CVS Caremark wins NCQA accreditation in utilization management

WOONSOCKET – CVS Caremark, the pharmacy benefits manager segment of CVS Health Corp., has been accredited by the National Committee for Quality Assurance in utilization management, the company recently announced.

NCQA Utilization Management Accreditation is a quality assessment program focusing on consumer protection and customer service improvement. Standards recognize that organizations applying for accreditation have open-access networks and can improve service quality and utilize customized structures to meet purchaser needs.

“At CVS Caremark, we are pleased to maintain our NCQA Utilization Management Accreditation, which we’ve held continuously for the past several years,” said Jonathan Roberts, chief operating officer of CVS Health. “This accreditation affirms that our program provides high-quality service and care to our PBM clients and their members as we strive to ensure that members access clinically appropriate and cost-effective therapies to help improve health outcomes and lower costs.”

The CVS Caremark Utilization Management Program is designed to encourage the appropriate and effective use of medications, identify optimal drug use and promote cost-effective drug benefit-plan designs for our clients. The program is based on evidence-based drug information, published guidelines, consensus statements and standards of medical practice.

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“Achieving utilization management accreditation from NCQA demonstrates that CVS Health has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards,” said NCQA President Margaret E. O’Kane.

The accreditation survey includes a rigorous evaluation conducted by a team of physicians and managed care experts. An independent review oversight committee of physicians analyzes the team’s findings and assigns an accreditation status based on the organization’s performance against standards. NCQA has reviewed and accredited CVS Health’s Utilization Management functions only. For complete details on the scope of this review, visit

Rob Borkowski is a PBN staff writer. Email him at