Program enhances patient care programs with new value-based cost management strategies and a client trend guarantee
WOONSOCKET, R.I., Jan. 17, 2018 /PRNewswire/ -- CVS Health (NYSE: CVS) today introduced Transform Rheumatoid Arthritis Care to help the company's pharmacy benefit management (PBM) clients better manage care and costs for Rheumatoid Arthritis (RA). The program is the latest addition to the company's suite of condition-specific, highly personalized Transform Care programs and adds value-based management strategies including outcomes based contracts and a new indication-based formulary for autoimmune conditions to CVS Health's integrated pharmacy care model. Given that the cost and utilization of drugs to treat RA are a top drug trend and spend driver, accounting for nearly half of overall specialty drug trend, this new multi-pronged approach also includes a trend guarantee based on the program's ability to improve both clinical care and cost management for RA.
"Rheumatoid arthritis is a complex condition and is one of the top drivers of specialty drug trend for our PBM clients," said Troyen A. Brennan, M.D., executive vice president and chief medical officer of CVS Health. "By leveraging our integrated pharmacy care model, we can provide highly personalized, whole-patient support through our specialty pharmacy and embedded AccordantCare nurses, while harnessing the power of our PBM's tools to encourage appropriate use of and adherence to lower cost therapies."
The Transform RA Care program is designed to help encourage appropriate use of lower-cost therapies through pharmacy network and utilization management tools along with value-based management strategies such as outcomes-based contracts and a new indication-based formulary for autoimmune conditions. Outcomes-based contracts tie reimbursement for a drug to achieving a specific target or goal. If the target is not met for instance if the patient discontinues therapy, indicating the drug was not well tolerated the manufacturer may be required to provide additional value. In addition, the indication-based approach determines formulary placement for drugs based on the specific diagnosis rather than for the therapy class as a whole. This multi-pronged approach is designed to help clients better manage trend and receive a trend guarantee for these expensive drugs.
"Treating Rheumatoid Arthritis costs the U.S. health care system $19 billion a year. Both spend and trend have also been rising for the autoimmune category in recent years and market analysts expect this category to be the fastest-growing drug class over the next five years," said Alan Lotvin, M.D., executive vice president of CVS Specialty, the specialty pharmacy of CVS Health. "Our program is unique in that we can pull together resources enabled by our integrated pharmacy care model to deliver both a truly member-focused clinical management program while also helping to manage the rising costs within the autoimmune category through new approaches to contracting and formulary management."
Members enrolled in Transform RA Care will continue to receive proactive, personalized care and disease-specific expertise from the RA CareTeam, a team of specially-trained pharmacists and Accordant nurses in our RA Center of Excellence. The RA CareTeam provides a range of support specific to the member's needs including symptom, comorbidity and side effect management; care coordination; and coaching and education. The RA CareTeam also offers initial clinical assessments, benefits verification and medication dispensing and distribution. In addition, proactive patient outreach can help improve engagement rates, improve adherence to medication, and reduce complications, such as hospital and emergency room visits. Members with RA also have access to innovative digital tools to help them start and stay on their therapies and, through Specialty Connect, the ability to pick up their medication at a local CVS Pharmacy or have it delivered to their home or office by mail.
Clients enrolled in the Transform RA Care program could expect to see savings of up to 5 percent on their annual spend for RA drugs. For example a client that manages 100,000 lives could see up to $500,000 in annual savings.
RA is the second most common form of arthritis, impacting more than 1.5 million people in the U.S. It is characterized by chronic inflammation of the joints and, over time, can lead to bone deformation. The disease is also complex and hard to manage, and our research shows that approximately one quarter of patients who start on an autoimmune drug discontinue therapy within 180 days, which can lead to poor health outcomes and higher costs for payors and members. Those with RA can benefit from holistic disease management, which can help improve medication adherence, address gaps in care, and reduce condition-related complications and visits to the hospital and ER. In addition, cost management strategies can create additional value for both payors and patients.
About CVS Health
CVS Health is a pharmacy innovation company helping people on their path to better health. Through its more than 9,700 retail locations, more than 1,100 walk-in medical clinics, a leading pharmacy benefits manager with nearly 90 million plan members, a dedicated senior pharmacy care business serving more than one million patients per year, expanding specialty pharmacy services, and a leading stand-alone Medicare Part D prescription drug plan, the company enables people, businesses and communities to manage health in more affordable and effective ways. This unique integrated model increases access to quality care, delivers better health outcomes and lowers overall health care costs. Find more information about how CVS Health is shaping the future of health at https://www.cvshealth.com.
SOURCE CVS Health