CVS explores cause, cost of nonadherence
Industry members would likely agree that those patients who are adherent to their prescription medications use less health care and have lower overall costs; however, how much adherence lowers total costs, why some patients do not take their medications as prescribed and whether what’s saved in health care offsets higher drug costs are among the questions that have not been as clearly understood.
To answer such questions, CVS Caremark inked a multiyear collaboration with Harvard University and Brigham and Women’s Hospital to better understand patient behavior and how the healthcare system can improve it — especially as it relates to medication adherence. Excess healthcare costs due to nonadherence in the United States are estimated to be as much as $300 billion annually. To date, researchers have unearthed a great deal of invaluable data aimed at curbing medication nonadherence. Some highlights appear on the following pages.
MinuteClinic passes 10 million visits
CVS Caremark’s MinuteClinic continues to evolve and play a greater role in the U.S. healthcare system as evidenced by its expanding footprint, broadening scope of service and growing roster of strategic affiliations.
Since opening its doors in 2000, MinuteClinic has surpassed 10 million patient visits and remains on course to add about 100 clinics annually over the next five years — putting the clinic operator in an ideal position to play an important role in the U.S. healthcare system.
“Healthcare reform is a positive development for retail clinics because there are about 30 million people who are currently uninsured who will have healthcare coverage,” said Andrew Sussman, president of MinuteClinic and SVP and associate chief medical officer of CVS Caremark. “Add to that the aging of the population and the shortage of primary care practitioners, and the opportunity for services such as those provided by MinuteClinic has the potential for growth.”
In fact, MinuteClinic, which currently operates more than 600 locations, already has taken steps to broaden its suite of services. For example, in 2010, it launched a health condition monitoring service for patients with diabetes, high cholesterol, high blood pressure and asthma. In 2011, it began offering vitamin B12 injections and the human papillomavirus vaccination Gardasil.
To help with patient education, it launched earlier this year the Ask Me 3 program, which is designed to enhance communication between healthcare providers and patients in order to improve health outcomes.
“Research shows that patients who understand health instructions get well sooner, tend to take their medication regularly and make fewer mistakes with their care. In particular, clear communication helps individuals do a better job of managing chronic health conditions,” stated MinuteClinic chief nurse practitioner Paulette Thabault, who joined MinuteClinic in July 2010.
Over the past few years, MinuteClinic has formed affiliations with a number of health systems and, since the end of the first quarter 2011, it has added five strategic affiliations to its roster. The company announced No. 11 in August, when it announced its partnership with Indiana University Health, the state’s largest health system.
In addition to patient education and disease state management programs, these partnerships also share the common goal of integrating electronic medical records to streamline communication around a patient’s care for providers on either side of the partnership.
PBM postioned to ‘effectively compete’
At press time, the industry was weighing the potential merger of pharmacy benefit manager rivals Express Scripts and Medco Health Solutions, but executives at CVS Caremark remain more confident than ever that its PBM business is ideally positioned to “effectively compete,” regardless of what federal trade regulators decide for ESI-Medco. And there’s good reason why.
“With the evolution of U.S. health care to more consumer-directed care, our multiple consumer touchpoints make us best-positioned to promote cost-effective and healthy behaviors. And the success that we’re having in both the 2011 and 2012 selling seasons clearly demonstrates that our model is resonating with payers,” Larry Merlo, president and CEO of CVS Caremark, told analysts in August.
Not only did the PBM business experience double-digit revenue gains during the second quarter ended June 30 — due in large part to the addition of the Aetna contract and the acquisition of the Medicare prescription drug business of Universal American — but the company continues to make progress on its five-point PBM growth plan, which includes:
Achieving continued momentum in new business wins and strong client retention;
Continuing to develop and up-sell its unique clinical offerings;
Driving growth in 90-day mail choice and generic dispensing rate;
Focusing on high-growth areas, especially Medicare Part D, specialty pharmacy and Aetna; and
Executing successfully on the PBM streamlining initiative, with a goal to deliver more than $1 billion in related cost savings from 2011 through 2015.
“In addition to the anticipated benefits from this five-point plan for PBM growth, 2012 also begins the generic wave, which will carry through the next several years with about $100 billion of branded products coming off patent between now and 2016,” Merlo told analysts. “So I remain very confident that 2012 will be the year that our PBM breaks trend and demonstrates healthy operating profit growth.”
Broadly available for implementation beginning Jan. 1, 2012, will be a new medical benefit drug management service for the company’s PBM and specialty pharmacy clients. “This offering will enable CVS Caremark to identify the unrecognized specialty pharmacy spend currently billed through the medical benefit for oncology patients,” explained Per Lofberg, president of CVS Caremark’s PBM business. “We can provide our clients with an opportunity to better manage these expensive drugs while also improving the quality of care for their members.”
One year ago, Jonathan Roberts, EVP Rx purchasing, pricing and network relations, also was named COO of the PBM business, assuming leadership of PBM operations, mail-service pharmacy and specialty pharmacy.