CVS Health’s Prem Shah Talks Specialty Pharmacy During COVID-19

Specialty pharmacy was undergoing dynamic change before coronavirus disease 2019 (COVID-19), and the pandemic has accelerated opportunities for innovation in this area of healthcare delivery. For insights on how COVID-19 has affected specialty pharmacy, Managed Healthcare Executive® (MHE) turned to Prem Shah, PharmD, executive vice president, Specialty and Product Innovation, CVS Health, who has responsibility for specialty pharmacy strategy, including opportunities for growth and innovation.

MHE: How has the pandemic affected the prior approval process in specialty pharmacy?

Shah: We know getting patients their medications faster can have a positive impact on health, and CVS Specialty was already investing in digital tools to streamline the prior authorization request process and expedite onboarding for patients. When the COVID-19 pandemic hit, we had the foundation in place to minimize disruption and help patients get treatment more quickly using our automated process, which securely gathers appropriate patient information like insurance details, lab results and diagnostic codes through a doctor’s electronic health system.

MHE: How is the digital prescription process changing the pharmacy process?

Shah: Many specialty patients are particularly vulnerable to COVID-19, so it is critical to offer flexible options that ensure safe access to medications. Through CVS Specialty, patients can receive real-time updates on their prescription status and delivery over text or email, enabling them to stay safely at home and continue their treatment regimen. Even though the traditional process of going to the pharmacy might have changed, we still prioritize the patient experience by offering specialty patients digital access to their care team in real time, much like the consultation they would have in person with their pharmacist or nurse.

MHE: Are more patients using home delivery to fill prescriptions? How do pharmacists address the need for patient instructions? Do patients pay before the drug is delivered?

Shah: Yes, we saw an increase in both Specialty and standard mail-order prescription delivery over and above what we expected this year. We enhanced both our Pharmacy Advisor program for pharmacy benefit management clients and our CVS Specialty secure messaging platform to support patients/members requiring specific instructions or consultation during this unprecedented time. In terms of payment, patients have the option to securely save their information with a pharmacy team member to reduce contact and make processing future payments faster. All of these efforts aim to ensure continuity of care, medication adherence and condition management, while keeping patients safe at home.

MHE: When the pandemic began, there were predictions of a shift to greater use of oral oncolytics vs infusion to avoid visits to infusion centers where possible. Have you seen this? Is there an impact on cost? Is there an impact on cost-sharing and/or medication adherence?

Shah: There has been a shift towards greater use of oral cancer therapies, but this is mainly a result of the chemotherapy pipeline having primarily oral therapies in development. There is little effect on cost, as route of administration is not what drives cost. New therapies are commonly at or near $100,000 for a treatment, regardless of route of administration, and cost-sharing is dependent on a particular member’s benefit design.

MHE: Have there been noticeable shifts in medication adherence or prescription abandonment at the counter since the pandemic began? How have pharmacies worked to avoid this?

Shah: Initially, we made sure that patients had more information. With our digital tools, we were able to provide guidance on staying healthy while taking a specialty medication, and just as important, to connect patients with specially trained nurses and pharmacists. In fact, at the click of a button we were able to message patients proactively to contact us with any questions. This helped patients continue to use their specialty medication as prescribed.

CVS Specialty warehouses and storage had sufficient medication in inventory to support dispensing medications. As soon as it was issued, we complied with CDC guidance for medication on hand to ensure patients did not experience gaps in therapy. At the same time, our intelligent medication monitoring helps ensure patients do not accumulate too much medication (stockpiling). Overall, we did not see that adherence was impacted.

Affordability is a challenge that is even more prevalent during this pandemic. Our everyday activities include educating patients about available resources to support affording their medication. We offer assistance to our patients, including use of copay cards and companies like Prudent Rx to help patients pay for their medications.

MHE: What shifts in prescription drug plans or formularies are notable as patients sign up for ACA open enrollment?

Shah: Overall, we see a continued movement towards benefit designs to drive cost savings, and the financial stress created by the COVID-19 pandemic has further accelerated plans considering ways to further reduce cost. We have responded with continued changes in our formularies to create savings through generics, biosimilars where appropriate, and preferred brands. We have also evolved our utilization management approaches to address the wave of rising utilization seen in costly specialty classes.

MHE: Are more employers and health plans expressing interest in biosimilars? Any particular drug classes?

Shah: The rise in utilization of high-cost specialty medications in recent years was already challenging employers and health plan sponsors before the pandemic. With more biosimilars coming to market, we’ll see an increase in competition within the therapeutic category and a greater opportunity for significant patient and payor savings.

This has led to an increased interest in biosimilars from health plans, particularly for therapeutic classes like oncologic treatments used for certain cancers. Since CVS Health first added a biosimilar to the formulary plan design back in 2017, we have continually monitored the pipeline, reviewed all new drugs and evolved our formulary strategies to keep pace with the changing market. In fact, in July, we expanded our in-market medical rebates program to now include 23 classes.

MHE: How is CVS preparing for availability of the COVID-19 vaccine?

Shah: We are proud to have been chosen to administer COVID-19 vaccines for long-term care facilities and are prepared to play a prominent role in COVID-19 vaccination efforts by offering FDA-authorized COVID-19 vaccinations when available to the general public.

Our army of health care professionals—pharmacists, nurse practitioners and licensed pharmacy technicians—have significant experience administering vaccines and are looking forward to being part of the solution. This year we’ll administer nearly 20 million flu shots, which is more than double our 2019 total. We’re already running flu clinics in thousands of long-term care facilities, which means our health care professionals are very familiar with this population.

When we receive the green light for administering vaccines in a retail setting, we’ll apply learnings from our massive COVID-19 testing operation, including safety measures and cleaning protocols and providing a seamless digital experience that will allow people to book their appointments and, in the case of five of the six vaccine candidates, schedule a follow-up booster shot as well.