Rheumatoid Arthritis (RA) is an autoimmune disorder characterized by chronic inflammation of the lining of the joints that can cause painful swelling, bone erosion and/or distortion or deformity of the joints.
It is a hard and complex disease to treat and manage as symptoms and the progression of the disease vary greatly by patient. In addition, RA drugs are very expensive for both payors and patients. In fact, at CVS Health, RA is one of the top drivers of specialty drug spend for our pharmacy benefit management clients.
Complicating treatment is the fact that patients may also respond differently to medication therapies. As such, those with RA need holistic disease management and support, which can help address gaps in care, improve medication adherence and reduce condition-related complications and visits to the hospital or ER. This can result in better health outcomes and lower costs for both payors and patients.
CVS Health is uniquely positioned to provide this type of support to RA patients and as such, recently launched a new program to help the company’s pharmacy benefit management (PBM) clients better manage care and costs for 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.
Better controlled RA pharmacy costs
The program helps PBM clients control costs in this category by:
- Encouraging appropriate use of lower-cost, clinically appropriate RA therapies through pharmacy network and utilization management tools;
- Employing value-based management strategies, such as outcomes-based contracts and a new indication-based formulary for autoimmune conditions; and
- Including a trend guarantee for these expensive drugs.
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.
Comprehensive, personalized care
Enrolled PBM members will continue to receive proactive, personalized care delivered by a team of specially-trained pharmacists and Accordant nurses with disease-specific expertise, who help:
- Provide symptom, comorbidity and side effective management as well as coaching and education;
- Coordinate care with members’ doctors;
- And, coordinate initial clinical assessments, benefits verification and medication dispensing and distribution.
In addition, members with RA also have access to innovative digital tools to help them start and stay on their therapies as well as have the ability to pick up their medications at a local CVS Pharmacy or have it delivered to their home or office by mail via Specialty Connect.
“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,” said Alan Lotvin, M.D., executive vice president of CVS Specialty, the specialty pharmacy of CVS Health.
For more information about CVS Health’s efforts to improve pharmacy care, visit our Health Care Delivery & Innovation information center and the CVS Health Impact Dashboard. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.