Key stakeholders in the health care industry gathered to discuss prevalent topics at this year's Asembia annual summit. Medication adherence emerged as one of the most talked-about issues. In a session led by Lucille Accetta, PharmD, MBA, MSPH, senior vice president of CVS Specialty Operations, the audience gained fresh insights into combating nonadherence and learned new strategies to improve patient care.

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Dr Lucille Accetta: I'm Lucille Accetta. I'm [the] senior vice president of CVS Specialty Operations. I work for CVS Health. I'm a pharmacist by training. I also have a master’s in health policy and management and an MBA from Fordham University. I oversee all the specialty pharmacy operations across CVS Health.

That includes our mail facilities, our pharmacy retail facilities that handle specialty medication, as well as our infusion medications that nurses handle in the home.

What are the primary challenges patients encounter when attempting to understand and adhere to their medication regimens?

Dr Accetta: I would place the challenges that patients face, especially with specialty medications–I call them the ABCs, A, affordability. They're usually very expensive, out-of pocket co-pays, B is the basics. Really understanding their diagnosis. Fifty percent of the time when a patient leaves the doctor's office, they don't remember what was told to them.

And then also the basics around the medication that they've been prescribed because that's really important. And then I would call the C as continuing—that's adherence, [eg] staying on the medication. That's a large part of how we as a specialty pharmacy, especially CVS, really drive with the nearly 2 million patients that we service, trying to make sure that the patient understands their diagnosis, understands their medication, how to take it, side effects, ways to manage the day-to-ay or weekly and monthly utilization of the medication and to stay on it.

Then we look at the challenges that they face with the different channels of communication. Starting on these medications [is not] always very easy. You need to go through some therapy, some testing, [and] some documentation of the outcome of the testing to be able to be placed on these drugs [to] really understand how to take them. Majority of them are injectables. Some of them are orals. Some of them are required to be refrigerated at certain temperatures, shipped in certain temperature-sensitive packaging. So, a lot of it is very complicated. Some of these medications show up with tubing, needles, syringes, so explaining the entire process to them is not as simple as just picking up a prescription at your local pharmacy.

And then lastly, it's the affordability part, and what we try to do is to help them understand if a generic is available, their co-pay structure [and/or] their out-of-pocket falls on their pharmacy benefit. Sometimes it falls on their medical benefit. There's a different out-of-pocket fee for that, so just trying to help patients understand on top of that, helping them with co-pay assistance. And if there are any external foundational support that we can get through various organizations that support many disease states.

All of these complexities and challenges are what we're all about. And what we try to do is really work with the prescriber in getting the process started as easily as possible, which I think electronic health records have allowed us to do very, very well. So, that's probably the major parts of getting started and keeping on it.

We have over, I would say at CVS Health, 95% of our patients are digitally engaged with us. Originally in specialty pharmacy, you pretty much talk to patients either over the phone or possibly face to face. Nowadays, patients have become very savvy in wanting to interact with us digitally.

We have secure messaging that goes back and forth with our clinicians. And we have found that patients tell us more about their symptoms, how they're feeling, their side effects, [and] how they're managing through chat and through digital interaction. So, we're open to whatever channel the patient prefers.

But I think we're seeing a very savvy electronic patient nowadays. Our prescribers are very much wanting us to interact with them through their electronic health system and their EMR. And we're able to help them as well reduce the administrative burden on their office by interacting with them on the digital platform that they have in their office.

So that helps on filling out the prior authorization, knowing how the patient is progressing, looking for any side effects. So, I feel like this whole world in the electronic process is making it easier for the prescriber, but also for the patient. We're finding that patients want more on the digital platform. Certain drugs are sometimes a little bit more challenging to do digitally, but the majority of them we're finding can get through a digital asset pretty well, and we call it “all the way to checkout,” which is really a positive experience for members and patients.

What strategies do you recommend for health care professionals to effectively support patients who are starting a new medication regimen, ensuring that the information is communicated ina way that is easily understood by the patient?

Dr Accetta: I look at it twofold. First, it's the provider. At the point of, I'll call “with the click on the EMR,” there's something called real-time benefits that is offered to doctors through their system that we offer as well as CVS to tell them what is the right therapy for that particular drug that that doctor wants to prescribe.

It'll give them the preferred formulary drugs. They'll tell them potentially how costly those drugs will be for that patient. So, kind of leveraging all the tools available to prescribers on that really first time writing of the medication.

And then if you think about it, the ability to then take the information that's in their EMR to reduce the administrative burden on the team. Almost nearly all, and I'm going to say not 100%, but nearly all of specialty medications do at times require a prior authorization to start. And that requires some clinical data, either labs or certain types of tests that we need to validate to allow the drug to go through a prior authorization of benefit verification.

