Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658315
G. Knowles
Abstract Background: As the pharmacist (RPh) role has evolved from a dispensing to a clinical focus, the need to demonstrate the value of routine RPh interventions is necessary to drive the profession forward. In 2018, Saulles and Chang reported an estimate of the financial impact of 716 RPh interventions in a regional health system specialty pharmacy to be $299,415. While RPh-led anticoagulation and medication therapy management (MTM) is well established with reducing medical costs, the value of daily specialty pharmacy care is not as well studied despite interventions being made frequently. Aims: The objective of this study was to analyze the interventions in a specialty pharmacy and to provide an estimate of the economic value in terms of both RPh time and the potential adverse events (AEs) or unnecessary medical costs prevented had the intervention not taken place. Methods: In this retrospective study, interventions documented at Ardon Health specialty pharmacy were categorized using a coding system. A way to identify certain interventions was developed to distinguish a subset of interventions (termed RPh impacts) that directly led to or had a high likelihood to prevent negative outcomes. Impacts documented in 2017 were reviewed by a RPh, and the actual or predicted outcome, such as avoidance of hospitalization or medication waste, was predicted. A financial value was then attributed to each impact. The 2006 Health Care Utilization Project report was used to estimate the costs of prevented hospitalizations. Other costs were estimated using emergency room (ER) visit costs available in the literature and actual costs of avoided medication waste. Two scenarios were completed: one in which all the prevented outcomes were predicted to occur, and one where 50% of the total cost of prevented outcomes would be incurred. Surveys were completed by the RPhs to estimate the average time per intervention to estimate the value of devoted RPh time. Results: A total of 14,441 interventions were documented, of which 115 were identified as RPh impacts. The total estimated value of interventions ranged from $2,518,442 to $4,603,358, with an estimated value per intervention of $174 to $319. Most of the RPh impacts were predicted to have prevented an unnecessary hospitalization. Conclusions: While the estimative nature of this analysis poses limitations, the analysis demonstrates the profound clinical and economical value of RPh care in a specialty pharmacy setting.
{"title":"Estimating the value of pharmacist interventions in a specialty pharmacy setting","authors":"G. Knowles","doi":"10.1080/21556660.2019.1658315","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658315","url":null,"abstract":"Abstract Background: As the pharmacist (RPh) role has evolved from a dispensing to a clinical focus, the need to demonstrate the value of routine RPh interventions is necessary to drive the profession forward. In 2018, Saulles and Chang reported an estimate of the financial impact of 716 RPh interventions in a regional health system specialty pharmacy to be $299,415. While RPh-led anticoagulation and medication therapy management (MTM) is well established with reducing medical costs, the value of daily specialty pharmacy care is not as well studied despite interventions being made frequently. Aims: The objective of this study was to analyze the interventions in a specialty pharmacy and to provide an estimate of the economic value in terms of both RPh time and the potential adverse events (AEs) or unnecessary medical costs prevented had the intervention not taken place. Methods: In this retrospective study, interventions documented at Ardon Health specialty pharmacy were categorized using a coding system. A way to identify certain interventions was developed to distinguish a subset of interventions (termed RPh impacts) that directly led to or had a high likelihood to prevent negative outcomes. Impacts documented in 2017 were reviewed by a RPh, and the actual or predicted outcome, such as avoidance of hospitalization or medication waste, was predicted. A financial value was then attributed to each impact. The 2006 Health Care Utilization Project report was used to estimate the costs of prevented hospitalizations. Other costs were estimated using emergency room (ER) visit costs available in the literature and actual costs of avoided medication waste. Two scenarios were completed: one in which all the prevented outcomes were predicted to occur, and one where 50% of the total cost of prevented outcomes would be incurred. Surveys were completed by the RPhs to estimate the average time per intervention to estimate the value of devoted RPh time. Results: A total of 14,441 interventions were documented, of which 115 were identified as RPh impacts. The total estimated value of interventions ranged from $2,518,442 to $4,603,358, with an estimated value per intervention of $174 to $319. Most of the RPh impacts were predicted to have prevented an unnecessary hospitalization. Conclusions: While the estimative nature of this analysis poses limitations, the analysis demonstrates the profound clinical and economical value of RPh care in a specialty pharmacy setting.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43494236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658292
