Over the past decade, as the Food and Drug Administration (FDA) approved hundreds of novel breakthrough therapies, the number of Americans taking specialty drugs has continued to rise. In 2023 alone, these medications, which treat rare and complex conditions, represented more than 70% of the drugs approved by the FDA.
This trend is expected to accelerate over the next decade, with significant growth anticipated in new therapies, the number of patients who can benefit from those therapies, and the associated costs of treatment. This rapid advancement is bringing a unique set of challenges to the health care system, as specialty medicines are often expensive, complicated to administer, and require special handling.
Providing patients with best-in-class care and specialized capabilities are key ways to help manage the costs and patient needs associated with specialty medications. A key component of this is the way services are organized to support patients and optimize care across therapeutic areas, known as a care model.
At Accredo, Evernorth’s specialty pharmacy, our care model equips patients with around-the-clock support from experts in the patient’s disease state and with access to innovative tools that contribute to better quality care and the avoidance of costs associated with emergency department visits and hospital stays.
Connecting patients to best-in-class specialists
Accredo’s care model is built around its 15 condition-specific Therapeutic Resource Centers (TRCs), which house dedicated teams of care specialists who provide high-touch, personalized supportive care. Each TRC is staffed with pharmacists and other clinicians who specialize in the patient’s condition and who take the time to understand each patient’s unique circumstances.
Accredo’s TRCs also connect patients with specialty-trained experts who are available 24 hours a day, seven days a week. For example, Accredo’s National Customer Support Center (NCSC) is staffed by clinical experts who support patients receiving in-home infusion therapy, a common method of administering medications for diseases such as hemophilia and pulmonary arterial hypertension.
Many of these therapies must be infused constantly, and even a brief lapse in treatment can lead to severe medical consequences. If a patient faces a challenge – such as a pump malfunction or a dosing issue – a home infusion expert is always available to provide expert support.
Support from the NCSC and our specialty clinicians helps keep patients out of the emergency room and hospital, leading to better patient experiences and impactful savings for plan sponsors. Accredo estimates that patients treated by its Advanced Pulmonary Conditions TRC avoided $52 million in emergency room and hospitalization costs in 2023 alone.
In-home nurses provide better patient experiences and better value
As part of Accredo’s care model, many patients can choose to receive quality, cost-effective clinical care in the convenience of their home, where they feel most comfortable. In fact, patients diagnosed with chronic conditions report more independence and higher quality of life when they can receive treatment at home.
Accredo has a team of approximately 600 field nurses, available in all 50 U.S. states, who visit patients in their homes or other preferred sites of care and administer infused medications that would otherwise require a trip to an infusion center or clinic. In 2023, these nurses spent nearly 650,000 hours traveling to patients and administering care, averaging nearly three hours of face-to-face time per visit.
“Caring for patients directly in their homes can have a significant and positive impact on their overall comfort level and peace of mind,” said Annalyn del Rosario, an infusion nurse who has been caring for Accredo patients for 18 years. “It’s not just about treatment, it’s about enhancing their quality of life.”
Beyond convenience and patient preference, treatment in a home setting can drive significant savings for plan sponsors. Administering specialty drugs at home through Accredo has been found to cost 50% less than administering those drugs in an outpatient setting.
Access to digital tools improves medication adherence, drives savings
Accredo’s care model deploys a range of digital support tools that ensure patients get and stay on the medications they need. This improves health outcomes and reduces costs by avoiding preventable gaps in care and hospitalizations.
Medication nonadherence is associated with 10% of hospitalizations and contributes to 16% of overall U.S. health care spend. Conversely, medication adherence has the potential to reduce annual U.S. health care costs by $100 billion to $300 billion.
Accredo offers patients a variety of digital tools to help them stay adherent, including resources that are accessible online, through text messages or phone calls, via a mobile app, and through an interactive voice response program. These tools are designed to alert patients to refill opportunities and guide patients through managing their prescriptions. An Accredo study found that patients using these digital tools consistently demonstrated higher rates of medication adherence.