High-touch, whole patient care for PAH
Maximizing quality of life through holistic care and comprehensive management
Daniel Knecht, MD, MBA, Vice President & Chief Clinical Innovation Officer
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 $2,200 to $9,300 per month - significant pharmacy costs are driven by high drug utilization.1 Further, combination therapy for PAH is quite common: 46 percent of PAH patients are on dual and 9 percent are on triple therapy regimens.2 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 providers. 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 provider 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 provider 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.
Assess
Complete patient assessment
Home environment for safety
Patient and caregiver technique
Home medication profile
Educate
Drug therapy
Injection site therapy
Identification and management of adverse events
Patient and caregiver technique
Home medication profile
Review
Medication orders
Medication and supply expiration dating
Prescription label
Supply inventory
24/7 on-call support
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, digital tools such as secure two-way messaging and peer support through the MyPHTeam social network — whenever they need. CVS Specialty ongoing support for PAH includes:
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.
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.
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 provider for intervention. Provider interventions include dose adjustments, the addition of an additional medication from another class, or a follow-up visit. Ongoing communication with the provider and our pharmacy staff allows us to help ensure timely responses to worsening PAH symptoms. Many PAH therapies have REMS requirements, and our pharmacists are experts on those.**
Digital connectivity not only facilitates efficient referrals, it also plays a key role in PAH care management. Our digital programs offer additional support to our patients with medication therapy management support messages, adherence reminders and side effect support, along with refill reminders and order status messaging. Our digital solutions offer patients a choice of communication methods: text, email or postal mail.
94+% of PAH patients are opted into digital messaging
Our model helps ensure appropriateness of medication regimens and provides in-depth counseling and adherence support to create better outcomes.
Community resources change frequently. That’s why, five years ago, we created a new patient advocacy role to keep up with the shifting landscape and to focus on sharing information and resources with patients, caregivers and providers. This patient advocacy function is a key differentiator of CVS Specialty and completes the wrap-around care that we provide.
Our national liaison helps to connect new PAH patients with community resources, educational materials, support groups, financial assistance and digital tools. A key part of that role is fielding questions and managing deadlines for applications for foundation support, some of which are open only for a matter of hours. That person also is available to answer questions, connect nurses with support groups, open cases for resolution with the pharmacy team and many other tasks to help patients and their families navigate a new diagnosis of PAH.
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.
Our pharmacy care model — the hallmark of CVS Specialty — can help manage a rare and complex condition like PAH by providing holistic patient care.
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1. Sikirica M, Iorga SR, Bancroft T, Potash J. The economic burden of pulmonary arterial hypertension (PAH) in the US on payers and patients. BMC Health Serv Res. 2014;14:676. Published 2014 Dec 24. doi:10.1186/s12913-014-0676-0
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2. Highland KB, Hughes KE, Williams KJ, Kyei-Baffour B, Ferguson S. Ensuring appropriate access to pulmonary arterial hypertension therapy. Am J Manag Care. 2019;25:S119-S127
*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.
**Risk Evaluation and Mitigation Strategy, a formal plan required by the U.S. Food and Drug Administration to ensure that the benefits of certain drugs outweigh their risks. REMS include patient and provider information and elements to assure safe use.
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