White-glove support during a biosimilar transition

Autoimmune conditions, such as those treated by the Humira® biologic, have been one of the greatest contributors to specialty drug spend over the last decade. So, CVS Caremark did the math and followed the science and, once again, led the market by becoming one of the first pharmacy benefit managers (PBMs) to remove Humira from our major national commercial template formularies, preferring biosimilars instead. This change went into effect on April 1, 2024, requiring months of coordination, planning, and expertise from multiple teams across CVS Caremark and CVS Specialty to make the experience of patients and prescribers as seamless as possible.

Operationalizing the biosimilar transition with prescribers

Because Humira is the largest specialty drug by volume that CVS Specialty dispenses, we knew this transition was going to require a detailed plan. Our combined CVS Caremark and CVS Specialty teams worked together to anticipate and eliminate any friction in advance of the April 1 commercial template formulary change.

CVS Specialty started by identifying patients likely to be impacted by the change and proactively messaging their prescribers. Because we’re in constant communication with the prescriber community, we knew they were feeling unsure about which biosimilars should replace which biologics. Our Quality Team mapped the doses and strengths of current reference biologic scripts to the biosimilars that most closely aligned.

We then sent impacted prescribers prescription change requests, including which biosimilars were covered, and suggested mapping for each of their patients. With a single click, prescribers selected an appropriate covered biosimilar alternative and notified the CVS Specialty pharmacy, resulting in a frictionless prescriber and patient experience.

CVS Specialty designed this proactive prescriber outreach with the understanding that not all prescribers have the technology to receive electronic messages, so we communicated with the rest via phone or fax. We sent prescription messages early to allow time to follow up, if necessary. Our prescriber teams were available to talk through their patients’ options and answer any questions or concerns – whatever prescribers needed to feel comfortable with the change.

Drug shortages and supply chain issues have created a lot of frustration and disruption in the past few years. CVS Health launched Cordavis™ to bring safe and affordable biosimilar products to the market, with the goal of supporting a vibrant and competitive biosimilar marketplace in the United States. CVS Specialty worked with Cordavis to ensure that specialty patients had access to a steady supply of biosimilars, while helping these patients and their plan sponsors realize cost savings as a result of strong biosimilar adoption. Fulfillment teams were tasked with projecting prescription volumes to make sure pharmacies had an adequate supply of biosimilars. Simultaneously, teams were proactively reaching out to impacted patients to help them sign up for copay assistance, if eligible.

Daily touchpoints helped everyone stay on track. A lot of work happened behind the scenes to make the transition seem simple for patients and prescribers, including creating a biosimilars feedback loop that internal employees could reference to understand new and emerging issues and concerns and respond accordingly.

This prework resulted in a smooth transition on April 1, 2024: Required prior authorizations were in place, copay assistance providing $0 out-of-pocket costs for eligible patients were on file, and prescriptions were filled without delay.

Communicating with patients always, in all ways

Some patients have been taking their specialty medications for years, even decades. Biosimilars are a new concept, so we developed robust biosimilars content on CVSSpecialty.com consisting of helpful education, videos, podcasts, credible third-party resources, and answers to commonly asked questions for patients, prescribers, and internal colleagues. We started communicating early and often about the biosimilars included in the CVS Caremark template formulary change, developing a multi-pronged communications strategy. Because over 96 percent of CVS Specialty patients are digitally engaged,² we took a digital-first approach to educating them about the safety and efficacy of biosimilars. We also sent information about copay assistance digitally, giving them the convenience and flexibility to review it on their own time. 

CVS Specialty communicated with patients every step of the way to make sure there were no surprises – including the new drug name they were going to see on their prescription. While it’s not uncommon to get an influx of inbound patient and prescriber calls during a transition of this magnitude, the opposite actually occurred, with some patients calling in advance of April 1 to see if they could switch earlier. We were pleasantly surprised to see that NPS scores increased during the transition timeframe.³ The overall patient sentiment was that they were embracing the change and were excited to experience the savings – now and in the months and years to come.