPAA) • Support private-public partnerships on standards, including security

11. Patient Access to Care and Information Patient access to catastrophic coverage Design benefits that lower drug costs for patients E.g. Expanded drug discount card for the uninsured Coverage of preventative services Comparative efficacy Improving Quality and Lowering Costs Create a pathway for generic biologics Educate consumers about available generic drug substitutes Publish data on the safety and efficacy of generics or low-cost brand alternatives Promote medication therapy management (MTM) and disease management services More broadly, what can be done from a policy perspective to improve health care?