Earnings Labs

CVS Health Corporation (CVS)

Q1 2018 Earnings Call· Wed, May 2, 2018

$83.14

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Transcript

Operator

Operator

Ladies and gentlemen, thank you for standing by and welcome to the CVS Health First Quarter 2018 Earnings Release Conference Call. During the presentation, all participants will be in the listen-only mode. Afterwards, we will conduct a question-and-answer session. As a reminder, this conference is being recorded, Wednesday, May 2, 2018. I would now like to turn the conference over to Mr. Mike McGuire, Senior Vice President of Investor Relations. Please go ahead, sir.

Michael P. McGuire

Management

Thank you, Savanna. Good morning, everyone, and thanks for joining us. I'm here this morning with Larry Merlo, President and CEO; Dave Denton, Executive Vice President and CFO; and Jon Roberts, our Chief Operating Officer. Larry and Dave have some prepared remarks to share, after which we'll open it up for the question-and-answer session. During the Q&A, in order to provide more people with a chance to ask their questions, please limit yourself to no more than one question with a quick follow-up In addition to this call and our press release, we have posted a slide presentation on our website that summarizes the information in our prepared remarks as well as some additional facts and figures regarding our operating performance and guidance. Our Form 10-Q will be filed later today, and that too will be available in our website once filed. Additionally, during this call we will make certain forward-looking statements that reflect our current views related to our future financial performance, future events, and industry and market conditions, and forward-looking statements related to the Aetna acquisition, including the expected consumer benefits, financial projections, synergies and the timing for the completion of the transaction. These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from what maybe indicated in the forward-looking statements. We strongly encourage you to review the information in the reports we file with the SEC regarding these specific risks and uncertainties, in particular, those that are described in the Risk Factors section of our most recently filed annual report on Form 10-K and the cautionary statement disclosures in our quarterly report on Form 10-Q. You should also review the section entitled Forward-Looking Statements in our earnings press release. During this call, we will use non-GAAP financial measures when talking about our company's performance. In accordance with SEC regulations, you can find a discussion of these non-GAAP measures and the comparable GAAP measures in the associated reconciliation document we posted on the Investor Relations portion of our website. And as always, today's call is being webcast on our website, and it will be archived there following the call for one year. Now, I'll turn this over to Larry Merlo.

Larry J. Merlo

Management

Well, thanks Mike; and good morning, everyone. Thanks for joining us today. We delivered solid performance in the first quarter in line with our expectations. And while my remarks today will focus more on our past forward, our Q1 results confirm my confidence in the strength of our core model and the foundation it will provide in the CVS-Aetna combination. So let me begin by providing an update on our proposed Aetna acquisition. There have been three very important work streams that began shortly after the December announcement: the regulatory pathway, integration planning and shareholder approval. And we've already seen success on the last work stream, as we reached a key milestone on March 13, when CVS and Aetna shareholders each voted to approve the transaction with over 95% shareholder approval. On the regulatory front, we have a highly experienced legal and regulatory team that has made significant progress since the signing. Currently, we're in the process of responding to a second request for information from the Department of Justice, which we received on February 1. The scope of the request was not unexpected and we are working to provide all the information requested by the regulators. Now, we're also working through the approval process at the state level to secure all the appropriate operating licenses. All of the required Form A filings were submitted to 28 state departments of insurance in January. The states that require hearings are starting to schedule and hold those hearings. In fact, the hearing for the Department of Managed Health Care in California, is taking place later today. So we're making good progress with the states and have already begun to receive approvals. In fact, I'm pleased to share that the Florida Office of Insurance Regulation, a large and important state for both companies,…

