Prescription medicine helps sick people get better, but despite that an alarming percentage of patients do not take their medications as directed by their doctors. Research shows that 25 percent of patients who have been prescribed medications for a new illness fail to fill their initial prescription. Half of patients taking maintenance medications for a chronic disease stop taking their medications within a year of starting therapy. This non-adherence to essential medications is a frequent cause of preventable hospitalizations and patient illness, costing the U.S. health care system an estimated $300 billion annually.
As a pharmacy innovation company that is reinventing pharmacy for better health, CVS Caremark is examining why patients act the way they do when it comes to taking, or not taking, medicine. To do this, we launched a research collaboration with Harvard University and Brigham and Women’s Hospital in 2009.
CVS Caremark has also established a Behavioral Change Research Partnership, which has enlisted behavioral scientists and economists from Carnegie Mellon University, Dartmouth College’s Tuck School of Business and the University of Pennsylvania’s Medical School and Wharton School of Business. Through these collaborations, we are advancing adherence and expanding the science of pharmacy care. We are engaging patients by providing information to help them make more appropriate decisions about their health. We are educating patients, physicians and the public about the importance of staying adherent. We are engaging policy leaders in discussions about the importance of pharmacy care as a strategic health care improvement tool and have conducted an informational campaign directed to policymakers on this issue. We are also conducting a public education campaign that began in May 2011 with a forum on medication adherence at the National Press Club in Washington, D.C. and included the publication of compendiums of our research in May 2011 and March 2012.
Our research agenda has resulted in 20 peer-reviewed publications including studies about:
- the financial impact of adherence and how the use of cost-effective medications can impact behavior;
- contributing factors to medication adherence;
- the role and impact of health care professionals on adherence; and
- the role and impact of technology on adherence.
In addition, in March 2012, we published the State of the States: Adherence Report, a first-of-its-kind study that looks at how patients in all 50 states are complying with their doctors’ orders about taking medication. This review of CVS Caremark’s pharmacy benefit management claims data focused on four common disease states – hypertension, high cholesterol, diabetes and depression – that make up a large portion of what health plan sponsors spend for prescription medications.
We plan to share the State of the States: Adherence Report with state and regional officials and policy makers in all states. We hope by convening these discussions around adherence we can urge policy makers to make the goal of improving medication adherence a national priority.
Our medication adherence research has been essential in the development of our Pharmacy Care Economic Model (PCEM) that pinpoints the potential cost savings health plans can achieve by adopting programs that improve medication adherence. The CVS Caremark PCEM outlines savings in excess of $50 million in medical care cost avoidance and increased productivity for businesses with 100,000 health plan members.
The information we have assembled will help us drive innovation, further defining how we deliver patient care in the future.
Improving Adherence Through Pharmacy Advisor® and Maintenance Choice®
Pharmacy Advisor is CVS Caremark’s unique approach to help patients with chronic conditions achieve better health outcomes by promoting improved medication adherence and closing gaps in care. Through the program, CVS Caremark engages pharmacy benefit management plan members face-to-face at CVS/pharmacy or by phone when they fill prescriptions through CVS Caremark’s mail service pharmacy.
CVS Caremark launched Pharmacy Advisor for diabetes in early 2011 and early metrics show very promising and positive behavior change. For example, we saw a 7.6 percent decrease in prevalence of gaps in medication therapy in the Pharmacy Advisor program group as compared to a 3.2 percent increase in the control population. Additionally, we saw a 19 percent decrease in first fill drop-off percent for diabetes medications. By the end of the year, 640 clients representing 12.2 million lives had implemented one-on-one outreach for plan members with diabetes through Pharmacy Advisor. More than 700,000 members were contacted by the program and 1.6 million clinical interventions were delivered, including 1.2 million live interventions.
The Pharmacy Advisor program was recognized by the Pharmacy Benefit Management Institute (PBMI) with the 2011 Rx Benefit Innovation Award and by URAC for Best Practices in Health Care Consumer Empowerment and Protection. An independent, nonprofit organization, URAC is a leader in promoting health-care quality through accreditation and certification programs.
In 2012, Pharmacy Advisor will begin addressing chronic cardiovascular care, which will initially focus on improving medication adherence for four conditions: high blood pressure, high cholesterol, coronary artery disease and congestive heart failure.
CVS Caremark’s Maintenance Choice program is another example of the company’s commitment to providing quality pharmacy health care that is more convenient, accessible and affordable. The program gives eligible pharmacy benefit management plan members the option of picking up their 90-day maintenance prescriptions at CVS/pharmacy locations rather than receiving them through the mail. Plan members who use the program say they consider it to be a benefit enhancement and CVS Caremark data shows that for members who are new to therapy, 30 percent more stayed on therapy after 180 days in the Maintenance Choice program versus traditional prescription mail order programs. Approximately 10 million CVS Caremark plan members were enrolled in Maintenance Choice as of early 2012.
Patient Care Initiatives Driving Better Health Outcomes
CVS/pharmacy has also introduced a number of unique patient care programs to improve medication adherence in retail pharmacy patients. These initiatives help people on their path to better health and improve pharmacy service. Care 1on1™, introduced in 2011, offers CVS/pharmacy patients dedicated one-on-one time with a pharmacist to discuss savings, safety and side effects when their prescription for a maintenance medication is transferred or filled for the first time. Additional programs include first fill counseling, adherence outreach, refill reminders and ReadyFill®.
More than 150 million patient interventions have been conducted through these programs since 2008, including 60 million in 2011 alone.