H. Farkas, M. Fridman, D. Supina, J. Chiao, S. Prusty, M. Berger
Abstract Background: Autoimmune diseases are a leading cause of morbidity and mortality in the US (estimated prevalence: 4.5%) and often associated with dysregulation of the complement system (innate and adaptive immune response). The classic complement pathway is regulated by the C1-inhibitor (C1-INH), which binds to C1 to prevent its activation. Hereditary angioedema with C1-INH deficiency (C1-INH-HAE) may be linked to increased autoimmunity due to secondary deficiency of C1r, C1s, and other components. Aims: It was hypothesized that increased regulation of the complement system via C1-INH replacement therapy may reduce autoimmunity in patients with C1-INH-HAE. The coexisting autoimmune disease claims frequency was compared between C1-INH-HAE patients treated with plasma-derived (pd) C1-INH vs “other (non-C1-INH)” treatments. Methods: C1-INH-HAE patients were identified in the IMS Health PharMetrics Plus claims database between January 2012 and December 2015 by International Classification of Diseases 9/10 diagnosis code, and classified based on the use of pdC1-INH or “other (non-C1-INH)” treatments for HAE. Index date was the first claim for HAE treatment. For patients using pdC1-INH, the first fill was the index date, even if other HAE medications were used previously. Frequency of visit claims for autoimmune conditions was identified by diagnostic codes (primary or secondary). Mean visits per patient per year by treatment group, gender, and age (<50 vs ≥50 years) were summarized for autoimmune conditions. Results: Of 589 patients with HAE identified (69% female, 38% aged ≥50 years), 276 (729 patient-years) received pdC1-INH and 313 (860 patient-years) received “other (non-C1-INH)” treatments. In this cohort, 12.9% of patients had ≥1 visit associated with a coexisting autoimmune disorder – the most common were lupus, alopecia, rheumatoid arthritis, sicca (Sjogren) syndrome, and connective tissue disorders. The mean (95% CI) number of visits for autoimmune diagnoses per patient per year was numerically lower for patients treated with pdC1-INH compared to those receiving “other (non-C1-INH)” treatments (1.37 [0.56–2.19] vs 2.28 [0.83–3.73]). Conclusions: Based on these findings, it is concluded that treatment of C1-INH-HAE with pdC1-INH may have a positive impact on coexisting autoimmune conditions by normalizing complement. Further research is needed on this important issue. There may be implications for healthcare resource utilization among patients with HAE and coexisting autoimmune disorders.
摘要背景：自身免疫性疾病是美国发病率和死亡率的主要原因（估计患病率：4.5%），通常与补体系统失调（先天和适应性免疫反应）有关。经典的补体途径由C1抑制剂（C1-INH）调节，该抑制剂与C1结合以阻止其激活。遗传性血管性水肿伴C1-INH缺乏（C1-INH-HAE）可能与由于C1r、C1s和其他成分的继发性缺乏而导致的自身免疫增加有关。目的：假设通过C1-INH替代疗法增加补体系统的调节可能会降低C1-INH-HAE患者的自身免疫。比较了接受血浆来源（pd）C1-INH治疗的C1-INH-HAE患者与“其他（非C1-INH）”治疗的患者之间共存的自身免疫性疾病索赔频率。方法：根据国际疾病分类9/10诊断代码，在2012年1月至2015年12月期间，在IMS Health PharMetrics Plus索赔数据库中确定C1-INH-HAE患者，并根据pdC1 INH或“其他（非C1-INH）”HAE治疗的使用情况进行分类。索引日期是HAE治疗的第一个声明。对于使用pdC1 INH的患者，即使之前使用过其他HAE药物，第一次填充也是索引日期。通过诊断代码（原发性或继发性）确定自身免疫性疾病的就诊频率。按治疗组、性别和年龄（<50岁与≥50岁）对每位患者每年的平均访视次数进行了自身免疫性疾病总结。结果：589名HAE患者（69%为女性，38%年龄≥50岁）中，276名（729名患者-年）接受了pdC1 INH治疗，313名（860名患者-岁）接受了“其他（非C1-INH）”治疗。在该队列中，12.9%的患者有≥1次就诊与共存的自身免疫性疾病相关，最常见的是狼疮、脱发、类风湿性关节炎、干燥综合征和结缔组织疾病。与接受“其他（非C1-INH）”治疗的患者相比，接受pdC1 INH治疗的患者每年每名患者的自身免疫诊断平均访视次数（95%CI）较低（1.37[0.56-2.19]vs 2.28[0.83-3.73]）。结论：基于这些发现，结论是用pdC1-INH治疗C1-INH-HAE可能通过使补体正常化对共存的自身免疫性疾病具有积极影响。需要对这一重要问题进行进一步研究。这可能对HAE和共存自身免疫性疾病患者的医疗资源利用有影响。
{"title":"Hereditary angioedema C1-inhibitor replacement therapy and coexisting autoimmune disorders: findings from a claims database","authors":"H. Farkas, M. Fridman, D. Supina, J. Chiao, S. Prusty, M. Berger","doi":"10.1080/21556660.2019.1658292","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658292","url":null,"abstract":"Abstract Background: Autoimmune diseases are a leading cause of morbidity and mortality in the US (estimated prevalence: 4.5%) and often associated with dysregulation of the complement system (innate and adaptive immune response). The classic complement pathway is regulated by the C1-inhibitor (C1-INH), which binds to C1 to prevent its activation. Hereditary angioedema with C1-INH deficiency (C1-INH-HAE) may be linked to increased autoimmunity due to secondary deficiency of C1r, C1s, and other components. Aims: It was hypothesized that increased regulation of the complement system via C1-INH replacement therapy may reduce autoimmunity in patients with C1-INH-HAE. The coexisting autoimmune disease claims frequency was compared between C1-INH-HAE patients treated with plasma-derived (pd) C1-INH vs “other (non-C1-INH)” treatments. Methods: C1-INH-HAE patients were identified in the IMS Health PharMetrics Plus claims database between January 2012 and December 2015 by International Classification of Diseases 9/10 diagnosis code, and classified based on the use of pdC1-INH or “other (non-C1-INH)” treatments for HAE. Index date was the first claim for HAE treatment. For patients using pdC1-INH, the first fill was the index date, even if other HAE medications were used previously. Frequency of visit claims for autoimmune conditions was identified by diagnostic codes (primary or secondary). Mean visits per patient per year by treatment group, gender, and age (<50 vs ≥50 years) were summarized for autoimmune conditions. Results: Of 589 patients with HAE identified (69% female, 38% aged ≥50 years), 276 (729 patient-years) received pdC1-INH and 313 (860 patient-years) received “other (non-C1-INH)” treatments. In this cohort, 12.9% of patients had ≥1 visit associated with a coexisting autoimmune disorder – the most common were lupus, alopecia, rheumatoid arthritis, sicca (Sjogren) syndrome, and connective tissue disorders. The mean (95% CI) number of visits for autoimmune diagnoses per patient per year was numerically lower for patients treated with pdC1-INH compared to those receiving “other (non-C1-INH)” treatments (1.37 [0.56–2.19] vs 2.28 [0.83–3.73]). Conclusions: Based on these findings, it is concluded that treatment of C1-INH-HAE with pdC1-INH may have a positive impact on coexisting autoimmune conditions by normalizing complement. Further research is needed on this important issue. There may be implications for healthcare resource utilization among patients with HAE and coexisting autoimmune disorders.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48005666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658316
D. Simonson, Marj Wittenborg, M. Snyder, H. Wiest, A. Mcnamara
Abstract Background: Fairview Specialty Pharmacy provides comprehensive therapy management (TM) for patients, yet some patients require additional social, physical, and psychological support that may be unmet by a pharmacist or nurse. To address complex patient needs and remotely improve social determinants of health, a health coach is employed. The projected benefits of a health coaching program for patients include providing holistic support for health and mental well-being, identifying and overcoming barriers to healthy coping, and identifying additional resources for support. Aims: Goals of this study were to determine the impact of a health coach in patients who receive specialty pharmacy services as measured by number of referrals to this program, patient satisfaction and perceived impact on health, and impact on patient depression scores. Methods: Health coaching services were offered to patients during initial TM call or when a trigger was identified, such as emotional distress, new chronic illness diagnosis, life transition, coping issues, stress management, end of life, advanced care planning, or family concerns. Initial outreach health coach call to the patient provided program overview, confirmed interest, determined focus area (emotional/spiritual needs, loss/grief, lifestyle changes, or stress management), encouraged goal setting, and documented baseline depression score using the Patient Health Questionnaire (PHQ-9). Follow-up calls between the patient and health coach were focused on patient goals; referrals to additional services were documented. At the end of the third call, the PHQ-9 was given and a satisfaction survey was mailed to the patient. Program impact was determined based on satisfaction surveys, referrals, and the change in PHQ-9 after the third call. Results: 623 health coaching assessments were completed in 82 patients (April 2016-January 2019). The most common coaching focus (46% of patients) was combined emotional/spiritual and loss/grief. PHQ-9 was assessed in 54 patients at baseline and session 3; improvement occurred in 30 of the 54 patients (56%). In patients with baseline moderate to severe depression, 70% of patients experienced decreased depression. Anonymous patient experience survey (n = 21) revealed that 86% of patients in this program strongly agreed or agreed that their physical health and 95% strongly agreed or agreed that their mental health was positively impacted by working with the health coach. All patients (100%) strongly agreed or agreed that they were satisfied with the Fairview Specialty Pharmacy health coaching program. The health coach referred 37 patients to additional services, including support groups, social workers, case managers, physicians, psychiatrists, and hospice or advance care planning. Conclusions: The specialty pharmacy health coaching program was impactful, as measured by high patient satisfaction, positive patient perception of program impact on physical and mental health,
{"title":"Evaluation of a specialty pharmacy health coaching program","authors":"D. Simonson, Marj Wittenborg, M. Snyder, H. Wiest, A. Mcnamara","doi":"10.1080/21556660.2019.1658316","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658316","url":null,"abstract":"Abstract Background: Fairview Specialty Pharmacy provides comprehensive therapy management (TM) for patients, yet some patients require additional social, physical, and psychological support that may be unmet by a pharmacist or nurse. To address complex patient needs and remotely improve social determinants of health, a health coach is employed. The projected benefits of a health coaching program for patients include providing holistic support for health and mental well-being, identifying and overcoming barriers to healthy coping, and identifying additional resources for support. Aims: Goals of this study were to determine the impact of a health coach in patients who receive specialty pharmacy services as measured by number of referrals to this program, patient satisfaction and perceived impact on health, and impact on patient depression scores. Methods: Health coaching services were offered to patients during initial TM call or when a