David M. Denton

Management

Thank you, Larry. Good morning, everyone. This morning I'll share some financial and business highlights and provide a brief update on our guidance. Unlike past quarters, I won't go through all the details in my prepared remarks, but you could find additional information in the slide presentation that we posted on our website earlier today and also in our SEC filings. And with that in mind, let me start by touching on our capital allocation program. As a result of the Aetna transaction, we have suspended the share repurchase program and we'll be keeping our dividend flat until we turn to a leverage ratio that is more in line with our credit ratings. In March, we issued multiple tranches of senior notes totaling $40 billion. The tranches are well-lathered with maturities ranging from 2 years to 30 years. We issued the notes ahead of the closing the deal to take advantage of the current interest rate environment, allowing us to secure the debt at a favorable weighted average blended rate of approximately 4.19%. With the new debt, our pro forma trailing 12-month adjusted debt-to-EBITDA ratio is expected to be approximately 4.6 times post-closing of the transaction. We are committed to improving this ratio to 3.5 times within two years post-closing of the deal, utilizing our strong cash generation capabilities and the savings from tax reform. Ultimately, our goal is to maintain the company's leverage ratio in the low 3 times level. Additionally, beginning in the first quarter, we are excluding net interest expense associated with the Aetna-related debt from our non-GAAP metrics. As the transaction with Aetna is still pending approvals, we obviously are not benefiting from Aetna's cash flow and its earnings, but we are already incurring interest cost of the new acquisition-related debt. By adjusting this expense out,…

Larry J. Merlo

Management

Okay. Thanks, Dave. And before we open it up for Q&A, I do want to spend just a couple minutes talking about our focus on driving growth and highlight some recent innovations and product introductions that are capitalizing on the benefits that are inherent in our unique integrated model. And with health care costs continuing to rise at a remarkable pace, it's no surprise to anyone that people are looking at the market and asking themselves, what can be done better? It's a question that we challenge ourselves to answer on a daily basis as we think about our model and explore ways in which we can provide greater value to the health care stakeholders that we support across our enterprise. So with this in mind, we are continuing to innovate to improve the quality and lower the cost of health care for our patients and clients. And if you look over the last couple months, just last month we announced that we're marshaling our enterprise assets to help address an area of significant, unmet clinical need; that being chronic kidney disease. And our approach here is centered on two tenets. First, that we can use the wealth of data available to our enterprise to predict and support diagnosis earlier in the patients' disease course; and second, absent renal transplantation, home dialysis is potentially the best alternative for many patients. Earlier identification of patients allows for better symptom management, potentially delaying the need for dialysis; and dialysis in the convenience of the patients' home has the potential to provide a better patient experience, better health outcomes, and reduce total medical costs. Just as background, about 90% of patients in the U.S. are treated with hemodialysis, three days a week for three to four hours at dedicated centers. However, most nephrologists…

Operator

Operator

Thank you. And our first question comes from the line of Michael Cherny with Bank of America Merrill Lynch. Please proceed with your question.

Michael Cherny

Analyst · Bank of America Merrill Lynch. Please proceed with your question

Good morning, guys, and thanks for all the color so far. Just thinking about the selling season for the PBM. As you think about going to market with the messaging, especially with the pending Aetna transaction, what's been the feedback you've gotten over the course of the selling season, both with your own customers, are they working on for retention as well as new customers where you're pitching new business for an RFP, in terms of how you think about the value proposition and how they should think about the value proposition CVS can provide that evolves, as you work on onboarding Aetna and building out other capabilities from the store? I mean how is that message changing for you and how is that resonating in the market?

Larry J. Merlo

Management

Yeah, Mike, it's Larry. I'll start and I know Jon wants to jump in as well. But Mike, if you go back to December after the announcement, we had a pretty comprehensive outreach to our clients, especially our health plan clients. And we just had our Client Forum this past month. It was extremely well attended. I would say that the reaction from our clients has ranged from interest in learning more about how we can create value for them and their members. And I would tell you that there is a lot of engagement around the opportunities that can be created, recognizing that – we've talked about the fact that we want to make many of these solutions broadly available in the marketplace for our clients. So, Jon?

Jonathan C. Roberts

Analyst · Bank of America Merrill Lynch. Please proceed with your question

Yeah. And I think the one thing we heard really from all clients, both employers and health plans is, as they're trying to manage their overall health care costs down, they're having to work with a lot of different vendors to provide services. And so, they very clearly told us that they're looking to us for innovation that they are looking to reduce the number of vendors. And the fact that we have this Aetna acquisition and the fact that that will allow us to innovate much more broadly to have a positive impact on our overall health care costs, they're very excited about. So that was a message that we heard loud and clear from clients just a few weeks ago.

