CVS Launches Rheumatoid Arthritis Program to Improve Outcomes, Lower Costs

CVS Health recently launched the Transform Rheumatoid Arthritis Care program, which seeks to assist pharmacy benefit management (PBM) customers in managing the care and cost of treatment for patients with rheumatoid arthritis (RA), according to a press release.

The new RA program is the latest addition to CVS’ value-based management strategies, which also include outcomes-based contracting and an indication-based formulary for autoimmune diseases.

Due to high costs and utilization rates, RA drugs are considered a top driver of trend and spending, accounting for nearly half of specialty drug trend, according to the release.

The multi-pronged program includes a trend guarantee based on the ability to improve clinical outcomes and cost management, CVS reported.

"Rheumatoid arthritis is a complex condition and is one of the top drivers of specialty drug trend for our PBM clients," said Troyen A. Brennan, MD, executive vice president and chief medical officer of CVS Health. "By leveraging our integrated pharmacy care model, we can provide highly personalized, whole-patient support through our specialty pharmacy and embedded AccordantCare nurses, while harnessing the power of our PBM's tools to encourage appropriate use of and adherence to lower cost therapies."

CVS said that the Transform RA Care program aims to encourage the use of lower-cost treatments through pharmacy network, utilization management tools, outcomes-based contracts, and an indication-based formulary.

Under this model, manufacturers may have to provide additional value if a patient does not respond to therapy. The indication-based approach also guides formulary placement based on disease state rather than drug class, according to the release.

This approach is expected to help PBM clients better manage trend and receive a guarantee for the costly therapies, according to CVS.

Patients enrolled in the program will continue to receive personalized care from specially-trained pharmacists and Accordant nurses, according to the release.

CVS said that patients enrolled in Transform RA Care could expect to save up to 5% of their annual RA spending, which is significant.

"Treating rheumatoid arthritis costs the US health care system $19 billion a year. Both spend and trend have also been rising for the autoimmune category in recent years and market analysts expect this category to be the fastest-growing drug class over the next 5 years," said Alan Lotvin, MD, executive vice president of CVS Specialty, the specialty pharmacy of CVS Health. "Our program is unique in that we can pull together resources enabled by our integrated pharmacy care model to deliver both a truly member-focused clinical management program while also helping to manage the rising costs within the autoimmune category through new approaches to contracting and formulary management."CVS Health recently launched the Transform Rheumatoid Arthritis Care program, which seeks to assist pharmacy benefit management (PBM) customers in managing the care and cost of treatment for patients with rheumatoid arthritis (RA), according to a press release.

The new RA program is the latest addition to CVS’ value-based management strategies, which also include outcomes-based contracting and an indication-based formulary for autoimmune diseases.

Due to high costs and utilization rates, RA drugs are considered a top driver of trend and spending, accounting for nearly half of specialty drug trend, according to the release.

The multi-pronged program includes a trend guarantee based on the ability to improve clinical outcomes and cost management, CVS reported.

"Rheumatoid arthritis is a complex condition and is one of the top drivers of specialty drug trend for our PBM clients," said Troyen A. Brennan, MD, executive vice president and chief medical officer of CVS Health. "By leveraging our integrated pharmacy care model, we can provide highly personalized, whole-patient support through our specialty pharmacy and embedded AccordantCare nurses, while harnessing the power of our PBM's tools to encourage appropriate use of and adherence to lower cost therapies."

CVS said that the Transform RA Care program aims to encourage the use of lower-cost treatments through pharmacy network, utilization management tools, outcomes-based contracts, and an indication-based formulary.

Under this model, manufacturers may have to provide additional value if a patient does not respond to therapy. The indication-based approach also guides formulary placement based on disease state rather than drug class, according to the release.

This approach is expected to help PBM clients better manage trend and receive a guarantee for the costly therapies, according to CVS.

Patients enrolled in the program will continue to receive personalized care from specially-trained pharmacists and Accordant nurses, according to the release.

CVS said that patients enrolled in Transform RA Care could expect to save up to 5% of their annual RA spending, which is significant.

"Treating rheumatoid arthritis costs the US health care system $19 billion a year. Both spend and trend have also been rising for the autoimmune category in recent years and market analysts expect this category to be the fastest-growing drug class over the next 5 years," said Alan Lotvin, MD, executive vice president of CVS Specialty, the specialty pharmacy of CVS Health. "Our program is unique in that we can pull together resources enabled by our integrated pharmacy care model to deliver both a truly member-focused clinical management program while also helping to manage the rising costs within the autoimmune category through new approaches to contracting and formulary management."