trigger was identified, such as emotional distress, new chronic illness diagnosis, life transition, coping issues, stress management, end of life, advanced care planning, or family concerns. Initial outreach health coach call to the patient provided program overview, confirmed interest, determined focus area (emotional/spiritual needs, loss/grief, lifestyle changes, or stress management), encouraged goal setting, and documented baseline depression score using the Patient Health Questionnaire (PHQ-9). Follow-up calls between the patient and health coach were focused on patient goals; referrals to additional services were documented. At the end of the third call, the PHQ-9 was given and a satisfaction survey was mailed to the patient. Program impact was determined based on satisfaction surveys, referrals, and the change in PHQ-9 after the third call. Results: 623 health coaching assessments were completed in 82 patients (April 2016-January 2019). The most common coaching focus (46% of patients) was combined emotional/spiritual and loss/grief. PHQ-9 was assessed in 54 patients at baseline and session 3; improvement occurred in 30 of the 54 patients (56%). In patients with baseline moderate to severe depression, 70% of patients experienced decreased depression. Anonymous patient experience survey (n = 21) revealed that 86% of patients in this program strongly agreed or agreed that their physical health and 95% strongly agreed or agreed that their mental health was positively impacted by working with the health coach. All patients (100%) strongly agreed or agreed that they were satisfied with the Fairview Specialty Pharmacy health coaching program. The health coach referred 37 patients to additional services, including support groups, social workers, case managers, physicians, psychiatrists, and hospice or advance care planning. Conclusions: The specialty pharmacy health coaching program was impactful, as measured by high patient satisfaction, positive patient perception of program impact on physical and mental health, ","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47817492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658288
Binita Bhusal, K. Oleru, V. Arikian, R. Jaster, Marc Stranz, J. Lindhorst
Abstract Background: Specialty medications (SP-D) are high cost prescription medications designed for the treatment of complex chronic conditions, i.e. cancer and neurological diseases. Such medications require special handling and shipping, administration, and patient education. To achieve the desired treatment outcomes, including minimizing adverse events, medication adherence is key. There are barriers to poor medication adherence, some of which include high cost, poor understanding of disease and associated therapy, psychological status, forgetfulness, complex dosing regimens, and side-effects. The consequences of non-adherence include increased healthcare resource consumption and poor disease treatment outcomes, e.g. increased relapse, decreased survival time, and/or lack of patient satisfaction. Specialty pharmacy provided medication therapy management (SPMTM) can be important to achieving acceptable medication adherence and, therefore, better treatment outcomes. The specialty pharmacy is a community pharmacy focused on dispensing and providing clinical services pertaining to SP-D. It has pharmacy permits in 50 states as well as in Washington DC, Puerto Rico, and the US Virgin Islands. It is accredited by URAC and ACHC as a specialty pharmacy. Some of the key services provided by specialty pharmacy are: oncology, neurology, autoimmune disease, analgesia (non-controlled drug), investigational drugs, and other SP-D to treat rare/ultra-rare conditions. Aims: The primary objective of the study was to measure the adherence rate to the oncology and neurology SP-D dispensed by the specialty pharmacy. The secondary objective of this study is to compare the quality-of-life (QoL) of patients who voluntarily participated in the SPMTM program at the program’s start of care (SOC) assessment (before the SP-D had been started) and at the follow-up (F-U) assessment (after SP-D had been started). Methods: A retrospective, observational study of patient reported outcomes (PRO) was conducted at a specialty pharmacy among patients diagnosed with various forms of cancers and neurological issues who had prescriptions filled for SP-D from January 1, 2018 to December 31,2018. Patient education by the pharmacist was offered as part of the SPMTM program throughout patient participation in the program. Each patient was offered medication therapy assessment at SOC and 7 days prior to each refill dispense, using a proprietary clinical assessment instrument designed to capture patient reported data via telephonic interview with patients or their caregivers. Embedded in the assessment instruments were two QoL PRO metrics: (1) Number of days work/school missed; and (2) How have you been feeling? (1–10 scale, where 1 was feeling terrible and 10 was feeling wonderful). The means of the SOC (BEFORE SP drug state) and the F-U (AFTER SP drug state) data were captured monthly and annualized. The annualized means were compared, using the Mann-Whitney U-value (M-WU) two-tailed st
