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.
The enhanced CVS Specialty model provides a comprehensive view of patients with complex care needs and offers unmatched network access, proactive care management, complete infusion care, and connected digital tools. Our integrated pharmacy benefit management (PBM), specialty, and retail pharmacy model offers patients greater convenience and support by moving beyond the traditional standalone specialty model to address the challenges of patient care. Members can access their medications where they prefer without giving up the comprehensive clinical support they need from our specialized pharmacists and nurses dedicated to specific conditions.
Unmatched Access
Specialty Connect offers members convenient access to specialty pharmacy services. Patients can drop-off or pick up specialty prescriptions at any one of more than 9,700 CVS Pharmacy locations, or choose to have medications delivered by mail to their home or a location of their choosing. They can also change their preferred delivery/pick-up location temporarily if traveling and as frequently as needed. Research shows that 96 percent of users value being able to choose how they obtain their medication and 17.5 percent are more likely to refill their first prescription. Regardless of where they obtain their medication, they receive comprehensive clinical support.** Members can also synchronize all of their non-specialty prescriptions for pick up on the same day, which can help provide extra support to the five out of six specialty patients who also take non-specialty medications.** Members using prescription synchronization have average adherence of greater than 80 percent.
Proactive Care Management
Each specialty patient’s needs are unique and they change throughout their health care journey. More than 300 specially trained rare disease nurses embedded within a multi-disciplinary CareTeam provide holistic care and proactive support to help members manage their condition better and improve health outcomes. Many nurses have more than 20 years of experience in managing patients with rare conditions and can help address key issues including comorbidity and side-effect management, and assess and address any potential gaps in care. Patients with access to CVS Specialty pharmacy and care management saw an average of 5 percentage point increase in medication possession ratio (MPR) compared to those using a retail pharmacy only.
We also utilize Epic, one of the largest electronic health records vendors in the industry, to help improve connectivity with health systems and providers.
Complete Infusion Care
More than 800 nurses, many with over 30 years of experience, help 75,000 patients annually manage complex, high-cost infusion therapy with safe, convenient access to infused therapies at home, or at Joint Commission-accredited infusion sites. Patients on our services have an all-cause hospital readmission rate of less than 5 percent.
Connected Digital Tools
Innovative digital tools provide a more accessible, connected, and personal health experience. Members can manage all their specialty medications in real-time using the CVS Specialty app and more than 60 percent have opted in to receive email and text messages including refill reminders and order status. The app offers added convenience and adherence support with features such as scan to refill and medication reminders. The Integrated Customer Experience dashboard allows members to manage all specialty and non-specialty medications round-the-clock including changing pick-up and delivery location. Patients can also use secure messaging to contact their CareTeam with any questions. Our social network, MyHealth Teams, enables members to connect with other patients with the same chronic condition.***
Digitally engaged users had a 2.4 percent lower drop-off rate, 3.5 fewer gap days on refill and 3 percent higher MPR after six months.
- How are you identifying which members may need additional clinical support?
- Do your members have the right support to improve clinical outcomes, cost savings and satisfaction?
- Could refining your patient care strategy lead to greater cost savings?
Other Specialty programs
Medical Benefit Management
Spend under the medical benefit comprises half of specialty spend for payors. Our differentiated solutions, including automated prior authorization across benefits, site of care optimization and claims editing help enable payors to view and control specialty costs under the medical benefit effectively.
Specialty Cost Management
The rapid growth of specialty spend requires an active and innovative approach to manage costs effectively. Our integrated model provides comprehensive management strategies to help manage spend, while ensuring quality of care, regardless of benefit. We offer a broad set of proven capabilities including formulary solutions, managed network strategies, and utilization management through specialty guideline management.
* 11% reduction in total health care costs for managed conditions
** Where allowed by law. In-store pick up is currently not available in Oklahoma and West Virginia. Some states require 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. Patients have the freedom to select the pharmacy of their choice. Eligible prescriptions are 30-day medications taken on a regular basis.
*** CVS Health is an investor in MyHealth Teams. CVS Health and MyHealth Teams have partnered to offer additional help and support to those living with many chronic conditions.
Unless otherwise noted, all data is from CVS Health Enterprise Analytics.
Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan.
CVS Health uses and shares data as allowed by applicable law, our agreement and our information firewall.