PHARMACY

CVS Caremark study: Focus on Rx adherence saved PBM clients $2.4B in 2011

BY Antoinette Alexander

WOONSOCKET, R.I. — CVS Caremark has aggressively set its sights on enhancing medication adherence, and the initiatives are paying off as the company estimates that its PBM clients saved nearly $2.4 billion in 2011 because of improved medication adherence for chronic conditions, according to findings of its annual Insights Report.

The report, released on Wednesday, reviews drug trend and highlights key issues in pharmacy care. 

The report also found that, in 2011, the drug trend for the company’s PBM employer clients (2.1%) and health plan clients (2.2%) represented the company’s lowest recorded trend for the past seven years.

"Over the past several years, CVS Caremark has conducted research on the causes and impact of medication nonadherence, and we know that taking medications for chronic diseases as directed keeps patients healthier and helps avoid extra costs associated with nonadherence," stated Troyen Brennan, EVP and chief medical officer of CVS Caremark. "Based on our research, we have implemented programs to help our customers and members improve their adherence, and in 2011, the results of these programs increased optimal adherence rates for our clients, resulting in nearly $2.4 billion in overall healthcare savings across our book of business."

"Last year, even consumers with insurance continued to feel the impact of a sluggish economic recovery and responded by rationing their healthcare spending, resulting in relatively flat utilization of pharmacy services," added Per Lofberg, president of CVS Caremark’s PBM business. "As a company focused on helping people on their path to better health, we worked closely with our clients to find opportunities to control costs through formulary management and increased utilization of generic drugs while also continuing to promote programs to improve medication adherence and keep members healthy."

During 2011, the generic dispensing rate for the company’s book of business grew to 74.1% because of the combination of a stream of patent expirations for blockbuster branded drugs and the company’s implementation of formulary and plan design strategies to encourage the use of cost-effective generic drugs.

Another trend driver in 2011 was continued growth in the utilization of complex specialty pharmaceuticals. CVS Caremark’s book of business analysis showed that while specialty drugs may make up as little as 2.5% of a payer’s total prescriptions, they can add up to 31% of overall pharmacy spend. Over the next few years, the impact of specialty medications on pharmacy spend will continue to grow as more specialty drugs enter the market and higher cost per unit prices continue. In 2011, specialty drug trend ranged from 16.5% for employer clients to 19.1% for our health plan clients.

Drug price also was one of the largest drivers of trend in 2011 for CVS Caremark commercial clients, with average wholesale price per day trend showing price increases across both specialty and nonspecialty branded drugs. In fact, since 2007, brand-drug price inflation has increased 27%, the company stated. CVS Caremark noted that it takes these types of market developments into account when developing its formulary and plan design strategies, which promote the use of generic drugs whenever possible and provide for the appropriate use of single-source brand drugs when necessary. CVS Caremark stated that it works with clients to address the impact of price and drug mix by implementing narrower formularies, dispense-as-written penalties and step therapy plan designs to help promote the use of clinically appropriate and cost-effective medications.

The cost savings because of improved adherence was calculated using the company’s pharmacy care economic model, which enables CVS Caremark to calculate the financial value of improved pharmacy care by taking a holistic approach and reviewing adherence, gaps in care and use of generic alternatives. The company’s pharmacy care programs, such as Pharmacy Advisor for diabetes, are succeeding in moving a significant portion of PBM members to optimal levels of medication adherence. The savings calculated using the PCEM are because of medical cost avoidance, drug cost savings and productivity loss avoidance.

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PHARMACY

NACDS emphasizes to Senate committee value of community pharmacy

BY Antoinette Alexander

ALEXANDRIA, Va.  — The National Association of Chain Drug Stores has emphasized the commitment of NACDS and the chain pharmacy industry to partner with policy-makers and others to improve quality and lower costs in the healthcare delivery system in a statement sent to the U.S. Senate Health, Education, Labor and Pensions Committee, NACDS announced on Tuesday.

