Evolving Pharmacy Advisor

Significantly More Adherence Support for High-Risk Members

July 1, 2020
Executive Vice President & Chief Medical Officer, CVS Health

Since its inception in 2011, Pharmacy Advisor has provided more than 54 million adherence interventions to plan members. Among clients enrolled in the program for two years, nearly four percent more members achieved optimal adherence compared to clients who did not adopt it. Optimal adherence — considered to be at least 80 percent — is the level needed for the therapy to be most effective.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6789652/. Accessed 6/26/20.

Pharmacy Advisor addresses

10 chronic

That affect

1 in 4

Pharmacy Advisor addresses 10 chronic conditions, that affect 1 in 4 members

While “take your medicine” may seem simple, it’s estimated that adherence to chronic medications is stalled at around 50 percent in the United States.https://www.ncbi.nlm.nih.gov/pubmed/22964778. Research has repeatedly shown that not only are the reasons for non-adherence plentiful, they can also be complex and vary by individual. It’s not a simple matter to solve.

At CVS Health, we believe that a new transformative approach is needed to help people with chronic conditions, and better adherence is foundational to such a transformation. It’s one of the most effective ways of improving management of conditions like diabetes, hypertension and depression. As an organization, we have been studying adherence and patterns of prescription utilization for more than a decade. With more than 9,900 pharmacies and more than a billion prescriptions filled each year, CVS Health is uniquely equipped to understand barriers to adherence and how to help. Analysis of published, peer-reviewed medical literature indicates that helping even one member achieve optimal adherence can save more than $1,000 per year by reducing downstream medical costs and increasing productivity.

Significant Annual Savings from Each Optimally Adherent Member

As part of our Transform Chronic Care suite of programs, we have further evolved Pharmacy Advisor for even greater impact:

Checkmark Increased use of advanced analytics to help anticipate and understand risks and barriers to adherence
Checkmark Intensified outreach to high-risk members to make counseling more effective

Real-Time Member View

The personalized care plan that guides Pharmacy Advisor counseling is based on the individual member’s pharmacy claims, demographic information, and engagement history. Member data is continually updated to reflect current prescription activity and interventions. Our analytic engine sorts and organizes the data to generate individualized insights, assessing the member’s risk for non-adherence and negative health outcomes. Based on this information, the engine prioritizes the member’s next best action to maintain prescription adherence and lower the risk of adverse events.

Intensified Support for High-Risk Members

Workflow and scheduling have been reconfigured to prioritize time for counseling in the pharmacy. Register prompts alert the pharmacy staff when a member scheduled for counseling is picking up a prescription. We’ve also incorporated a best-in-class documentation system to support the real-time member view and ensure continuity. Our goal is to build an ongoing relationship of trust between member and pharmacist.

Members identified as high-risk are enrolled in Pharmacist Panel, where they receive ongoing one-on-one support from specially trained pharmacists, either at their CVS Pharmacy or telephonically. To ensure that counseling is optimally effective, pharmacists receive in-person and online training that addresses both clinical and behavioral factors. Individualized interventions provided by the pharmacists are based on the member’s personalized care plan and designed to uncover and resolve adherence obstacles. Pharmacists use motivational interviewing and clinical knowledge to counsel the member and discuss adherence support tools such as prescription synchronization, 90-day supplies, and ScriptSmart dosing schedules, all of which can address some of the most common adherence hurdles members experience.

Member data is reviewed regularly to identify counseling opportunities, which are incorporated into the pharmacist’s schedule. The system prompts telephonic outreach and can anticipate when a member may be visiting the store to pick up a refill. In either case, the pharmacist reviews the member’s open opportunities and their interaction history in advance to prepare to address that individual’s next best action.

Optimized Outreach

Member engagement histories show that individuals have communication preferences and may respond differently depending on how a message is delivered. That’s why Pharmacy Advisor employs multiple communication channels, including face-to-face at CVS Pharmacy and more than 56,000 participating pharmacies, telephonically through our URAC-accredited call centers, and by text, email, and interactive voice response. Multiple channels also enable appropriate timing of the message. For example, members with a new prescription receive in-person first-fill counseling at CVS Pharmacy locations to ensure they understand why they’ve been prescribed a medication, and how and when to take it. This is more than a standard “offer to counsel” — it’s a proactive, personalized, pharmacist-initiated discussion to help a member stay adherent. If a member is late in refilling a prescription, we can call or send a text reminder, based on their communication preferences, reaching them wherever they are.

Guaranteed ROI

Pharmacy Advisor is one of three Transform Chronic Care programs. The suite also includes Health Advisor and Transform Diabetes Care, both of which build upon Pharmacy Advisor by incorporating medical and lab data to drive deeper advanced analytics for intervention targeting. One-on-one engagement for high-risk members is driven through Pharmacist Panel for all three programs.

Expected results include adherence improvements, positive behavior change, and better outcomes.

In line with our commitment to bring transformative change to health care in the U.S., CVS Health is guaranteeing a 2:1 return on investment (ROI) for clients who implement one Transform Chronic Care program, with incremental ROI for opting in to additional programs.

Do you have any questions about optimizing member adherence and potential savings? Ask Us
July 1, 2020
Executive Vice President & Chief Medical Officer, CVS Health

Conditions for 2:1 ROI guarantee apply. May not be available in all states or for all lines of business; subject to applicable state law.

Data source, unless noted otherwise, CVS Health Enterprise Analytics, 2020.

CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall.

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Image source: Licensed from Getty Images, 2020.

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