Larry J. Merlo

Management

And Mike, I think the only other point I'd add and Dave alluded to it in his prepared remarks that in terms of the 2019 selling season, we are seeing RFP activity down. And I do think that, tied to your question, there is a better of a wait-and-see approach as to how does the landscape shake out, okay, as people better understand the various offerings that will be out in the marketplace as they are thinking about making a three-year decision which, as you know, are the typical length for these contracts.

Jonathan C. Roberts

Analyst · Bank of America Merrill Lynch. Please proceed with your question

And then, Michael, the only other thing I would say is, regards to the selling season, I mean payers really have three priorities. One is service the members and themselves as the client, and we clearly are doing a great job there with everything that we do from sales and account management to all of our support to their members in care, in mail and specialty. Secondly, they are looking to optimize unit cost, so our size and scale allows us to do that along with programs and plan designs like Maintenance Choice and preferred or narrow networks. And Larry talked about the results that we delivered to our clients with our trend at 1.9%, and then they're very interested in reducing overall health care costs. And that's what I talked about earlier, and I think that is becoming more of a priority and that's why they're so excited about the new company that we will become.

Michael Cherny

Analyst · Bank of America Merrill Lynch. Please proceed with your question

Excellent. Thank you.

Larry J. Merlo

Management

Thanks, Mike.

Operator

Operator

Our next question comes from the line of Glen Santangelo with Deutsche Bank. Please proceed with your question.

Glen Santangelo

Analyst · Glen Santangelo with Deutsche Bank. Please proceed with your question

Yeah. Thanks and good morning. Larry, thanks for all the details on the Aetna situation. I think investors very much understand and appreciate the long-term bull case of the combination. But we hear a lot of concerns about the potential for integration issues, incremental investments that may be required to get to where you want to be. And so my two quick questions are: one, when do you think you'll be in a position to give us more detailed information about the integration plan, the services you may look to provide at MinuteClinic, how much you'll need to invest, et cetera? And then secondly, assuming you successfully close the deal in the second half of this year, as you look to 2019, what do you see as the biggest integration challenges? And then I'll stop there. Thanks.

Larry J. Merlo

Management

Okay. Glen, as I alluded in our prepared remarks, the integration work is going very well. Keep in mind that as you think about integration risks, the fact that Caremark and Aetna have had an eight-year relationship, you always worry about systems and that work is behind us. So, we can take that one off the table because of – we did that about eight years ago or started that process eight years ago. And as we've talked about the tools or the areas of investment, we'll have a lot more to say on that as we get further into the work. But keep in mind that we typically at CVS spend around $2.2 billion in CapEx each year. And we believe that there are elements of that CapEx that can be repurposed that would support some of the investments that we understand will be important to bring things to life. So keep in mind, we've been at this now for probably 8 to 10 weeks. As I mentioned, the work's gone very well and we have not seen anything surface to date that we would say is unexpected, especially as you think, back to your question, large cost ticket items.

Glen Santangelo

Analyst · Glen Santangelo with Deutsche Bank. Please proceed with your question

Okay. Thank you.

Operator

Operator

Our next question comes from the line of George Hill with RBC. Please proceed with your question.

George Hill

Analyst · George Hill with RBC. Please proceed with your question

Hey, good morning, guys, and thanks for all the question. I guess, Larry, I'm going to ask one of these big picture macro questions. As you guys laid it out in the presentation, I think it's interesting that you guys are looking about reducing the cost of care delivery on a disease state by disease state setting versus like a care delivery treatment area setting, given the collection of assets that you guys are going to have. And I guess, can you talk about whether or not like why is that more important and why does that seem to be the focus as opposed to the assets that you guys have in place in driving higher utilization?

