A leading pharmacy benefit manager has shaved its drug trend — the combination of a drug's cost and its usage — to its lowest point in four years, but specialty drug costs are still hard to swallow for employers and their advisers.

CVS Caremark’s overall drug pricing and usage trend fell to an average of 3.2% last year from 5.0% in 2015 with the help of price protection, return of more than 90% of overall rebates, use of generics and targeted approaches. Other bright spots include 38% of commercial customers actually achieving a negative trend and out-of-pocket costs for members decreasing 3% during this period.

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