Adherence

Investing in adherence helps reduce overall health care costs and drive better health outcomes.

With an estimated annual cost of $290B, non-adherence is an expensive problem for the health care system. The reasons people stop taking their medicines are varied and complex, ranging from simple forgetfulness to complicated therapy regimens, from cost concerns to lack of pharmacy access.

Improving adherence can lead to better clinical outcomes and lower costs. Payors can support better adherence by building in benefit features that encourage the use of low-cost generics, 90-day prescriptions and automatic refills whether at mail or retail. CVS Health has a range of programs and services that offer personalized counseling and support for members managing chronic conditions to help drive even greater improvements in adherence. These programs leverage our multiple touch points and proprietary technology to identify opportunities and prompt interventions when members are thinking about their health.

Pharmacy Advisor Counseling

With Pharmacy Advisor, members can get one-on-one counseling from pharmacists either in-person at a CVS pharmacy location, or through our URAC-accredited call center. Trained pharmacists can help determine and address the root cause of member non-adherence. Our pharmacists utilize their medication management expertise and are trained in behavioral and motivational interviewing to help members start and stay on therapy. Targeted interventions through Pharmacy Advisor can deliver up to 10 percent greater adherence to hypertension medication, 9 percent for anti-diabetics, and 12 percent for cholesterol therapy.

Pharmacy Advisor results are enhanced by using predictive analytics applied to detailed member pharmacy data, which can help determine at what point in the treatment they may become non-adherent. This enables personalized interventions to be delivered at key points in therapy for that member and can yield savings of up to $4,000 per-member-per-year, by mitigating adverse health events resulting from the member not taking their medication.

Transform Care

Transform Care programs are highly targeted to address the needs of members managing specific conditions such as diabetes. Nearly 90 percent of members with diabetes have two or more comorbidities and take an average of 15 medications a day.3 Therapy complexity as a result of multiple prescriptions is a known risk factor for non-adherence. Transform Diabetes Care includes personalized pharmacist counseling and the support of a diabetes coach to help ensure members stay adherent to their treatment regimen.

Specialty CareTeam

Patients taking specialty medications also have complex care needs. Proactive support from our CareTeams has been shown to improve adherence for these patients by 11.4 percent and lower overall health care costs by 11 percent.

ScriptSync

ScriptSync, a CVS Pharmacy service, prepares patients’ eligible prescription medications so they’re ready for pick-up on the same day each month. Patients can also choose to receive a phone, email or text notification when their order is ready at their preferred CVS Pharmacy location. Since the launch of the program in 2015, nearly 1.5 million patients have enrolled. Among those patients there has been a 6 percentage-point lift in medication possession after enrollment.

Digital Tools

Promoting the use of digital tools to help manage prescriptions can also help boost adherence. Refill reminders and scan-to refill capabilities make it easier to have needed prescriptions on hand. Savings alerts and the ability to check drug costs can help address member cost concerns. CVS Health research shows that digitally engaged members are both more adherent and more satisfied. Payors can save up to $23 a year, from medical cost avoidance, per digitally engaged member.

Accessibility and Choice

Due to our integrated model, CVS Health is able to offer plans and members a unique degree of choice and accessibility, which have proven to help improve adherence as well. Our Maintenance Choice program allows members to fill 90-day prescriptions either through the mail service pharmacy or at their local CVS pharmacy at no additional cost. Research shows that members with Maintenance Choice were 30 percent more likely to achieve optimal adherence.

Specialty Connect offers members the option to drop-off or pick up specialty prescriptions at any one of more than 9,700 CVS Pharmacy locations, or choose to have medications sent to their home or office. Research shows that 96 percent of users value being able to choose how they obtain their medication and 17.5% are more likely to refill their first prescription. Regardless of where they access their medication, they always have access to comprehensive clinical support.

Considerations for your business
  • Do you know how well your member population adheres to prescribed therapies?
  • Are you doing the right things to improve member adherence?
  • Can investing in adherence help you meet your long-term financial goals?
Have a question about our Adherence programs?

Other Improving Health programs

Health Engagement Engine

Our Health Engagement Engine is a powerful clinical rules engine that integrates our enterprise assets, providing real-time, actionable health care information. It allows us to aggregate data from both internal and payor sources, and combine it with our clinical research to identify opportunities to improve adherence and close gaps in care. The engine helps us deliver proactive, targeted outreach to members at the right time through the right channel.

1. Association Among Change in Medical Costs, Level of Comorbidity, and Change in Adherence Behavior –AJMC, Aug. 2016. http://www.ajmc.com/journals/issue/2016/2016-vol22-n8/Association-Among-Change-in-Medical-Costs-Level-of-Comorbidity-and-Change-in-Adherence-Behavior#sthash.J2Pq3SJW.dpuf

2. CVS Health Enterprise Analytics 2012-2013; Evaluating the Impact of Pharmacy Advisor on Adherence and Gaps in Care. Results are based on PBM client member populations. Results may differ depending on the specific line of business and for non-PBM member populations. Data is only shared in accordance with the law and our agreements with our PBM clients that elect health engagement messaging.

3. Medication Management Systems: Comorbidities and Drug Therapy Problems in Patients with Diabetes

Unless otherwise noted, all data is from CVS Health Enterprise Analytics. 

Savings and clinical results will vary by client depending on member demographics and other factors. Client-specific modeling available upon request.

Programs mentioned here may not be available for all plans.