Larry J. Merlo

Management

Yeah. George, first of all, I would say, think of it a little bit as both. And I'll start with, we know today that chronic disease accounts for a disproportionate share of those health care costs. And keep in mind that – I think we've given some examples. We've learned some things from the CVS-Caremark combination over the years that whether you're looking at a patient with diabetes and that patient they visit their doc on a quarterly basis, it's all about the execution of that care plan. That ultimately manages the patient to achieve their best health at the lowest possible cost. And we've seen some things with our Transform Care program, where – that has been rolling out that – there's about $2,800 per patient that can be reduced by just making sure that their A1C levels are in the appropriate range, that ultimately avoid some unintended medical event. So, we think there is a huge unlock in terms of the management of those patients with chronic disease. At the same time, we've also talked a lot about site of care in terms of whether it's transitions in care, whether it's how do we ensure that care is being delivered in the right setting with cost as a variable. And again, we think that there is a huge opportunity there when you look at the bricks-and-mortar asset as well as what can be provided for in the home. And George, you recall, I think it was three years ago at Analyst Day that we've started talking about this retailization of health care that picks up some of these themes and that health care was becoming more local. And certainly, the growth of consumer-directed health plans have driven that even in a bigger way as accountability and decision making is shifting to the patient. So, we think there is a surround sound capability that we're looking to build out with that in mind.

George Hill

Analyst · George Hill with RBC. Please proceed with your question

Maybe a quick follow up would be, if you look at a couple of years, does health care become deflationary? And how do you think about kind of the impact to that like as you think about the enterprise income statement?

David M. Denton

Management

George, it's probably too early to understand whether it can be, in fact, deflationary. I do think that with certain members, as we think about again taking a big step back and thinking about the retailization of health care and the assets that we have in place and we'll put in place, is all about wrapping ourselves around a member and helping that member better navigate the health care system and be more efficient as they use the health care system. And as we do that, we do believe that we can lower the cost year-over-year for those members, and actually at the same time improve the outcomes as that patient matures. So in those categories, yes, I do think there's some opportunity to really bend the cost curve.

George Hill

Analyst · George Hill with RBC. Please proceed with your question

Okay. I'll hop back in the queue. Thanks.

Larry J. Merlo

Management

Thanks, George.

Operator

Operator

Our next question comes from the line of Ricky Goldwasser with Morgan Stanley. Please proceed with your question.

Ricky R. Goldwasser

Analyst · Ricky Goldwasser with Morgan Stanley. Please proceed with your question

Yeah. Hi, good morning. Two questions here. First one is around the discussions we're hearing out of Washington on potential changes to Part D. If you can provide us just some context of what you are hearing out of D.C., and what could mean to the business? And then the second question is around the MinuteClinic. You've shown very nice growth around 15%. So, should we think about it as a new kind of like run rate for the business? And are you seeing more clients adapting MinuteClinic as part of their offering? Or is it that the consumers just feel more comfortable with the concept?

Larry J. Merlo

Management

Yeah. Ricky, let me start with the second one. Ricky, obviously in the first quarter, MinuteClinic is experiencing the intensity of the flu season that we saw largely in the months of January, February began to tail off in March. So, I wouldn't use the first quarter trajectory as a new run rate. At the same time, as part of what we're talking about, one of the work streams is, what is the trajectory from a scope – I'll say, the scope of practice and services at MinuteClinic? And those are things that we're working on and we'll have more to say on that in the coming months. And I would say, Ricky, that the consumer awareness of MinuteClinic has grown substantially. And obviously, I think that that is helping to drive utilization as well.

Jonathan C. Roberts

Analyst · Ricky Goldwasser with Morgan Stanley. Please proceed with your question

And then, Ricky, we're going to be launching what we're calling, virtual care, later this year that will either be an online visit or a video visit. So, the video visit will be able to treat things like minor illnesses or injuries, skin conditions and wellness services. And then the online visits will be on-demand diagnosis for limited scope areas like birth control, allergies, hair loss and acne. And we're doing that under our brand that we think will help this virtual care model that has been in the market for quite some time, but had limited traction. In addition, when we look at our clients, employers, we see a lot answers from employers in creating an incentive for their employees to go to MinuteClinic; MinuteClinic's open at nights and weekends. So it keeps them at work, but still gives them the care that they need. And then with health plans, very interested in MinuteClinic so that their members can go to a MinuteClinic versus the emergency room and it really is just a cost save for the health plans. So we're just saying, continued interest. And as Larry said, we're continuing to evolve this model.