{"title":"Adherence of patients to oral oncolytic and neurologic specialty medications provided by a specialty pharmacy","authors":"Binita Bhusal, K. Oleru, V. Arikian, R. Jaster, Marc Stranz, J. Lindhorst","doi":"10.1080/21556660.2019.1658288","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658288","url":null,"abstract":"Abstract Background: Specialty medications (SP-D) are high cost prescription medications designed for the treatment of complex chronic conditions, i.e. cancer and neurological diseases. Such medications require special handling and shipping, administration, and patient education. To achieve the desired treatment outcomes, including minimizing adverse events, medication adherence is key. There are barriers to poor medication adherence, some of which include high cost, poor understanding of disease and associated therapy, psychological status, forgetfulness, complex dosing regimens, and side-effects. The consequences of non-adherence include increased healthcare resource consumption and poor disease treatment outcomes, e.g. increased relapse, decreased survival time, and/or lack of patient satisfaction. Specialty pharmacy provided medication therapy management (SPMTM) can be important to achieving acceptable medication adherence and, therefore, better treatment outcomes. The specialty pharmacy is a community pharmacy focused on dispensing and providing clinical services pertaining to SP-D. It has pharmacy permits in 50 states as well as in Washington DC, Puerto Rico, and the US Virgin Islands. It is accredited by URAC and ACHC as a specialty pharmacy. Some of the key services provided by specialty pharmacy are: oncology, neurology, autoimmune disease, analgesia (non-controlled drug), investigational drugs, and other SP-D to treat rare/ultra-rare conditions. Aims: The primary objective of the study was to measure the adherence rate to the oncology and neurology SP-D dispensed by the specialty pharmacy. The secondary objective of this study is to compare the quality-of-life (QoL) of patients who voluntarily participated in the SPMTM program at the program’s start of care (SOC) assessment (before the SP-D had been started) and at the follow-up (F-U) assessment (after SP-D had been started). Methods: A retrospective, observational study of patient reported outcomes (PRO) was conducted at a specialty pharmacy among patients diagnosed with various forms of cancers and neurological issues who had prescriptions filled for SP-D from January 1, 2018 to December 31,2018. Patient education by the pharmacist was offered as part of the SPMTM program throughout patient participation in the program. Each patient was offered medication therapy assessment at SOC and 7 days prior to each refill dispense, using a proprietary clinical assessment instrument designed to capture patient reported data via telephonic interview with patients or their caregivers. Embedded in the assessment instruments were two QoL PRO metrics: (1) Number of days work/school missed; and (2) How have you been feeling? (1–10 scale, where 1 was feeling terrible and 10 was feeling wonderful). The means of the SOC (BEFORE SP drug state) and the F-U (AFTER SP drug state) data were captured monthly and annualized. The annualized means were compared, using the Mann-Whitney U-value (M-WU) two-tailed st","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47585574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658326
A. Zuckerman, Megan E. Peter, Samuel A. Starks, M. Maulis, Josh Declerq, Leena Choi, M. Jagasia
Abstract Background: Barriers to accessing oral oncolytic therapy include insurance authorization, high copays and limited distribution drug (LDD) networks. In September 2015, a pharmacist joined an outpatient hematology clinic to facilitate timeliness of medications (for which the pharmacy has access) dispensed by Vanderbilt Specialty Pharmacy (VSP). The scope expanded to manage non-VSP medications (LDD) in June 2016. Aims: Compare access time to oral oncolytic therapy between drugs to which VSP has access vs. non-VSP medications, and to test whether patient access time to non-VSP agents reduced after integrating a pharmacist. Methods: We reviewed medical records of adult patients prescribed oral oncolytic therapy by a hematology provider. The primary outcome was the time (in days) from treatment decision to medication shipment, stratified by drug access (VSP vs. non-VSP) and time (Time 1: September 2015–May 2016; Time 2: June 2016–September 2017). Using proportional odds logistic regression, we compared time to medication shipment between VSP and non-VSP drugs, and tested whether time to shipment decreased for non-VSP drugs from Time 1 to Time 2. Results: A total of 367 patients with 410 prescriptions were included: 285 VSP drugs and 125 non-VSP drugs. Median time from treatment decision to shipment was 6 days (IQR: 3–9) for non-VSP and 3 days (IQR: 1–6) for VSP drugs. In Time 1, time from treatment decision to shipment was significantly longer for non-VSP vs. VSP drugs (OR = 6.5, p < .001). For non-VSP drugs, time to shipment reduced from Time 1 to Time 2 (OR = −0.41, p = .04). Conclusions: Integrating a pharmacist into clinic significantly shortened time from treatment decision to shipment for non-VSP drugs. However, access to these drugs is still slower than VSP medications as they cannot be fully integrated into clinic workflow. The integrated pharmacist at VSP adds value to patient access and outperforms LDD medications, challenging the value of LDD networks beyond medical economics.
