A tale of two companies seems to be emerging when it comes to CVS Caremark and the push for greater patient adherence to prescribed medication.
To be clear, patient non-adherence to prescribed medications is a serious public health issue of concern across the pharmacy spectrum. Its costs have been estimated at $300 billion annually. NCPA has urged community pharmacists to take on the challenge of medication adherence One independent pharmacy’s approach was recently profiled in The New York Times front-page article, “Pharmacists Take Larger Role on Health Team.”
But how committed to patient adherence can CVS Caremark ever be given its unique role in the industry? On the one hand it is a pharmacy provider of care. On the other, it is a pharmacy benefit manager (PBM) dedicated to increasing its market share and answering to its shareholders.
CVS Caremark’s Dr. Jekyll side was on full display in a presentation by a company official to an Aug. 18 conference. CVS Caremark’s top medical officer summed up their approach this way in a company press release brought to our attention by the WSJ Health blog:
“We are looking at this issue from all angles because it is well known that medication non-adherence is costing the health care system billions of dollars every year because people who stop taking medications may face unnecessary hospital admissions and other health care expenditures. Our plan is to develop innovative programs that encourage adherence because good pharmacy care is among the most cost-effective health care options.”
Unfortunately, in the real world, CVS Caremark’s Mr. Hyde side trumps such lofty aspirations on a daily basis. Its definition of patient non-adherence might as well be when the patient fills their prescription anywhere other than a CVS store or Caremark mail order.
An Oregon woman shared her experience with CVS Caremark this summer with NCPA (on the condition that her name and medication be withheld). Her story exemplifies the unparalleled, heavy-handed tactics the company apparently employs in putting its market share above the interest of patient wellbeing. It is one of the hundreds of testimonials from patients and independent pharmacists that NCPA has shared with Federal Trade Commission and others investigating the CVS Caremark merger’s ill effects.
Her story: “Basically, we are having all the problems that you folks, National Community Pharmacists Association (NCPA) and the Federal Trade Commission (FTC), are currently investigating on CVS Caremark. We are being told that we have to use CVS or Caremark mail order to get our prescriptions filled at the $7.50 co-pay for generic. If we continue to use Safeway our co-pay will go up to $39. This is a huge jump and being on Social Security we cannot afford this. Plus some of our medications are exactly 28 days and we go to our Provider on the 28th day to get a written prescription to be hand delivered to Safeway which at this time we do not have any medication left and we cannot miss a dose or our health will be in danger. Because there is no CVS Pharmacy in our area we would have no choice but to use the mail order and this would not work.”
In this case, the CVS Caremark coverage is administered through Medicare Part D by SilverScript. According to the patient, the plan’s phone representative conceded that the company had failed to notify her of this catch.
She continued: “We can’t change [to another Part D plan] mid-stream because of the open enrollment. There’s nothing we can do about it for the next six months. The service rep we’ve worked with submitted a grievance, but they said they won’t change anything. They agree that there’s nothing in writing that has told all the members of SilverScript that the plan is changing this year, that when you hit your donut hole, your co-pay goes up unless you go to CVS.”
This is not the first time a CVS Caremark/SilverScript plan has been accused of misleading Medicare beneficiaries.
Research indicates that the more barriers there are to patients getting their meds, the less adherent they are. CVS Caremark’s approach to patient adherence could be summed up: One step forward with academic research; two steps backward with unreasonable restrictions on patients.