High-Touch, Whole Patient Care for PAH

BRIEFING
May 31, 2018
Executive Vice President, Chief Medical Officer, CVS Health

Pulmonary arterial hypertension (PAH) is a rare, life-threatening disease in which the blood vessels in the lungs thicken, making it difficult for blood to flow through the lungs. PAH makes it challenging for patients to obtain enough oxygen and ultimately exhausts the heart. PAH is treatable, though not currently curable. But it is difficult — and expensive — to manage.

The cost of treating PAH can average between $100,000 and $200,000 a year, and roughly 40 percent of that is for medications, according to one recent study.https://www.ahip.org/wp-content/uploads/2016/04/HighPriceDrugsReport.pdf.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301626/. Several PAH-specific drugs rank among the world’s costliest medications. Drugs like these require careful management. CVS Caremark has a range of solutions to help payors manage cost, including the Advanced Control Specialty Formulary and utilization management strategies that help ensure the right patient gets the right drug at the right time. We also closely monitor the drug pipeline to help payors make informed decisions about coverage for upcoming new drugs, and stay ahead of changes in the marketplace.

To help ensure the longest survival and best possible quality of life, plan members need holistic care and comprehensive management at the therapy level.

The core of our model for managing care for members with PAH is our extensive clinical expertise and whole patient care. PAH severely limits physical activity, and even with treatment it can progress, necessitating careful observation of patients and adjustments of dosages or drugs. Many PAH medications, especially those typically used in the disease’s late stages, can be difficult to administer, with potentially severe side effects. Any abrupt interruption of therapy can also cause symptoms to grow much worse. To help ensure the longest survival rate possible with the best possible quality of life — and avoid the cost of unnecessary emergency department visits and hospital admissions for payors — members need holistic care and comprehensive management at the therapy level.

A Proactive, Team-Based Approach

At CVS Specialty, we take a proactive approach. We don’t wait for members to call for help. Instead, we reach out to members with PAH on a regular basis. We provide holistic care — including for members on prescriptions that do not require specialty pharmacy services — through our dedicated PAH CareTeam, and unique services like Specialty Connect and digital tools. Our focus is educating and counseling members and collaborating with prescribing physicians. This helps members minimize symptoms, manage comorbidities, increase functional capacity, and thus improve outcomes — while helping lower overall cost of treatment.

Our clinical and personal support begins when their physician sends a prescription to CVS Specialty or one of the CVS Pharmacy locations. Members receive support from a dedicated CareTeam consisting of a pharmacist, nurses (drawn from our team of more than 100 PAH nurses nationwide), patient service representatives, and intake coordinators. The CareTeam offers members 24/7 access to counseling and clinical support, and works with the prescribing physician to develop a customized care plan and an anticipated timeline for reaching treatment goals.

Dedicated CareTeam nurses have a series of meetings with members who are prescribed one of the more complex PAH therapies, typically in members’ homes to thoroughly prepare them to deal with the condition and their specific medication regimen. Topics include:

Checkmark In-depth PAH therapy and disease information, and educational materials
Checkmark Baseline clinical assessment
Checkmark Member-specific therapy goals
Checkmark Drug administration education for IV and inhaled therapies
Checkmark Self-titration and dosing regimen adherence
Checkmark Safety and drug-drug interaction review

Once the prescription is ready, our integrated model also makes it easy for members to receive their specialty drugs. With Specialty Connect, members can choose to pick up their medications at a CVS Pharmacy location or have them delivered to their home or office*, all while still receiving support from our trained clinicians. The goal is to create a more convenient, more flexible, and less complicated experience, leading to improved adherence and improved clinical outcomes.

Support for the Duration of Therapy

Self-care is a critical component of effective care management for a complex condition like PAH. Our PAH CareTeam has great depth of experience with this very rare disease. Our pharmacists and nurses can help improve member engagement, awareness, and adherence. Members also have access to additional support — including compliance reminders, 24/7 clinical support, and digital tools such as secure two-way messaging, and peer support through MyHealthTeam social networks — whenever they need. CVS Specialty ongoing support for PAH includes:

High-Touch, Whole Patient Care for PAH Accordion

Medication Optimization
We help address adherence challenges, such as side effects, safety monitoring, and potential drug...

We help address adherence challenges, such as side effects, safety monitoring, and potential drug interactions. Clinicians review risk factors to help ensure members are receiving optimal treatments and have appropriate drug supplies, support adherence, and mitigate clinical worsening and unexpected emergency care.

Care Optimization
Members receive help and advice on issues such as cost and transportation concerns. The PAH CareTeam...

Members receive help and advice on issues such as cost and transportation concerns. The PAH CareTeam can engage resource specialists including the CVS Health PAH patient advocate for assistance, when needed.

Management of Symptoms
Trained clinicians help members learn to effectively manage myriad symptoms including shortness of...

Trained clinicians help members learn to effectively manage myriad symptoms including shortness of breath, chest pain, and activity limitations, as well as medication side effects.

Clinical Intervention
We monitor members for their functional capacity, weight, symptoms, shortness of breath, and the emergence...

We monitor members for their functional capacity, weight, symptoms, shortness of breath, and the emergence of new symptoms. When a gap in care or an elevated risk of disease progression is identified, we conduct outreach to the physician for intervention. Physician interventions include dose adjustments, the addition of an additional medication from another class, or a follow-up visit. Ongoing communication with the physician and our pharmacy staff allows us to help ensure timely responses to worsening PAH symptoms.

Proven Clinical Success

To measure the impact of the CareTeam approach, CVS Health studied selected PAH patients to determine how their condition changed after clinical intervention. Additionally, the pharmacy team worked with prescribing physicians for 22 patients who required drug and dosage adjustments.

CareTeam Approach Maintained or improved their breathing capability Maintained or improved their symptom status
Following clinician interventions: 78% 85%
Following drug dosage adjustments: 77.3% 90.9%

From therapy initiation to ongoing care, we offer members with PAH support from specialized PAH clinicians to help ensure this unique patient population receives comprehensive care that maximizes functioning and quality of life, while identifying interventions to help manage treatment costs and improve outcomes.

Do you want to learn more about how to improve outcomes for your members with PAH? Ask Us
BRIEFING
May 31, 2018
Executive Vice President, Chief Medical Officer, CVS Health

Explore Programs

Specialty Cost Management

Specialty is growing and changing rapidly. Innovative strategies and active management can help plans anticipate trends and control spend.

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.

Improving Health

Optimizing prescription therapy is key to improving outcomes for chronic conditions that drive a majority of health care spend.
 

*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.

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

Image source: Licensed from Getty Images, 2018.