{"title":"Predicting time to medication access for hematologic malignancies: the impact of an integrated specialty pharmacy and limited distribution drug networks","authors":"A. Zuckerman, Megan E. Peter, Samuel A. Starks, M. Maulis, Josh Declerq, Leena Choi, M. Jagasia","doi":"10.1080/21556660.2019.1658326","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658326","url":null,"abstract":"Abstract Background: Barriers to accessing oral oncolytic therapy include insurance authorization, high copays and limited distribution drug (LDD) networks. In September 2015, a pharmacist joined an outpatient hematology clinic to facilitate timeliness of medications (for which the pharmacy has access) dispensed by Vanderbilt Specialty Pharmacy (VSP). The scope expanded to manage non-VSP medications (LDD) in June 2016. Aims: Compare access time to oral oncolytic therapy between drugs to which VSP has access vs. non-VSP medications, and to test whether patient access time to non-VSP agents reduced after integrating a pharmacist. Methods: We reviewed medical records of adult patients prescribed oral oncolytic therapy by a hematology provider. The primary outcome was the time (in days) from treatment decision to medication shipment, stratified by drug access (VSP vs. non-VSP) and time (Time 1: September 2015–May 2016; Time 2: June 2016–September 2017). Using proportional odds logistic regression, we compared time to medication shipment between VSP and non-VSP drugs, and tested whether time to shipment decreased for non-VSP drugs from Time 1 to Time 2. Results: A total of 367 patients with 410 prescriptions were included: 285 VSP drugs and 125 non-VSP drugs. Median time from treatment decision to shipment was 6 days (IQR: 3–9) for non-VSP and 3 days (IQR: 1–6) for VSP drugs. In Time 1, time from treatment decision to shipment was significantly longer for non-VSP vs. VSP drugs (OR = 6.5, p < .001). For non-VSP drugs, time to shipment reduced from Time 1 to Time 2 (OR = −0.41, p = .04). Conclusions: Integrating a pharmacist into clinic significantly shortened time from treatment decision to shipment for non-VSP drugs. However, access to these drugs is still slower than VSP medications as they cannot be fully integrated into clinic workflow. The integrated pharmacist at VSP adds value to patient access and outperforms LDD medications, challenging the value of LDD networks beyond medical economics.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49078304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658300
C. Tyson, A. Relan, P. Adams, A. Haynes, R. Magar
Abstract Background: Hereditary angioedema (HAE) is a rare C1-inhibitor (C1-INH) deficiency disease involving recurrent painful episodes of severe swelling that should be promptly treated. Aims: To determine cost and utility estimates for on-demand treatment of HAE attacks in order to better clarify and control expenses related to disease management. Methods: A decision-tree model included four comparators (ecallantide, icatibant, plasma-derived [pd] C1-INH, and recombinant human C1-INH [rhC1-INH]) and incorporated probabilities for self-administration vs healthcare provider administration, re-dosing, and hospitalization risk. Modeled costs comprised HAE therapies and healthcare system expenses. Effectiveness considered utility during attacks (0.51), no-attack baseline (0.83), and time to attack resolution. Overall drug cost and effectiveness per attack were used to estimate cost per quality-adjusted life year (QALY). Sensitivity analyses were performed to establish cost-effectiveness ranges. A budget impact model was developed for a health plan of 1 million (M) covered lives. Results: Costs and utility per attack were, respectively, $12,342 and 0.804 for rhC1-INH, $14,369 and 0.749 for icatibant, $13,993 and 0.759 for pdC1-INH, and $20,315 and 0.786 for ecallantide. At a mean annual attack rate of 26.9, cost per QALY was $402,769 for rhC1-INH, $475,942 for icatibant, $462,275 for pdC1-INH, and $666,153 for ecallantide. Re-dose rate was identified as a primary driver of cost-effectiveness variability. Estimated annual cost to the plan was $6.64 M for rhC1-INH, $7.73 M for icatibant, $7.53 M for pdC1-INH, and $10.93 M for ecallantide. A 5000-trial probabilistic sensitivity analysis (PSA) indicated that rhC1-INH was the most cost-effective in many scenarios, while ecallantide was the least cost-effective: mean costs (effectiveness) from PSA were $12,390 (0.786) for rhC1-INH, $14,132 (0.738) for icatibant, $13,050 (0.746) for pdC-1INH, and $20,286 (0.785) for ecallantide. Conclusions: This model demonstrated that rhC1-INH was the most cost-effective and ecallantide the least cost-effective on-demand HAE treatment and, overall, cost-effectiveness was substantially impacted by re-dosing rates. For icatibant, re-dosing rates of up to 44% to treat an HAE attack have been reported, and prescribing information allows up to three doses per 24-h period to treat a single attack. Driven by higher re-dosing rates, icatibant suffers from a higher per-attack drug cost and comparatively poor effectiveness.