Larry J. Merlo

Management

And then, Ricky, back to your first question in terms of Part D, what are we hearing in D.C.? Obviously, there's been a lot of dialogue about Point of Sale rebates in Part D. And keep in mind, Ricky, as you've heard us and quite frankly others talk about the dynamic here that 100% of that rebate value in Part D is passed through the plan design in the form of a lower premium. So as it relates to the PBM, that would have no impact on profitability if that ended up moving forward. I think the concern that exists there is, as you model that out, what is the dynamic as it relates to beneficiary premiums going up? What is the consequence associated with that? And ultimately, what's the government costs associated with that? So, I think that work has been done and you've seen some published studies associated with that. I think the other things that we are hearing is, moving certain Part B drugs into Part D. And then there'll be ongoing dialogue about the dynamics associated with the six protected classes, where formulary management typically does not come into play and the opportunities to further reduce the cost of the program for beneficiaries and the government.

Ricky R. Goldwasser

Analyst · Ricky Goldwasser with Morgan Stanley. Please proceed with your question

Thank you.

Operator

Operator

Our next question comes from the line of Lisa Gill with JPMorgan. Please proceed with your question.

Lisa C. Gill

Analyst · Lisa Gill with JPMorgan. Please proceed with your question

Thanks very much and good morning. Jon or Larry, I just wanted to start going back to the 2019 selling season. So, I understand your comments around being halfway through, not as much opportunity in 2019. But can you talk about what you're seeing in the marketplace? Some of the things we're hearing right now is the shift in contracting towards total care. Even if you don't own the health plan today that some of the contracts are coming out that way, number one. You did talk about point of service (sic) [Point of Sale] rebates, but are you seeing that in the commercial market today where an uptake on that side, if maybe you could just talk about what your expectations are as far as plan design goes, as we think about 2019.

Jonathan C. Roberts

Analyst · Lisa Gill with JPMorgan. Please proceed with your question

Yeah. Lisa, this is Jon. So, I do think that there is interest in integrating the medical and pharmacy benefit. And you'll see that more in the mid-level sized employers, where they generally have one health plan and their workforce is more localized, because they're a little more challenging with the large national plans that have multiple health plans. But we spend a lot of time talking about things we can do in pharmacy to lower their overall health care costs, and Transform Diabetes Care is a good example. Larry talked about that earlier. We have over 100 clients and 2 million lives in this program, very targeted to their members with diabetes. So, I just think there will continue to be a growing interest in how pharmacy can help bend the overall cost curve with health care costs. With respect to Point of Sale rebates, I think as we see continued growth and high deductible health plans, I think there will be even more interest in Point of Sale rebates. We have 10 million members in a Point of Sale rebate program today. We can administer that. We can actually encourage those plans with either percent copays or in high deductible plans to adopt those, and we're able to show them how it actually helps members stay adherent and lowers their overall health care costs. So, we think it's a good thing to do. And it's just been a challenge because people like the flexibility of having that rebate check in either applying it to lower premiums or use it for other programs that they're interested in. But I think you'll continue to see us progressing in that direction.

Lisa C. Gill

Analyst · Lisa Gill with JPMorgan. Please proceed with your question

Okay, great. And then just a point of clarification. Larry, I think you talked about virtual care being under a CVS brand. But can talk to us about your teleservices relationship with Teladoc?

Larry J. Merlo

Management

Yeah. Lisa, it pretty much is what you just alluded to, we will use Teladoc as the engine that provides telehealth services through the CVS app through and direct it back into MinuteClinic and other providers. So, essentially think of them as private labeling our telehealth program.

Lisa C. Gill

Analyst · Lisa Gill with JPMorgan. Please proceed with your question

Helpful. Thank you.

Operator

Operator

Our next question comes from the line of Mohan Naidu with Oppenheimer. Please proceed with your question.

Mohan Naidu

Analyst · Mohan Naidu with Oppenheimer. Please proceed with your question

Thanks for taking my questions. Dave, first on the Point of Sale rebate offerings. Should we think about this as something that could impact your margins? And I just have a quick follow up on the Aetna combination as well.