The committee held a hearing on Tuesday titled “Identifying Opportunities for Health Care Delivery System Reform: Lessons from the Front Line.” In its statement, NACDS illustrated the value of community pharmacies in helping to improve patient health and lower healthcare costs through medication therapy management.  
 
“Community retail pharmacies are at the front line in the healthcare system, interacting with patients on a daily basis,” NACDS said in its statement to the committee. “Community pharmacists are uniquely qualified through their comprehensive education and training to significantly reduce the problem of poor medication adherence. We are convinced that [medication therapy management] is a key way to vastly improve health outcomes and reduce costs by ensuring that individuals receive the maximum health benefit from their prescription medicine.”
 
NACDS also emphasized the importance of efforts to expand the ability of pharmacists to administer vaccinations in the Medicare Part D program and increase the utilization of generic drugs as additional ways to improve health and reduce costs.  
 
“Currently all 50 states allow pharmacists to provide certain immunizations. Encouraging Medicare beneficiaries and others to obtain vaccinations at their neighborhood pharmacy is a cost-effective and convenient way to prevent illness and reduce healthcare costs,” NACDS stated. “Pharmacies have long promoted generic drugs as safe, cost-effective alternatives for many patients. Community pharmacy has a higher rate of generic dispensing — 73% — than any other practice setting.”
 
“NACDS thanks the committee for allowing us to share our comments on the role of community pharmacies in improving patient care and reducing healthcare costs through healthcare delivery system reform,” NACDS concluded in the statement.

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AACP, NCPA announce Innovative Medication Adherence Educators Challenge winners

BY Allison Cerra

ALEXANDRIA, Va. — The American Association of Colleges of Pharmacy and the National Community Pharmacists Association announced the winners of a competition designed to highlight the best practices in medication adherence teaching among the nation’s 127 colleges and schools of pharmacy.

The University of Arizona College of Pharmacy, University of Maryland School of Pharmacy and the Ohio State University College of Pharmacy were all named winners of the competition, which was launched this year. A total of 37 entries from 26 colleges and schools of pharmacy were received and judged on criteria that included the impact, scalability and innovation of the tool, as well as the tool’s application in an interprofessional learning environment, AACP and NCPA said. Each winning school received a $1,000 award and all entries will be compiled to create an adherence educators toolbox that will be available on the AACP and NCPA websites, AACP and NCPA said.

"With increasing importance being placed on the issue of medication adherence, it is very encouraging to see that tomorrow’s pharmacists have the opportunity to experience these innovative teaching strategies," NCPA CEO Douglas Hoey said. "We look forward to working with AACP and continuing to showcase these and other innovative adherence teaching tools as a way to elevate the role of the pharmacist as an expert team member who can effectively identify and resolve medication issues."

The schools were recognized for the following programs:

  • The University of Arizona’s entry, submitted by Richard Herrier and Jeannie Lee, featured a didactic adherence course for second-year student pharmacists. The required course combines 20% lecture and 80% practice, and covers a variety of adherence-related topics, including theoretical foundations of medication adherence, assessment of risk factors, behavioral techniques and use of adherence aids. Lectures are followed by small group exercises and other activities to allow students to practice and apply skills and principles learned in lecture;

  • The University of Maryland’s submission from Amy Ives, featured an adherence-related lab activity in which students are given case studies and hands-on learning activities to experience real-world barriers to patient medication adherence. Students are asked to wear lab goggles obstructed with stickers in order to simulate a patient with vision problems. Similarly, students are asked to wear work gloves while filling a pill organizer in order to experience the dexterity challenges of a patient with arthritis; and

  • The Ohio State University’s entry, submitted by Katherine Kelley, featured an interdisciplinary adherence learning activity that involves the colleges of pharmacy and medicine, with future plans to expand the program to the College of Nursing. The activity, which involves first-, second-, and third-year student pharmacists, as well as second-year medical students, requires the students to adhere to a complex placebo medication regimen over a five-day period. First-year student pharmacists work to fill and label more than 1,600 prescriptions. The medications are dispensed by third-year student pharmacists to second-year pharmacy and medical students, who are counseled on their medications and asked to record their adherence and observations in a medication log.


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