And we have visibility pretty much to more than 80% of the prescriptions that we have. We can actually get into the EHR to helps that prescriber reduce the administrative burden. So, trying to manage this burden on doctors is really our preferred behind-the-scenes way of helping them. And then if you look at the patient's perspective, it's when they're new to therapy is [where] we're looking to create these moments where we're connecting with them right at the start. [We have] your [prescription], we understand that it has to go through a prior authorization. Let me tell you where it is in the process.

I'm trying to give them as much information as we can so that they know that we're taking care of them through all the points that [they] have to go through in a prescription process. We have what we call a “first fill tracker,” so we track all the fills. They can look at when it's being delivered, they can connect with us to have those clinical interactions with our pharmacists, [and] with our clinical nurses.

And we always want to be messaging them as well throughout their therapy. So, it's not a one and done, it's a continuation of each of the fills. We know for certain drugs, we want to contact them at day 7 of the therapy or at day 10, because we know that they might be experiencing a side effect.

We want to know how they're doing. We don't want people to be on therapy that they can't take, so we'll follow up with their doctor. All of our interventions are responsible pharmacists to our patients care.

Would you agree that preplanning can contribute to medication adherence?

Dr Accetta: [There is a lot] of pre-planning and a lot of tech involved, and each drug is different. [For] some, it's the first week [or] it's the first month. We work very closely and personalize some of those interactions so that we know, [for example], Lucille is maybe going refill a little later. Do we ping her? She [has] to stay on track versus maybe an Emily who's always early, and may be stockpiling. We don't want her to do that. We know, based on a lot of data, how we're managing our patients through their product and through their therapy care.

What were the main insights or highlights from your Asembia session that could significantly enhance patient medication adherence?

Dr Accetta: Well, first, we kicked off the Asembia session with this incredible video of a patient [on a specialty medication], which really brought to life in the room. [Specifically], what it's like to be a patient on a specialty medication and the importance of the connectivity to your caregivers, as well as your pharmacy team. And that can be your nurse, your pharmacist, and it could be even a customer service rep who you're reaching out to to refill your medication or ask a question. We found that the video really started this whole dialogue about the importance of the connectivity of the doctor, the patient, and our colleagues, [eg] the folks who are connecting to these patients and the way we're trying to make it easy for them to manage their care.

And I think that was one insight that we really tried to pull through at Asembia, how CVS really does use technology to interact with patients and with providers hitting the easy button. But, we showed how much we care through our centers of excellence. We had about 3 colleagues connected with me on the podium that helped me create that story of the patient experience, the provider experience, and our centers of excellence that really focus on unique therapies that are usually rare and patients need a little bit more care in.

What is the key message you aimed to convey to the Asembia audience during your session, and what takeaway do you hope they gained from it?

Dr Accetta: Well, I hope when they left that session that they really saw how much we care about our patients, right? How we really look to making their experience the best possible while interacting with us, recognizing that their condition is complicated [and] stressful, and that we place our patients at the center of everything we do. We talked a lot about feedback from our patients. We talked a lot about how we started a patient and care advisory committee, where we have our own patients in an advisory group that guide us along in some of the things they'd like to see done, better, smarter, simpler for them.

We really talked about, I'll call, it making it easy for patients and our prescribers, and how everyone involved in the process, be it the provider, a payer, a pharmacy, a pharma company, are all trying to do the same thing and bring the best care to our patients, and how we do that in a connected way. I hope that we came across that not only are we technically savvy with patients and technically savvy with our prescribers, but we also have gotten really involved in how our colleagues can have a lot of the tech in front of them to help guide patients along their way. I think with all of the data and information that patients have to absorb. How do we make it easy and absorbable for patients to get through their therapy, starting and staying on it?

Usually the two biggest challenges that patients have to take when [they’re] on these types of medications is either you have to inject yourself or where somebody has to inject you. It's not easy to do.

It's not like you can swallow a pill and be fine. A lot of them are injectable, and some of them require nurses to be in your home to infuse you, and that's not always easy either. So, we really try to look at the patient at the center and how we can make the experience best as possible, and I hope that the folks who were in the audience at Asembia really felt that CVS specialty does place the patient at the center of it all.

Is there anything else you’d like to share with the audience?

Dr Accetta: I think when you hit the majority of what we did at Asembia, what I was really happy about at the end was we had a lot of individuals come up to us when the session ended, telling us that it was a really personal, caring type view of how we interact with our patients. They hadn't seen that in a lot of the sessions. They also felt that we weren't reading from a book or a notebook.

We were very real. I was very proud of the team that we had at the podium with us that discussed what we do and how we wake up every day to care for our prescribers and our patients. That really resonated with folks [who] understood the challenges. And I think sometimes we forget the word specialty—what does that mean? To bring it to life and [show] how we manage these patients is really what we wanted to show as part of who we are at CVS Health.