To help fight the rising tide of specialty drug costs, CVS Specialty has been elevating its digital tool capability for drug management and integrating it with its care coordination programs.
A glimpse of the specialty drug cost burden is evident in recent reports. Ten countries, including the U.S. and European countries, will spend an estimated $318 billion on specialty medication in 2018, representing 41 percent of their overall drug spend, says a new report entitled, “2018 and Beyond: Outlook and Turning Points,” by IQVIA Institute.
Express Scripts’ latest Drug Trend Report says specialty medication spending increased 9.4 percent in 2018, with specialty medications now accounting for 44.7 percent of the total drug spend—an increase of 3.9 percent from 2017.
“Complex conditions and fragmented care are the major drivers of the cost problem, which is why CVS is taking an integrated specialty pharmacy approach—one that merges people, digital technology and data management,” according to Prem Shah, executive vice president of specialty pharmacy at CVS.
With specialty drug costs representing so much of overall drug spend—often under the medical benefit offered by payers—CVS Specialty is integrating utilization management strategies that drive the most appropriate therapies while preventing adverse events and drug waste, Shah says.
CVS's secure messaging—where specialty care teams offer clinical and drug adherence support via two-way text messaging to keep patients on track—is ultimately reducing costs for payers, Shah says. CVS Specialty has been using the secure messaging for a number of years, but continues to develop the process and is accelerating how much they use it.
“We are using clinical secure messaging to get patients to have their providers at their fingertips,” he says. CVS Specialty is also using clinical trial data and information on a drug’s label to discern key challenges patients might have while taking the medication, and to then use messages to help the patient through a difficult time in maintaining adherence.
For example, if there is a rash expected to appear on the fifth day of taking the medication, CVS alerts patients via a real-time message on that day, to inform them, remind them and to also provide a link to enable patients to ask questions. Adherence has improved as a result, Shah says.
Currently, CVS is seeing greater adherence to medication for chronic myeloid leukemia through the use of secure text messaging, he says.
“I do think it’s a very interesting time in specialty pharmacy,” Shah says. “A lot of things are going on with technology, as specialty pharmacies serve some of the sickest patients in the country, with highly complex autoimmune diseases and cancer.”
In the past, care was managed through phone, paper, faxes and mail order, but now the healthcare industry is “laying down pipes” for a digital delivery, Shah says. “CVS Specialty is using text messaging to bring specialty pharmacy to the 21st century.” The company uses the messaging to connect patients with providers and is building a more modern consumer experience, which he says is “extremely important.”
Also in its technology arsenal to contain costs, is a new wearable app to help monitor on a daily basis how well MS patients walk, a key indicator of their health status. Though CVS is unable to reveal more on this project to date, it is reported by Shah to be an exciting development on the horizon.
“We continue to try to manage these [specialty] patients differently—and in different ways,” Shah says. “We should be talking to patients when they call us and solving their needs.” Patients expect solutions at their fingertips, much like ordering an Uber ride. However, “Uber is about getting from point A to point B. Imagine if you just got diagnosed with cancer?” he says. Patients need a transparent journey for tracking their drugs. They need to be concerned about their healing process, not where their drug is. “That is ultimately our responsibility as market leaders.”
