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Moving beyond dispensing and toward adherence

BY Antoinette Alexander

CVS Caremark is also working to reinvent the role of its retail pharmacists and is gaining share by focusing on customer service, greater adherence, increased access and patient 
care improvements.

Pharmacy same-store sales increased 3.1% in 2011 — pushing CVS/pharmacy’s share of the total U.S. retail prescription market to 19.5%, up nearly six percentage points 
since 2004.


No doubt that much of the growth is credited to CVS Caremark’s more than 22,000 retail pharmacists, as their role increasingly shifts from primarily dispensing prescriptions to also providing services, including flu vaccinations and face-to-face patient counseling with respect to adherence to drug therapies, closing gaps in care and more cost-effective 
drug therapies.


For example, the company’s Retail Pharmacy adherence program is now in its fifth year and continues to experience strong performance. In the first half of this year alone, the CVS Caremark pharmacy teams proactively delivered 40 million live customer interventions across all of its stores, helping to improve adherence.


Then there is CVS Caremark’s Pharmacy Advisor program, which enables pharmacists to engage with PBM members who are diagnosed with chronic conditions, including diabetes and cardiovascular disease. The pharmacists counsel their patients about the importance of being adherent to their medications and identify gaps in care that they educate the patient about and can bring to their physician’s attention. A recent analysis showed that after one year in the Pharmacy Advisor program, certain members using CVS/pharmacy retail locations had a 17.2% decline in gaps in care.


With nonadherence costing the U.S. healthcare system an estimated $300 billion annually in avoidable healthcare costs, it is clear that improving adherence is critical.


Another growth driver for retail pharmacy profits is generics. CVS Caremark sees significant opportunities on the horizon to further increase its generic dispensing rate. 


Between 2012 and 2015, about $90 billion of branded drugs are scheduled to go generic. Generic penetration currently is approximately 73%, but it could rise to 85% to 90% as many new generics are introduced in the market.


It should also be noted that CVS Caremark expects to retain many of the scripts it gained as a result of the Walgreens-Express Scripts impasse and has set retention strategies in motion to help it achieve that goal.

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Integration key to managing specialty patients

BY Antoinette Alexander

Specialty may be the fastest-growing segment, but it may also be the most complicated, as this segment is comprised of very complex medications to treat such serious diseases as cancer, multiple sclerosis and hemophilia. The good news for CVS Caremark is, unlike the typical PBM, it can serve specialty patients through multiple touch points that include specialty mail pharmacies, as well as CVS/pharmacy and retail specialty 
pharmacy locations.


Specialty pharmacy is expected to be a $15 billion business for CVS Caremark, growing 17% annually over the past two years as it has added PBM lives and the category itself has grown.


During the second quarter, the specialty business continued to achieve significant growth as revenues rose a robust 44%. According to the company, that growth was driven by new PBM clients, new product launches and drug 
price inflation.


As part of its effort to further advance the business, CVS Caremark has developed programs to manage the portion of drugs that are billed directly to the payer under the medical plan and that fall outside of the traditional PBM contract terms. As previously reported by Drug Store News, this largely involves injectable drugs that are administered in a clinical setting, and the drug is then billed by the physician to the payer. Through the program, CVS Caremark believes it can generate savings of 15% to 20%.


During CVS Caremark’s Analyst Day in December, Per Lofberg, EVP of CVS Caremark and president of Caremark Pharmacy Services, told analysts that its integrated assets afford CVS Caremark a unique opportunity to further improve its value proposition in the specialty field.


“By more tightly coordinating these member touchpoints and including a subset of CVS retail pharmacies, much like Minute
Clinics are established in close to 10% of CVS retail stores, we can make a meaningful improvement in results for patients and clients. And this is another example of how we are reinventing pharmacy to help members improve their health,” said Lofberg. “This integration will provide patients with a truly seamless experience, from initial intake to dispensing and adherence management. It will give patients easier access to their medications, as well as personal access to expert 
clinical pharmacists.”

