Called Transform Rheumatoid Arthritis Care, the new program aims to foster the use of lower-cost therapies via 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, CVS said Wednesday.
PBM clients enrolled in the program could expect savings of up to 5% on their annual spend for rheumatoid arthritis drugs, CVS reported. For example, a client that manages 100,000 lives could realize as much as $500,000 in annual savings, the company said.
Outcomes-based contracts tie reimbursement for a drug to a specific target or goal. So if the target isn’t met — such as a patient discontinuing therapy, indicating that the drug wasn’t well-tolerated — the manufacturer may be required to provide additional value. The indication-based approach determines formulary placement for drugs based on the diagnosis rather than for the therapy class as a whole.
This multipronged approach helps clients better manage trend and receive a trend guarantee for these expensive drugs, according to CVS. The company noted that the cost and use of drugs to treat rheumatoid arthritis account for nearly half of the overall specialty drug trend.
“Rheumatoid arthritis is a complex condition and is one of the top drivers of specialty drug trend for our PBM clients,” Troyen Brennan, executive vice president and chief medical officer of CVS Health, said in a statement. “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.”
Patients enrolled in Transform Rheumatoid Arthritis 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 CVS’ RA Center of Excellence. The team provides support specific to a 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.
CVS noted that proactive patient outreach can help improve engagement rates, improve adherence to medication and reduce complications, such as hospital and emergency room visits.Transform Rheumatoid Arthritis Care members also have access to digital tools to help them start and stay on their therapies and, via Specialty Connect, can pick up their medication at a CVS Pharmacy store or have it delivered to their home or office.
The second most common form of arthritis, rheumatoid arthritis is a complex, hard-to-manage disease that affects more than 1.5 million Americans. CVS said its research shows that about a 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.
“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,” explained Alan Lotvin, 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.”
CVS launched Transform Care in December 2016, starting with Transform Diabetes Care. Then last August, the company said it plans to expand the integrated chronic care program to more disease states — such as asthma, hypertension, hypercholesterolemia and depression — over the next couple of years.