{"title":"Cost-effectiveness model for on-demand treatment of hereditary angioedema (HAE) attacks","authors":"C. Tyson, A. Relan, P. Adams, A. Haynes, R. Magar","doi":"10.1080/21556660.2019.1658300","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658300","url":null,"abstract":"Abstract Background: Hereditary angioedema (HAE) is a rare C1-inhibitor (C1-INH) deficiency disease involving recurrent painful episodes of severe swelling that should be promptly treated. Aims: To determine cost and utility estimates for on-demand treatment of HAE attacks in order to better clarify and control expenses related to disease management. Methods: A decision-tree model included four comparators (ecallantide, icatibant, plasma-derived [pd] C1-INH, and recombinant human C1-INH [rhC1-INH]) and incorporated probabilities for self-administration vs healthcare provider administration, re-dosing, and hospitalization risk. Modeled costs comprised HAE therapies and healthcare system expenses. Effectiveness considered utility during attacks (0.51), no-attack baseline (0.83), and time to attack resolution. Overall drug cost and effectiveness per attack were used to estimate cost per quality-adjusted life year (QALY). Sensitivity analyses were performed to establish cost-effectiveness ranges. A budget impact model was developed for a health plan of 1 million (M) covered lives. Results: Costs and utility per attack were, respectively, $12,342 and 0.804 for rhC1-INH, $14,369 and 0.749 for icatibant, $13,993 and 0.759 for pdC1-INH, and $20,315 and 0.786 for ecallantide. At a mean annual attack rate of 26.9, cost per QALY was $402,769 for rhC1-INH, $475,942 for icatibant, $462,275 for pdC1-INH, and $666,153 for ecallantide. Re-dose rate was identified as a primary driver of cost-effectiveness variability. Estimated annual cost to the plan was $6.64 M for rhC1-INH, $7.73 M for icatibant, $7.53 M for pdC1-INH, and $10.93 M for ecallantide. A 5000-trial probabilistic sensitivity analysis (PSA) indicated that rhC1-INH was the most cost-effective in many scenarios, while ecallantide was the least cost-effective: mean costs (effectiveness) from PSA were $12,390 (0.786) for rhC1-INH, $14,132 (0.738) for icatibant, $13,050 (0.746) for pdC-1INH, and $20,286 (0.785) for ecallantide. Conclusions: This model demonstrated that rhC1-INH was the most cost-effective and ecallantide the least cost-effective on-demand HAE treatment and, overall, cost-effectiveness was substantially impacted by re-dosing rates. For icatibant, re-dosing rates of up to 44% to treat an HAE attack have been reported, and prescribing information allows up to three doses per 24-h period to treat a single attack. Driven by higher re-dosing rates, icatibant suffers from a higher per-attack drug cost and comparatively poor effectiveness.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49026077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658296
R. Ferraro, S. Quillen, R. Phillips, Brandon Newman
Abstract Background: The area and population served by the Southern Ohio Medical Center (SOMC) is one that has been hit hard by the opioid epidemic, resulting in a very high incidence of Hepatitis C virus infected individuals. In this rural area, many patients have struggled with access to specialty healthcare. In January 2018, specialty pharmacy services were started. The main goals were to provide a valuable and personalized service to patients and increase access to specialty medications. When taken as prescribed, HCV therapies can lead to high cure rates (>95%). The program integrated a clinical pharmacist and pharmacy liaison in the infectious disease clinic to begin providing in-clinic education, 24/7 support, prior authorization assistance, financial aid assistance, refill reminders, and other services to patients. The specialty pharmacy service has assisted many local patients to obtain treatment for HCV. The following data analysis details the study design and results. Aims: The study was completed to assess the impact of the clinic-based specialty pharmacy program on medication access, affordability, and clinical outcomes for patients with HCV. Methods: The study was IRB-approved. Endpoints measured were SVR12 rates, rates of patient return for SVR12 labs, and out-of-pocket costs for patients using the SOMC Specialty Pharmacy. To be eligible for the study, patients must have started an HCV regimen written by an SOMC provider after January 1, 2018. Data was collected by reviewing patient electronic medical records and pharmacy dispensing records. Results: The study included 67 HCV patients who utilized the SOMC specialty pharmacy program to obtain treatment. Thirty-seven of the patients were male, none had liver decompensation, and 65 were treatment-naïve. By offering in-clinic specialty pharmacy services to patients, SOMC was able to remove barriers, such as cost, to improve specialty medication access and adherence. This resulted in 100% medication access and therapy completion rates for participating patients. SVR12 rates were higher than clinical trials. Finally, the average out of pocket cost to patients was found to be $0.75, with 90% of patients having zero copay. Clinical pharmacists and pharmacy liaisons played a key role in achieving this result by providing in-person education to patients, securing financial assistance for patients, and regularly following-up with patients regarding their therapy. Conclusions: Clinic-based health system specialty pharmacy programs can play a vital role in improving medication access and adherence, leading to better clinical outcomes. By offering on-site specialty pharmacy services, SOMC provides a personalized patient experience and affordable access to specialty prescriptions. These elements help ensure patients adhere to their treatment regimens over time and fully realize the benefits of their specialty medications.
