# Faultprint Assessment Draft: CVS Caremark

## Status

Draft generated from the calibrated v3 operating/postmortem crosswalk and the client-output eligibility gate.

This draft is findings-only. It does not recommend actions, predict failure, assert illegality, or claim that the institution has failed.

## Corpus Position

- Institution: CVS Caremark
- Sector: Pharmacy benefit management
- Client-eligible findings included: 4
- Caveated findings included: 4

## Pathology Mix

- Classification Gatekeeping: 3
- Record-Authority Capture: 1

## Resemblance Mix

- elevated_resemblance: 2
- moderate_resemblance: 2

## Findings

### Finding 1: Classification Gatekeeping

Condition: Prior authorization includes quantity limits step therapy and non-formulary review

Resemblance band: elevated_resemblance

Output status: client_ready_with_caveat

Finding statement: Operating row shows elevated resemblance to known breakdown conditions, with at least one postmortem-supported pathology or companion condition.

Evidence anchor: CVS Caremark states prior authorization may include exception reviews for quantity limitations step therapy protocol and non-formulary review.

Falsification evidence: Plan-specific rules showing the member's medication has no such requirement would narrow this finding.

Boundary: Does not prove the requirements are inappropriate.

### Finding 2: Record-Authority Capture

Condition: Clinical criteria and exception forms indexed by medication or condition

Resemblance band: elevated_resemblance

Output status: client_ready_with_caveat

Finding statement: Operating row shows elevated resemblance to known breakdown conditions, with at least one postmortem-supported pathology or companion condition.

Evidence anchor: CVS Caremark directs users to select medication or condition to find forms and states drug coverage depends on plan and formulary.

Falsification evidence: Plan records showing criteria are not used in decisions would downgrade exposure.

Boundary: Does not prove criteria are wrong or opaque to clinicians.

### Finding 3: Classification Gatekeeping

Condition: ePA is framed as significantly faster

Resemblance band: moderate_resemblance

Output status: client_ready_with_caveat

Finding statement: Operating row shows a condition also present in postmortem libraries, but current public evidence is not enough to treat it as high exposure.

Evidence anchor: CVS Caremark states ePA processes prior authorizations and exceptions significantly faster.

Falsification evidence: Processing-time records showing ePA does not reduce delays would weaken this mitigant.

Boundary: Speed does not prove correct or fair outcomes.

### Finding 4: Classification Gatekeeping

Condition: ePA processes prior authorizations and exceptions electronically

Resemblance band: moderate_resemblance

Output status: client_ready_with_caveat

Finding statement: Operating row shows a condition also present in postmortem libraries, but current public evidence is not enough to treat it as high exposure.

Evidence anchor: CVS Caremark states ePA is a fully electronic solution that processes prior authorizations formulary exceptions and quantity-limit exceptions.

Falsification evidence: ePA logs showing electronic routing does not affect review or decision timing would downgrade exposure.

Boundary: Does not prove automation makes final decisions.

## Internal Exclusions

No internal revise/hold rows were included in this report draft.

## Report Boundary

This draft is based on the reviewed corpus and the current Faultprint evidence libraries. It identifies structural conditions and evidence requirements. It is not a legal opinion, audit conclusion, compliance certification, or prediction.