After the successful launch of its Pharmacy Advisor program for diabetes, CVS Caremark Corp. now is directing its adherence efforts toward patients managing chronic cardiovascular illnesses. The program will focus on boosting medication compliance for four conditions: high blood pressure, high cholesterol, coronary artery disease and congestive heart failure (CHF).

Such strategies are becoming more important for plan sponsors, particularly those that offer Medicare Advantage or Part D products, as CMS has more heavily weighted drug adherence measures in its quality ratings and bonus programs (see box, p. 3).

“Cardiovascular as a whole is a pretty large part of any client’s spend,” explains Bill Grambley, director of health services at CVS Caremark. “There are a lot of generics there, and cardiovascular is a condition set that is expanding. It is one where there are very real outcomes that we can impact with adherence interventions, and it’s one where there’s a very real connection to medical claims so that employers and health plans can avoid higher expense issues.” Grambley declines to disclose specific outcomes results, however, as the PBM will unveil those Dec. 20 at its annual investor day.

Through the initiative, CVS Caremark reaches out to members at risk of falling off their drug regimen via strategically timed face-to-face and phone interventions, depending on how they typically obtain their prescribed therapies (i.e., via a retail store or mail-order facility). This is not unlike the Pharmacy Advisor program targeted to diabetes, which CVS Caremark launched in January 2011 after a six-month pilot in 2009 with the 80,000-employee firm ArcelorMittal (DBN 3/8/11, p. 5). The difference here is that the PBM is reviewing pharmacy claims only to boost adherence, not to close gaps in care and improve compliance as was done for the diabetes program.

“With diabetes, the linkage between a specific group of therapies is very indicative of the condition. In essence, there are medicines to control blood sugar and with very few exceptions, people who use those are diabetic. With the cardiovascular conditions,” clarifies Grambley, “the linkage is not quite as specific for us to confidently identify a gap in care and allow us to discuss that gap with the member. A whole bunch of people could be on a statin but not qualify for a gap in care that would be indicated if we had medical data. There could be somebody who has the profile of a coronary artery disease patient but actually doesn’t have coronary artery disease; it just looks like it from our medications.”

As a result, the PBM looks at the medicines that are already on file for cardiovascular patients and identifies those who have a need for personal counseling. Triggers could be a person who is several weeks late in refilling a targeted therapy or a patient with one of the four conditions who is beginning a new targeted therapy.

Retail-Based Method Wins

In lieu of specific outcomes figures, Grambley offers the following general findings from both Pharmacy Advisor programs:

• Store-based interventions outperformed those conducted by the call center. There are a number of interventions that take place on the retail side, not all of them confined to the store. For instance, gaps-in-care interventions and first-fill counseling would occur at the store, but the retail pharmacist may make an outreach call for someone late in refilling a targeted script. “The fact that the person calling you is just three miles down the road helps with the conversation,” observes Grambley. “It’s not just a nameless, faceless person 1,000 miles away. It’s somebody that you would see if you walked into the store and could have that conversation with.”

Meanwhile, the call center has similar goals of improving adherence and gaps in care, but all of the interventions are done by phone. CVS Caremark has not directly measured the performance of a store-based call versus a call-center based call. Pilot data released by the company earlier this year showed that gaps in care were closed at rates bettering a control group by 59% for phone counseling and 91% for a face-to-face intervention.

• People tend to go back to their original behavior without interventions. Because there was a period of roughly seven months between the end of the ArcelorMittal pilot and the full launch of the program for diabetes, CVS Caremark was able to observe what happens over time when those “high-touch” interventions go away.

“For example, when somebody noticed they were two or three weeks late in refilling, they let it go for another two or three weeks until they remembered or happened to go to their doctor or some other trigger occurred, so it was pretty interesting to see that we had an impact. But if we stopped doing these things, over a period of time — it wasn’t immediate — the population tended to return to what it would have been doing without these interventions,” Grambley says.

Cardio Adherence Has High Savings Potential

CVS Caremark claims to have performed 1.7 million successful member interventions since last January and estimated earlier this year that it could save employers approximately $600 per year for each member with diabetes. The company would not disclose a similar savings estimate for the cardio program, citing plans to publish that data in the near future.

But a study conducted earlier this year by Aetna Inc., Harvard University and Brigham and Women’s Hospital found that patients with hypertension who followed their prescribed medication regimen saved nearly $4,000 per year, those with high cholesterol saved up to $1,200 per year, and CHF patients saved nearly $8,000 annually.

PBM Will Add More Conditions

Grambley explains that the cardiovascular initiative is a very natural extension of the diabetes program. “There are a lot of comorbidities between these [two conditions]; there’s obviously history that we can get from leveraging or reaching out on those cardiovascular therapies within the diabetes set. Within diabetes, there are specific therapies that are also used to treat cardiovascular conditions — ACE inhibitors, ARBs [angiotensin II receptor blockers], lipid control drugs — so we performed adherence interventions across those classes since we launched diabetes, and that gave us a good foundation on the cardiovascular side of what we would expect with those types of therapies.”

CVS Caremark now is enrolling clients, and would start serving cardiovascular patients in the spring. About nine to 12 months after that, predicts Grambley, the company plans to roll out Pharmacy Advisor for additional conditions.

The AIS E-Savings Club offers regular opportunities to buy AIS products and services at substantial savings. Click here to see the current specials — including an $80 discount on a one-year subscription to Drug Benefit News.