David M. Denton

Management

I don't know if it will affect our margin substantially. I do think it's obviously a product and service that we'll offer in the marketplace pretty comprehensively today. I think it's an opportunity for us to reduce the cost at the pharmacy counter for those members in the deductible phase. I think the adoption of that has been pretty slow at this point in time. I will also let you know that we've been talking about the fact that, while we collect rebates, the vast majority of those rebates go back to our plan sponsors in form of lower cost to them. We have said in the past that about 90% of those rebates have gone back to the payers. Today, probably a lot closer than 95% of all those rebates go back to the payer in the form of lower cost into the pharmacy program.

Mohan Naidu

Analyst · Mohan Naidu with Oppenheimer. Please proceed with your question

That's very helpful, Dave. Larry, just one more quick follow up on the Aetna combination and you talked about this in the last couple of questions, I guess. As we think about post approval and post Aetna combination, what can you do immediately within the, I guess, first couple of years in terms of offering new services at the store versus what you can do or years (00:55:04) with more investments in the store? Can you do the chronic disease management stuff that you talked about right now as soon as the deal is closed? Thank you.

Larry J. Merlo

Management

Yeah. Mohan, it's a great question and I do believe that we'll have elements of that that we'll be able to do early on, recognizing the assets and capabilities that are already resident in each of the companies. And that's one of the things that the teams are currently working on, whether it's site of care, we talked about MinuteClinic, we talked about infusion in the home as well as the role that – the additional role that we can play around improving medication adherence. So these are just a handful of examples of things that we will be able to do out of the gate.

Mohan Naidu

Analyst · Mohan Naidu with Oppenheimer. Please proceed with your question

Thanks, Larry.

Larry J. Merlo

Management

Thank you.

Operator

Operator

Our next question comes from the line of Charles Rhyee with Cowen. Please proceed with your question.

Charles Rhyee

Analyst · Charles Rhyee with Cowen. Please proceed with your question

Yeah. Hey, thanks for taking the question. Most of mine have been asked here. I guess, just maybe first on – Dave, can you just go into what's going on in Long-Term Care specifically? Obviously, you acquired Omnicare a few years back and there seem to be a lot of opportunities there to bring maybe some of the more CVS kind of brand services into that channel, particularly assisted living. Curious whether – just want to get an update here, what might has been going on here and when do you think some of these challenges could subside?

David M. Denton

Management

Yeah. Well, first and foremost, within the Long-Term Care space, there's – many of the players in that space are facing financial distress and that has created pressure from a growth perspective just as we service those homes across the country. Secondly, reimbursement pressure continues to evolve in that space and probably a little bit higher than what we originally planned. At the same time, census has been a bit lower across the industry. We experienced that, just given our market share. And then finally, as you indicated, we believe that there is a big opportunity for growth within the out market. However, the growth in that market has not been as fast, from a case perspective, as we originally planned. We have several pilots underway and the success of those pilots have been pretty strong, but we haven't created a platform yet that we can scale nationally across our business line. And so, that's an area of work that we have underway. We think we're optimistic about that in the long term; but in the short term, we're not exactly where we need to be.

Charles Rhyee

Analyst · Charles Rhyee with Cowen. Please proceed with your question

I see. And just a follow up on telemedicine, in particular, I guess is – because you talked about hemodialysis and if I recall correctly, I think as part of the – some of the pilots that are going underway, there's another one with home hemodialysis using telemedicine for, I guess, two out of every three patient visits. Is that something that you expect to also deploy? Or is that part of the opportunity when you're thinking about your home hemodialysis opportunity here?

Jonathan C. Roberts

Analyst · Charles Rhyee with Cowen. Please proceed with your question

Well, this is Jon. Home hemodialysis, we're taking it to trial and it will take probably 12 months to 18 months to get through the clinical trials. And then that solution is targeted for the home, so there's about 10% of dialysis that takes place at the home today with about 1% of it hemo and the balance peritoneal. So we'll be going after that narrow segment of the market. I think what's interesting is, when you look at other countries, you see home dialysis up to 30%, 40%, even 50%. So, we think there is an opportunity to expand that market as well. So, nothing really related to telemedicine with the hemodialysis that's planned at this point.

