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A Message From the President of PerformRx

Dear PerformRx Review readers:

Welcome to the Summer 2023 issue of PerformRx Review. In this edition, we are excited to present a collection of insightful articles that shed light on the latest advancements in the field. As the pace of innovation in health care accelerates, it is crucial to share the impactful progress being made.

At PerformRx, we firmly believe in the power of robust pharmaceutical care management programs that harness the expertise of both clinical and retail pharmacists. By utilizing this collaborative approach, we can achieve better outcomes for the members we serve while exploring new strategies and breakthroughs that pave the way forward.

One area of focus in this issue is the advancement of Respiratory Syncytial Virus (RSV) treatment. We delve into RSV's background in the U.S., current treatment options, and the exciting therapies under development for infants and adults. With a clear public health need for additional preventative options, we anticipate the potential approval of three new products at the start of the next RSV season, which could revolutionize longterm treatment approaches.

Furthermore, we delve into the emergence of digital therapeutics and its potential to enhance access to personalized care. While still in its early stages, digital therapeutics holds promise in improving patient outcomes, reducing the overall cost of care, and advancing health equity. We examine current use cases and explore the opportunities this digital transformation presents.

In this issue, we also highlight PerformRx's Clinical Outcomes and Therapeutics (COTO) team's approach to comprehensive medical reviews. With a significant percentage of Americans taking multiple medications, there is an inherent risk. By dedicating time to individual patient care, PerformRx aims to drive improvements across the population and ensure the safety and efficacy of medication regimens.

Additionally, we discuss the vital role and shared responsibility of pharmacists in advancing asthma management. At PerformRx, our Asthma Management DTM Program, in collaboration with various health plan partners, provides a unique opportunity to drive improved outcomes and enhance the quality of care for asthma patients.

As passionate industry professionals committed to delivering quality and affordable care, we must constantly explore new techniques and refine strategies to achieve the best possible outcomes for our members. Our goal is to offer thought-provoking viewpoints that spark discussion and intuition among our readers, bringing us closer to our shared mission.

We invite you to immerse yourself in this edition of PerformRx Review, and we hope that these articles will inspire meaningful conversations and drive us further towards our common goal of delivering exceptional care to all.

Best regards,

Jim Gartner, MBA, R.Ph. President PerformRx & PerformSpecialty #BetterTogether

What Are Digital Therapeutics?

Editorial Staff

John Butts

Travis Taylor

MEDIA RELATIONS CONTACT

Scott D. Bluebond

1-215-840-8605 mediarelations@performrx.com

ADVERTISING AND SALES

John C. Butts

1-215-937-8073 jbutts@performrx.com

Disclaimer

The contents of PerformRx Review are copyrighted by PerformRx. The contents are presented for informational and educational purposes only, and should not be construed as medical advice. Never delay or disregard professional medical advice because of something you have read in this publication. The inclusion of third-party advertisements does not constitute an endorsement, recommendation, guarantee, or warranty by PerformRx of any product or service. Any advertiser appearing in this publication has no influence on content or presentation. PerformRx Review is provided to its readers at no charge.

About Performrx

PerformRx is a pharmacy benefit manager (PBM) dedicated to clinical culture, boutique service, and holistic solutions. Our mission is to help customers, doctors, and patients use effective medication therapy to improve health and wellness. For more than 20 years, our focus has been on providing optimal service through a clinical culture that seeks to provide members with high-quality care while ensuring our partners receive favorable costs.

About Performspecialty

PerformSpecialty is a full-service specialty pharmacy. Our goal is to provide personalized patient care and better access to achieve healthier outcomes. Each patient works with a Patient Care Coordinator, who along with the prescriber creates a program to treat each condition individually and works to involve the patient in their own health.

PerformRx www.performrx.com

1-866-533-5492

About Amerihealth Caritas

PerformSpecialty www.performspecialty.com

1-855-287-7888

AmeriHealth Caritas is one of the nation’s leaders in health care solutions for those most in need. Operating in 13 states and the District of Columbia, AmeriHealth Caritas serves approximately 5 million Medicaid, Medicare, Children’s Health Insurance Program (CHIP), and Health Insurance Marketplace® members through its integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, and behavioral health services. Headquartered in Newtown Square, PA., AmeriHealth Caritas is a mission-driven organization with more than 40 years of experience serving low-income and chronically ill populations.

For more information, visit www.amerihealthcaritas.com.

VALUE-ADDED SERVICE: Asthma Management

Courtney McMahon, PharmD, BCACP

Asthma is a serious but treatable health condition characterized by chronic inflammation of the airways. Most common asthma symptoms include respiratory manifestations such as wheezing, coughing, and shortness of breath.1 Although asthma is most prevalent in children and adolescents, the impact of the disease spans across all stages of life and can change over time.2 In fact, children younger than five years old have the highest asthma attack rates, but asthma death rates are greatest among individuals older than 65 years old.2,3 Overall more than 350 million people across the world are affected by asthma and its prevalence continues to climb in many countries.1,3 In addition to health-related impacts, asthma imposes significant financial burdens as well. Uncontrolled asthma is associated with loss of productivity at work or school and an undue financial and resource burden at the individual and population level.1 The American Lung Association reported that asthma, in the United States alone, accounted for $81.9 billion annually in economic costs, including direct health care costs, mortality, and missed school and workdays, from 2008 to 2013.2