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MinuteClinic expands scope of services

BY Antoinette Alexander

On pace to reach about 1,000 clinic locations by 2016 and a robust team of 1,800 nurse practitioners and physician assistants working tirelessly to provide patients convenient access to quality care, MinuteClinic has demonstrated the integral role that it plays not only within CVS Caremark’s healthcare offering but within the entire U.S. healthcare system.


Since its inception in 2000, the retail-based clinic operator has come along way. For example, it has seen 11 million patients, with more than 10 million being in the last five years; has formed clinical affiliations with well over a dozen health systems; and is serving as a critical point of entry to the healthcare system for the 50% of clinic patients who report having no medical home. These successes have helped pave the way for MinuteClinic’s growth, and now the clinic operator is taking an even greater role in 
reinventing pharmacy.


MinuteClinic, which experienced a 17% boost in revenues during the second quarter, is now expanding its focus beyond acute ailments and, through its expanded collaboration with Caremark, is proving to be an important “integration sweet spot” for the entire CVS Caremark enterprise. 


Non-acute care is MinuteClinic’s fastest-growing segment, due in large part to the rise in chronic diseases and the primary care physician shortage that is plaguing the nation. The company has stated that it expects non-acute visits and non-flu vaccinations to reach 25% of its services over the next 
five years.


“We continue to focus on new programs at MinuteClinic aimed at identifying and monitoring chronic conditions. As an example, we’re focused on identifying patients with elevated blood pressure and encouraging them to follow-up with MinuteClinic or their primary care physician. As a result, we’ve seen a 50% increase in blood pressure evaluations compared to the same quarter last year,” Larry Merlo, CVS Caremark president and CEO, told analysts during its recent second-quarter conference call. “And we believe our plans to enhance our services and to double our clinic count over the next several years should position us well to play an important role in helping solve the primary care physician shortage, especially with millions of newly insured individuals expected to enter the 
healthcare marketplace.”


The collaboration between MinuteClinic and the PBM business also is enabling CVS Caremark to create programs for PBM members that are difficult for rivals to match. For example, clients have the opportunity to change their benefit structure to substantially reduce or eliminate co-pays at MinuteClinic. MinuteClinic also offers PBM clients flu vaccination and biometric screening programs, injection training and on-site, 
employer-based clinics.


Meanwhile, the overall convenient care industry is enjoying significant industry developments this year — moves that further solidify MinuteClinic’s critical role in today’s consumer-driven 
healthcare system.


For example, Massachusetts lawmakers recently passed a massive healthcare bill that seeks to control healthcare costs and expands the services of limited-service clinics to allow for anything within the scope of practice for a nurse practitioner. 


In response to the recently passed legislation, Andrew Sussman, president of MinuteClinic and SVP/associate chief medical officer of CVS Caremark, said in a statement sent to Drug Store News, “we’re very pleased to be able to bring an expanded scope of services to MinuteClinic patients in Massachusetts in areas such as monitoring of chronic diseases, and prevention and wellness offerings. These services are well within the scope of practice of our nurse practitioners and have been welcomed by our patients in the additional 24 states where we have 
MinuteClinic operations.”


As of August, South Carolina is allowing retail-based health clinics to enroll as providers in Medicaid, a move that will enable Medicaid patients to use clinics for wellness visits, preventive services and to treat acute ailments.


The state currently has about two-dozen retail-based health clinics, all of them MinuteClinics.


According to The Post and Courier, South Carolina Medicaid director Tony Keck said the move is designed to expand access to care and keep those patients with basic health issues from using high-cost emergency departments.


When comparing MinuteClinic users to non-MinuteClinic users, CVS Caremark found that MinuteClinic users had 8% lower overall healthcare costs, and their emergency room expenses were 12% lower, the company stated in its most recent annual report.

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