CVS Revamps To Meet Specialty Medicine Needs

Dealing with cancer, MS, and rheumatoid arthritis is tough enough. CVS is making it easier for patients to get the specialized treatments they need. One of eight Elite 100 Business Innovation award winners.

Kelly Sheridan, Staff Editor, Dark Reading

April 28, 2015

5 Min Read
<p align="left">CVS Health CIO Stephen Gold</p>

The process of filling prescriptions at CVS seems simple enough: Walk in or call, drop off prescription, pick up later. But for a select population of CVS Health customers, a prescription pick-up is anything but easy.

Patients living with complex illnesses such as rheumatoid arthritis, multiple sclerosis, and cancer often face a frustrating process to get their medications. Enbrel, for example, is a popular drug for rheumatoid arthritis that requires refrigeration and is administered via injection. Avonex is an injectable specialty treatment for multiple sclerosis. 

The average corner pharmacy doesn't have sophisticated storage for these kinds of drugs, and it doesn't have a steady demand for specialty drugs to justify investing in the necessary equipment and processes. But with diagnoses of these conditions increasing, and the number of more specialized treatments growing, CVS set out to simplify the process of obtaining and using specialty medications.

"Specialty pharmaceuticals are the fastest-growing and most expensive segment of pharmacy care," says Stephen Gold, senior VP and CIO at CVS Health.

Before last year, CVS Health had a multitude of restrictions on how specialty drug customers could acquire their medications. If they wanted them delivered to their homes, they had to send a prescription via mail. If they wanted in-store pick-up, they had to visit their pharmacy. Medication procurement aside, these patients also had to balance the daily rituals of a complex illness, and hefty medical payments, along with their normal day-to-day routines. 

In April 2014, CVS Health launched an initiative called Specialty Connect to provide simpler ordering and delivery options to specialty drug customers. Through the program, patients can call and have medications waiting for them at the counter, or they can visit a pharmacy and opt to have medications delivered by mail.

"Now, what we allow is that flexibility and choice that aligns with the convenience and schedule of the patients' needs," Gold says.

Customers can also access a centralized group of clinical and insurance experts to guide them through the process of using and paying for medication. The in-store pharmacist they see on a regular basis may not be able to answer specialized questions, but that person can connect the patient to an expert from CVS' Pharmacy Benefit Management Group, who can provide counseling on medication use over the phone.

The system also allows for patient outreach in case of complications. Once patients obtain their medications, they might get a call from the specialty team to check on side effects or other problems. If a local pharmacist recognizes that a patient isn't renewing a prescription, the specialty team is alerted to take the steps to learn what went wrong.  

Three Barriers To Specialty Med Use

CVS Health is one of the largest suppliers of specialty medications in the world, and it created the Specialty Connect program to address three key challenges typical to specialty patient care.

Submission of prescription: Many pharmacies don't carry specialty medications because of low customer demand or a lack of capabilities to maintain storage requirements, especially refrigeration. This often leaves patients confused and dissatisfied; many leave without filling the prescription at all. With Specialty Connect, pharmacies that don't carry a specific medication can arrange to have it delivered to the store or a customer's home.

Access to experts: Patients often need help researching medications, getting insurance or reimbursement, and learning about the clinical aspects of care. A pharmacist who doesn't work with these medications regularly doesn't have the same level of expertise to answer these questions.  

Receiving medication: Because of the special handling and temperature requirements, patients must know how and when they'll receive their prescriptions in order to maintain the medication's integrity.

In starting its Specialty Connect program, CVS Health aimed to offer patients an omnichannel experience by simplifying interactions over the phone, in person, and online. It also wanted to provide more choice and flexibility in how patients fill prescriptions, help them get started on therapy, and offer support to accompany medication throughout treatment.

Integration was at the heart of the project, which began in 2013. Many of the required systems existed but operated in parallel. CVS had functional programs for customer care such as dispensing pharmacy medications and sending drugs through the mail, but these had to be reconfigured in order to work together for specialty medication customers.

When connected, the systems could better share customer information so that a pharmacist can send a prescription to patients' homes or recognize when they didn't renew.

Integration of multiple high-volume core systems posed a couple of major hurdles.

The first was changing the configuration of these systems without hurting current performance. For example, CVS Health uses a system that handles clinical evaluation, workflow, and claims adjudication in stores -- a critical system that it couldn't afford to shut down during this project.

In an effort to maintain data flow among its systems, the team built an enterprise services layer intended to better manage data throughout the enterprise by sending and receiving information from systems containing patient data. This platform is also designed to meet the integration needs of future projects, preparing the company for growth.

The second challenge involved teams working outside their comfort zones, in terms of technology and business units. The technical team was used to handling workflow, documentation, and standards within a particular line of business. The Specialty Connect project required multiple teams to collaborate on a variety of systems built on different tech platforms, which proved a challenge for developers.

Since its launch, Specialty Connect has served approximately 75,000 patients. Half opt to pick up their medication at retail stores, and 97% report satisfaction with the program.

As the healthcare industry changes, CVS Health knows its technology will be judged on how it helps patients improve their health.

"There are a lot of things going on in our industry, and the pace of those changes is the fastest we've ever seen," says Gold. "What you're going to see is continued focus on the individual, enriching that experience, bringing things to customers that are more relevant to them, and helping them with the tools that improve their overall health." 

About the Author(s)

Kelly Sheridan

Staff Editor, Dark Reading

Kelly Sheridan is the Staff Editor at Dark Reading, where she focuses on cybersecurity news and analysis. She is a business technology journalist who previously reported for InformationWeek, where she covered Microsoft, and Insurance & Technology, where she covered financial services. Sheridan earned her BA in English at Villanova University. You can follow her on Twitter @kellymsheridan.

Never Miss a Beat: Get a snapshot of the issues affecting the IT industry straight to your inbox.

You May Also Like

More Insights