Larry J. Merlo

Management

Charles, it's Larry. You think back to some of the dialogue that we've had in terms of specialty and the role that Accordant has played in supporting our specialty pharmacy business, and our Accordant team, our Accordant nurses are working with a specialty patient in an effort to manage the patient holistically. And we think that that is the approach that we would apply to home hemodialysis. They'll play a key role in that regard, as...

Charles Rhyee

Analyst · Charles Rhyee with Cowen. Please proceed with your question

But not necessarily taking over – I guess, not also ruling up the role of the provider to these patients as well through CVS more directly, but still more as a support to the specialty pharmacy. Is that the better way to understand it then?

Larry J. Merlo

Management

Yeah. That's along those lines, Charles. Yes.

Charles Rhyee

Analyst · Charles Rhyee with Cowen. Please proceed with your question

Okay. Thanks for the clarification. Thank you.

Larry J. Merlo

Management

Sure.

Operator

Operator

Our next question comes from the line of Steven Valiquette with Barclays. Please proceed with your question.

Steven Valiquette

Analyst · Steven Valiquette with Barclays. Please proceed with your question

Great. Thanks. Good morning, everyone. So, I guess I'm just curious if you can speak about copay accumulator programs and whether there was greater adoption of this type of program by commercial employer clients in 2018 versus 2017 within your PBM book of business? And also do you see maybe even greater adoption in 2019, if you maybe more aggressively marketing this in the upcoming PBM selling season? Thanks.

Jonathan C. Roberts

Analyst · Steven Valiquette with Barclays. Please proceed with your question

Steven, this is Jon. So, it really is a capability that we have and it has to be something that our client opts into. I would say, there has been some interest, but not – I don't think it's not a priority for clients as we speak to them, because they know that these patients are challenged financially and they actually appreciate the help. But it's a client-by-client decision whether they opt into the program and we support as they do so.

Steven Valiquette

Analyst · Steven Valiquette with Barclays. Please proceed with your question

Okay. So adoption rates are pretty low right now? And just, by the way, could a customer adopt this mid contract if they wanted to? Or would this typically only change with the renewal of a contract? Just curious how that works.

Jonathan C. Roberts

Analyst · Steven Valiquette with Barclays. Please proceed with your question

They can implement this at any time. It's a pretty straightforward implementation.

Steven Valiquette

Analyst · Steven Valiquette with Barclays. Please proceed with your question

Okay. Got it. Okay. Thanks.

Larry J. Merlo

Management

Great. We're going to take two more questions. Thank you.

Operator

Operator

Our next question is from the line of Scott Mushkin with Wolfe Research. Please proceed with your question.

Scott A. Mushkin

Analyst · Scott Mushkin with Wolfe Research. Please proceed with your question

Hey, guys. Thanks for taking my questions. Really looking out beyond the Aetna closure, I just want to get your thoughts on a couple of things. First is – and I know we touched on it a little bit, but the risk to the health care plan book of business in Caremark. The second one is really just around drug coverage, and if we look at how many generics are out there. Do we need to look at drug coverage in a different way as we look out maybe beyond 2020? And then the third thing was as you pay down the debt, the appetite to do a deal like you did with Target? Thanks.

David M. Denton

Management

Well, I'll take the Target question as it relates to an incremental transaction there. Obviously, just given our leverage, as you said, we're not positioned to do something of scale at this point in time. I would say, secondly, as we look at the overlap of national players around the country, there's probably not a national player that would fit with our geographic needs at this point in time. There could be an opportunity for a small regional fill in as we think about access points around the nation, but those are going to be one-off and pretty small in nature if they were to come about.

Larry J. Merlo

Management

And Scott, I'll take that drug coverage question. Jon will take the health plan question. But Scott, if your question is really going down the generic path and listen, we have been pleased with what we're seeing from the leadership in the FDA in terms of streamlining the pathway, beginning to eliminate the backlog of potential generic approvals that have existed for quite a few years now, that has the prospects of moving more generics into the marketplace. And we think that there is an opportunity for greater adoption of things like value formularies that are largely, I'll say, staffed, if you will, with generics and the fact that we have now reached a point, especially as you look at chronic disease where there are multiple generic options within all of those different therapeutic classes. So, we think there is an opportunity for growth there. And we continue to explore different procurement models in terms of how can we work differently with pharma, with more of a focus on outcomes. Now, obviously I'm moving from generics into brands and we'll continue to explore those opportunities. And by the way, I think this – the CVS combination will open up the door to do even more of that.

