A virtual approach to keep specialty costs down

With a shortage of specialists, people are often getting treated by primary care physicians for their specialty conditions, which can lead to prescribing high-cost therapy that may not be clinically appropriate. The good news is virtual health services can help overcome a lack of specialist care and unnecessary costs for members facing complex conditions.

For many specialty conditions, patients have complex medical issues that require high-touch support. Long delays in care can adversely affect health,⁵ leading to worse health outcomes that can contribute to higher costs. Given the complexity and cost of specialty conditions, payors and members are seeking out innovative solutions to manage these health issues anytime, anywhere.

The solution: Virtual Specialist Care

We know how crucial it is for people to have access to necessary care, especially in areas with shortages and long wait times for specialists. Those challenges can drive up costs and compromise outcomes. CVS Health is harnessing the accessibility and convenience of standard virtual care and leveraging it as a cost-saving solution.

Virtualizing specialty care makes it easier and faster to access expert, personalized care and support throughout treatment – all without needing an in-office visit.

Our Virtual Specialist Care offers:

• Cost-effective therapy: Specialists help ensure the most cost-effective, clinically appropriate therapy is prescribed from the start. They also evaluate opportunities to optimize therapy throughout the journey.
• Convenience: Plan members can receive care from the comfort of their homes. They can also receive more timely appointments and quicker response times than an in-person visit.

Virtual Specialist Care includes condition-specific solutions – Virtual Psoriasis Care and Virtual PrEP Care – and will expand to other specialty conditions in 2023 and beyond.

How we deliver high-quality, connected care, with 2:1 guaranteed ROI

Psoriasis is a leading driver of specialty spend. The average annual drug cost per psoriasis patient is $44,000, which stems in part from non-dermatology providers prescribing more than a third of psoriasis therapies.⁶

Our new Virtual Psoriasis Care program, now available for early adoption, connects members with dermatology specialists to help determine the right medication to manage plaque psoriasis. When appropriate, members on specialty medications may be prescribed clinically effective, lower-cost therapies that will continue to help maintain or improve their skin clearance – targeting 10 percent savings on drug spend.

For example, a member has just enrolled in Virtual Psoriasis Care and has a telehealth appointment with a dermatology specialist. Plaques cover 0% of her body surface area and she’s interested in coming off her specialty medication. The provider, equipped with her prescription history, prescribes a topical with a follow-up appointment. Six weeks later, the member maintains her skin clearance and the provider continues her current therapy. Throughout the member’s journey, she can quickly get in touch with her dermatologist with a virtual visit to address any questions or concerns.

We also recently introduced our Virtual PrEP Care program that provides convenient, no-cost, stigma-free access to HIV preventive treatment. Roughly 50 percent of members using PrEP were on higher-cost brand medication since October 2020, costing up to $20,000 more per utilizer per year.

Our virtual approach enables prescribers to make better informed decisions and encourage the use of clinically appropriate generic drug therapies. Clients can save up to $11,000 a year or $700 for a 30-day fill for members on generic medications as opposed to brand-name therapy.

Imagine a member is on brand-name medication for HIV prevention. He has a telehealth appointment with a specialist, who reviews his history and recommends a lower-cost generic medication. The member receives a prescription for PrEP as well as comprehensive, confidential support. With Virtual PrEP Care, the ability to do labs and testing at home and have medication delivered directly to him helps support better adherence to therapy – helping him stay HIV-free and lowering overall health care costs.