Pharmacy Advisor - Improving Pharmacy Care for Diabetes

Problem identification:

More than half of people diagnosed with a chronic disease, including diabetes, are either nonadherent to their prescribed medication therapy or have a gap in care - contributing $290 Billion in excess health care cost and utilization.  Pharmacists, who are generally viewed as knowledgeable and trustworthy and have the expertise to advise patients on their entire prescription regimen are in a good position to provide effective counseling that drives positive, sustained behavior change.

Objectives:

To manage costs, improve medication adherence and close gaps in care for Diabetes. CVS Caremark developed Pharmacy Advisor, an integrated approach to improve pharmacy care. To test the concept, CVS Caremark partnered with ArcelorMittal, the world's largest steel company in the U.S. where the company currently has approximately 80,000 employees and a diabetes prevalence rate of 13.7 percent. In addition to having diabetes prevalence of nearly twice the national average; 48 percent had at least one gap in therapy and one third were non-adherent to prescribed medications.

Solution:

      Right Medicine                                                Right Behavior

      Identify interventions & gaps through                 Identify the right message & method for  

      clinical intelligence                                          achieving behavior change

 

       Pharmacy Advisor

       Execute the interventions, engaging the member at the

       appropriate time and through the appropriate communication channel

To achieve the program's goals, Pharmacy Advisor identifies both members with sub-optimal pharmacy care as well as those at risk to become sub-optimal. Pharmacists trained in medication therapy counseling discuss opportunities with identified members during teachable moments when members are focused on their therapy.  Counseling takes place with a pharmacist according to the member's preferred communication channel which includes on the phone or face-to-face at a local CVS/pharmacy store.

Target audience:

Pharmacy Advisor is available to all eligible plan benefit sponsors, including employers, health plans and third-party administrators.  The program currently focuses on Diabetes and CVS Caremark plans to expand the program starting with cardiovascular conditions.

Results:

The six-month pilot of the Pharmacy Advisor program achieved significant improvements in closing gaps in care and increasing medication adherence rates compared to a control group:

- 59 percent higher gaps closed for phone-based counseling

- 91 percent higher gaps closed for face-to-face counseling

- Members in the pilot group averaged 16 more days on therapy across the targeted drug classes. Furthermore, first fill persistency rates improved 7 percent across the same.

- Health Care savings of nearly $1,700 annually per member with diabetes; approximately $1 million a year for a plan with 10,000 covered lives and a high prevalence rate.