Jonathan C. Roberts

Analyst · Scott Mushkin with Wolfe Research. Please proceed with your question

And Scott, this is Jon. I'll take the health plan question and their reaction. They understand that the lines are blurring between who's a competitor and who's a partner. And they just want to make sure that they're not disadvantaged in the market. And we've been very clear with them that, as we build products – new products, we're going to make them not only available to Aetna, but all of our health plan partners in this open platform. And we use the example of SilverScript, where we have a Part D plan and it's the largest Part D plan in the country, where we compete with the 40 health plans that we support. And as I talk to these plans, I say, with your brand and your market if I can make you more competitive, you're going to be very successful in the marketplace. And that in fact is what has happened with our health plan partners that are in the Medicare space. They have grown faster than the market because of the product services and expertise that we bring them. And so, the fact that we proved and demonstrated that in SilverScript is giving them confidence that, with this Aetna acquisition that we'll do the same thing for them as we build out these products and services. So I would say, people are from enthusiastic to wait-and-see, but we haven't really had anybody react in a very negative way because of this acquisition. So we're very happy with how this has been received.

Scott A. Mushkin

Analyst · Scott Mushkin with Wolfe Research. Please proceed with your question

Okay. Thanks very much.

Jonathan C. Roberts

Analyst · Scott Mushkin with Wolfe Research. Please proceed with your question

Thanks.

Larry J. Merlo

Management

Thanks, Scott.

Operator

Operator

And our final question comes from the line of David Larsen with Leerink Partners. Please proceed with your question.

David Larsen

Analyst · Leerink Partners. Please proceed with your question

Hi. Congratulations on a good quarter. Dave, did you increase the revenue growth expectations for Retail? And then, I don't think I saw an increase in the operating profit growth expectations. Any color there would be great.

David M. Denton

Management

Yeah. We actually did, in fact, increase our revenue guidance for the Retail business. Keep in mind that two things have happened. One is, we are making the incremental investments from tax savings largely into the Retail business at the back half of this year. But probably more importantly, why we're not raising guidance is, as we indicated our Long-Term Care Omnicare business is not performing as we expected, so we had a little headwind in the back half of the year compared to our expectations in that. So, think about the Retail business strong from a top line, both from a script and a front store perspective, being offset slightly from softness in Long-Term Care.

David Larsen

Analyst · Leerink Partners. Please proceed with your question

Okay, that's helpful. And then, can you maybe talk a little bit about biosimilars and maybe your drug trend that you delivered in diabetes. The drug trend of I think 1% was fantastic. What was it for diabetes? And then the use of Basaglar over Lantus, I think, probably had a significant impact there. So it seems to me like CVS's use of biosimilars is actually very effective today. What other products should we be looking at in the near term to sort of see similar results? Thanks.

Larry J. Merlo

Management

Yeah. We're very happy with the biosimilar performance in diabetes. I don't have the trends specific for diabetes. I think when we talked about the 1.8% that was we saw adherence improving in that class. So as we look at the biosimilars that are coming to the market, most of them are in the medical benefit in the near term. And I think we're several years off from seeing biosimilars under the performance benefit. But when they come, we're very optimistic that we'll be able to leverage competition as we have been doing with our formulary strategies to dramatically reduce costs for our clients and their members.

David Larsen

Analyst · Leerink Partners. Please proceed with your question

Okay. Thank you.

Larry J. Merlo

Management

All right. Well, listen, we appreciate everybody's time this morning. We know it is a rather long call and we communicated a lot of information. And Mike McGuire is certainly available for any follow ups. So, thanks everyone.

Operator

Operator

Ladies and gentlemen, that does conclude the conference call for today. We thank you for your participation and ask that you please disconnect your lines.