An Easier Start to Therapy

A Better Plan Member Experience through Simplified Onboarding

BRIEFING
September 25, 2019
Executive Vice President, Specialty and PBM Product Innovation, CVS Health

With Specialty Expedite, patients can get started on appropriate therapy in as little as three days.

Getting diagnosed with a complex or rare condition is life changing. Patients may worry that they won’t be able to manage their condition and comorbidities — the average specialty patient has 2.4 comorbidities — and wonder how they will stay on track. CVS Health RxClaims data, 2017 P1001820419. These concerns are compounded by the fact that starting a specialty medication can be confusing and challenging. It’s often not as simple as stopping by the local pharmacy on the way home from their appointment to pick up their new medication. Instead, they may leave their physician’s office not knowing what comes next.

The process can also be more time intensive for the health care system due to increased phone calls, emails, and faxes to coordinate care and share information among payors, pharmacy benefit managers, and patients. These steps are critical to ensure that patients are receiving the appropriate medication and that the client’s formulary and plan design are closely followed. However, the current process can take weeks to complete and leads to inefficiency, a poor patient experience and the potential for patients to fall off therapy.

CVS Specialty is harnessing new technology to better support patients at every point along the health care journey, including making it easier for them to get started on appropriate therapy.

Onboarding in as Little as Three Days

We created Specialty Expedite to simplify the onboarding process, help patients get their appropriate medication faster, and keep them informed of the status of their prescription along the way.

Checkmark

Streamlined PA and Benefits Verification Process
Using our connectivity with electronic health record (EHR) systems, we seamlessly gather information necessary to process a specialty prescription and complete the appropriate prior authorizations (PAs), in accordance with payor requirements. Once a prescriber sends a prescription to CVS Specialty pharmacy through their EHR system, we can more quickly perform benefits and safety checks, confirm clinical information, and initiate the PA process.

Specialty Expedite shortens the onboarding process to as little as three days while still following rigorous clinical standards and the client’s utilization management and plan guidelines.

Checkmark Patient Engagement from the Start of Therapy
A newly diagnosed patient may feel overwhelmed or in the dark when they leave their physician’s office. It is crucial that patients receive support from the very beginning as most noncompliance begins during the first few months of therapy.

With Specialty Expedite, we begin building a relationship with a patient as early as possible — even before their first prescription is filled.
Examples of digital messages sent after a specialty prescription is received: "We are checking your benefits; Your Rx requires PA and we are processing it now; Your RX is being filled; Your Rx is on its way."
As soon as we receive a new specialty prescription, we send the patient a welcome message.* We then continue to keep them informed on the status of their prescription, alerting them when we are checking their benefits, processing a PA, filling the prescription and more.

As soon as we receive a new specialty prescription, we send the patient a welcome message.* We then continue to keep them informed on the status of their prescription, alerting them when we are checking their benefits, processing a PA, filling the prescription and more.

Examples of digital messages sent after a specialty prescription is received: "We are checking your benefits; Your Rx requires PA and we are processing it now; Your RX is being filled; Your Rx is on its way."

By establishing digital connectivity with patients from the start, we can continue to support them throughout their specialty journey with tools such as our Secure Messaging platform.

Patients Decide How and Where to Obtain Specialty Medications

Starting on a specialty medication can be more challenging due to the fact that filling a prescription is a different process than a non-specialty medication. Most consumers turn to their local retail pharmacy; however, they often do not stock many specialty medications.

Specialty Connect makes it easier for patients to get started by letting them choose how they want to get their specialty medications — at their local CVS Pharmacy or through specialty mail service**, all while preserving access to high-touch patient support from our therapy-specific CareTeams. These skilled clinicians help patients understand insurance requirements and provide financial assistance information and clinical support.

96% of patients value being able to choose how they receive their medication.CVS Caremark Enterprises Analytics, 2015 P1001570419.

When patients have more flexibility and choice, they are able to start their therapies sooner, and adherence and satisfaction improves.

Among patients who use Specialty Connect to fill their specialty prescriptions, 17.5 percent are more likely to refill their first prescription.CVS Caremark Enterprises Analytics, 2015 P1001570419. And for patients taking other medications to treat comorbidities, Specialty Connect lets them pick up all their medications — specialty and non-specialty — at one convenient location.

Want to learn more about how you can make it easier for your plan members to start and stay on therapy? Ask Us
BRIEFING
September 25, 2019
Executive Vice President, Specialty and PBM Product Innovation, CVS Health

Explore Programs

Specialty

Our integrated PBM and specialty pharmacy model helps lower medical and pharmacy costs, improve outcomes and create a better member experience.

Patient Care

Care for specialty patients is complex. A holistic approach helps ensure that patients have proactive clinical support as well as access to medication, helping to improve outcomes and lower costs.

Member Engagement

Our success in helping people on the path to better health depends on how well we engage members and encourage them to take the right steps.

Specialty Expedite is available exclusively for providers who use compatible EHR systems including Epic Systems and other EHRs that participate in the Carequality Interoperability Framework. All data sharing and usage complies with applicable privacy laws.

*Only patients who have opted in to receive digital communications will receive a welcome message.

**Where allowed by law. In-store pick up is currently not available in Oklahoma. Puerto Rico requires first-fill prescriptions to be transmitted directly to the dispensing specialty pharmacy. Products are dispensed by CVS Specialty and certain services are only accessed by calling CVS Specialty directly. Certain specialty medication may not qualify. Services are also available at Long’s Drugs locations.

Adherence results may vary based upon a variety of factors such as plan design, demographics and programs adopted by the plan. Client-specific modeling available upon request.

Image source: Licensed from Getty Images, 2019.

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