CVS launches care program to manage cost of RA
CVS Health has introduced Transform Rheumatoid Arthritis Care to help the company’s pharmacy benefit management clients better manage care and costs for rheumatoid arthritis. 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,” says Troyen A. Brennan, M.D., executive VP 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.”
According to company leaders, 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,” says Alan Lotvin, M.D., executive vice president of CVS Specialty, the specialty pharmacy of CVS Health. “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. 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 the CVS 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.
According to company leaders, 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 United States. 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. CVS research shows that about 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. Thus CVS executives believe that 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. medadnews