Despite ongoing, concerted efforts surrounding appropriate asthma management, recent studies indicate that asthma control is still suboptimal in many areas, especially within the pediatric population and nations with low incomes. The U.S. is often thought of as a highincome country, however, there are still significant populations in the U.S. whose clinical outcomes are limited by the availability, accessibility, and affordability of appropriate asthma medications.2 In conjunction with lack of medication and health care access, lack of evidence-based treatment acceptance and use also significantly impacts asthma outcomes.1,2

The 2022 GINA Report, Global Strategy for Asthma Management and Prevention outlines clinical recommendations and best practices for the management of asthma. This guideline highlights the need for increased access to effective medications and the implementation of asthma management recommendations in practice to drive improved asthma care and optimal patient outcomes. It is also noted that putting evidence-based guidelines into practice requires a concentrated multidisciplinary effort and consideration of social determinants of health (SDOH).1

The pharmacist’s role

The pharmacist is a key member of the patient’s health care team that shares responsibility for advancing asthma management. In addition to reviewing medication regimens and making clinical interventions, a pharmacist, as the medication expert, also has the training and accessibility to help overcome several provider and patient barriers limiting implementation and uptake of evidence-based recommendations in the real world.

A pharmacist can assist a provider with updates to evidence-based clinical recommendations, application of guideline to clinical practice and time and resource constraints. Patient barriers impacting appropriate asthma care include low health literacy, cultural and economic barriers, and inadequate understanding of the disease state and treatment options. During a comprehensive medication review, a pharmacist has the time and knowledge to educate members, explain treatment options, and address any questions or concerns from a patient with the goal of empowering them to manage their asthma and overall health.

In addition, the clinical pharmacy team at the patient’s pharmacy benefit manager (PBM) has a unique and advantageous perspective of a patient’s overall care and the ability to drive improved outcomes. Ideally, a PBM has insight into pharmacy and medical claims, and medication formulary status — all of which are important when assessing disease state management and making recommendations. As a PBM committed to advancing the quality of care provided to patients and improving overall health outcomes, PerformRx has designed and implemented asthma drug therapy management (DTM) programs in collaboration with several health plan partners to help drive improvement in asthma care and patient outcomes.

The asthma DTM program enrollment criteria are flexible and can be adjusted to meet the needs of a specific client or population, but typically targets asthmatic patients found to be non-adherent to controller medication or over-utilizing rescue inhalers, and patients with recent asthma-related emergency room visits and hospitalizations.

The goals of the PerformRx asthma DTM program include:

• Optimize medication regimens as evidenced by fewer gaps in evidence-based care, fewer safety issues such as drug interactions and duplicate therapies, improved controller medication adherence, and improved Healthcare Effectiveness Data and Information Set (HEDIS) quality scores.

• Improve patient outcomes in surrogate markers of health (such as lung function test results), decreased utilization of emergency health services, and increased quality of life.

• Decrease the cost of care (pharmacy cost increases because of closed care gaps and improved medication adherence are expected to be more than offset by medical cost savings).

Due to the complexity of asthma management and the number of external factors that impact asthma outcomes, each member enrolled in the DTM program is offered a holistic comprehensive medication review with a pharmacist. The pharmacist reviews the member profile, which includes demographic information and pharmacy and medical claims, in addition to any information gathered from the patient consultation.

Medication-related problems are identified, prioritized, and addressed based on the clinical review. The pharmacist will address each intervention with the patient or the prescriber, or both. An individual issue may be addressed with one or more providers to facilitate collaboration among the patient’s health care team.

An important piece of the PerformRx DTM program is collaboration with our health plan partners. This partnership includes a two-way referral process that expands the resources available to patients as they are offered both DTM and case management services when needed. This program design creates a pathway for quick and effective resolution of SDOH-related issues. SDOH significantly impact a patient’s health and contribute to health disparities. A collaborative approach to addressing these drives health equity improvements.4

Program impact and outcomes

Follow-up on each individual patient and provider intervention is completed, and pharmacy and medical claims are used to determine an outcome. The acceptance of interventions is tracked and reported quarterly to the health plan. Traditionally, the provider acceptance rate for the PerformRx DTM program provider recommendations is 41%. On a larger scale, a cost and utilization analysis was completed for the asthma DTM program in one Medicaid line of business in 2022. The enrollment time period included in the evaluation was January 1, 2019, to June 30, 2021. The analysis concluded that medical utilization and cost decreased after program enrollment and intervention.

Our Authors

References

1. Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma, 2022. Available from: www.ginasthma.org

2. Asthma trends and burden. American Lung Association, 2018. Available from: https:// www.lung.org/research/trends-in-lung-disease/asthma-trends-brief/trends-and-burden

3. Garcia-Marcos L et al., Asthma management and control in children, adolescents, and adults in 25 countries: a Global Asthma Network Phase I cross-sectional study. Lancet Glob Health 2023;11:e218-228.

4. “Healthy People 2030,” U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved September 2, 2022, from https://health.gov/ healthypeople/objectives-and-data/social-determinants-health

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