{"title":"Real-world assessment of an integrated clinical model on oral hepatitis C therapy at Southern Ohio Medical Center","authors":"R. Ferraro, S. Quillen, R. Phillips, Brandon Newman","doi":"10.1080/21556660.2019.1658296","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658296","url":null,"abstract":"Abstract Background: The area and population served by the Southern Ohio Medical Center (SOMC) is one that has been hit hard by the opioid epidemic, resulting in a very high incidence of Hepatitis C virus infected individuals. In this rural area, many patients have struggled with access to specialty healthcare. In January 2018, specialty pharmacy services were started. The main goals were to provide a valuable and personalized service to patients and increase access to specialty medications. When taken as prescribed, HCV therapies can lead to high cure rates (>95%). The program integrated a clinical pharmacist and pharmacy liaison in the infectious disease clinic to begin providing in-clinic education, 24/7 support, prior authorization assistance, financial aid assistance, refill reminders, and other services to patients. The specialty pharmacy service has assisted many local patients to obtain treatment for HCV. The following data analysis details the study design and results. Aims: The study was completed to assess the impact of the clinic-based specialty pharmacy program on medication access, affordability, and clinical outcomes for patients with HCV. Methods: The study was IRB-approved. Endpoints measured were SVR12 rates, rates of patient return for SVR12 labs, and out-of-pocket costs for patients using the SOMC Specialty Pharmacy. To be eligible for the study, patients must have started an HCV regimen written by an SOMC provider after January 1, 2018. Data was collected by reviewing patient electronic medical records and pharmacy dispensing records. Results: The study included 67 HCV patients who utilized the SOMC specialty pharmacy program to obtain treatment. Thirty-seven of the patients were male, none had liver decompensation, and 65 were treatment-naïve. By offering in-clinic specialty pharmacy services to patients, SOMC was able to remove barriers, such as cost, to improve specialty medication access and adherence. This resulted in 100% medication access and therapy completion rates for participating patients. SVR12 rates were higher than clinical trials. Finally, the average out of pocket cost to patients was found to be $0.75, with 90% of patients having zero copay. Clinical pharmacists and pharmacy liaisons played a key role in achieving this result by providing in-person education to patients, securing financial assistance for patients, and regularly following-up with patients regarding their therapy. Conclusions: Clinic-based health system specialty pharmacy programs can play a vital role in improving medication access and adherence, leading to better clinical outcomes. By offering on-site specialty pharmacy services, SOMC provides a personalized patient experience and affordable access to specialty prescriptions. These elements help ensure patients adhere to their treatment regimens over time and fully realize the benefits of their specialty medications.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43242745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658322
Adina Petrosan, Kristen D. Belfield, E. Cohen, M. DelVecchio, Martha Stutsky
Abstract Background: Post-kidney transplant patients are initiated on a complicated medication therapy regimen including 6-7 new medications, with each consisting of multiple tablets or capsules. Medication adherence may be difficult due to the complexity of the regimen and non-adherence can lead to an increased risk of rejection. At Yale New Haven Transplant Center (YNHTC), patients are presented with the option to receive their medications through Outpatient Pharmacy Services (OPS), a Yale New Haven Health specialty pharmacy. Aims: The objective of this study is to determine the impact of OPS on patients’ medication adherence. Methods: A retrospective, single center, chart review was conducted of 50 patients who received a kidney transplant at YNHTC between January 2017 and June 2017. Exclusion criteria included patients who were actively enrolled in a research study, deceased within one year of transplant, or had incomplete medical records. Refill data of patients’ prescribed doses of anti-rejection medications (tacrolimus, cyclosporine, mycophenolate and azathioprine) was manually retrieved from pharmacies. Adherence was assessed by calculating the proportion of days covered (PDC) in a 365-day time period. The adherence rate between each drug class was then averaged. The primary outcome was the relationship between the patient’s pharmacy and the adherence rate (PDC). Patients were divided into three groups; patients who use OPS (n = 26), patients who use both OPS and another pharmacy (n = 8), and patients who use another pharmacy only (n = 16). Secondary outcomes included pre-transplant adherence survey, MediSetGo score, and number of post-transplant readmissions (hospital stay greater than 24 hours). Results: PDC ranged between 65.5-100% for OPS (average = 94.8%), 56.5–98.5% for OPS and another pharmacy (average = 83.2%), and 53.5–100% for another pharmacy only (average = 91.8%). The PDC was significantly lower for patients who used OPS and another pharmacy compared to either OPS alone or another pharmacy alone (p = .045). Secondary endpoints studied, such as third-party payer, pre-transplant adherence survey and MediSetGo score, were not found to be related to the PDC. Conclusions: Use of OPS alone did not impact the one-year medication adherence rate of post kidney transplant patients. However, a patient’s medication adherence rate may be related to the use of multiple pharmacies versus one single pharmacy. Further studies to investigate this relationship should be conducted.
{"title":"Impact of outpatient specialty pharmacy on medication adherence in post-kidney transplant patients","authors":"Adina Petrosan, Kristen D. Belfield, E. Cohen, M. DelVecchio, Martha Stutsky","doi":"10.1080/21556660.2019.1658322","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658322","url":null,"abstract":"Abstract Background: Post-kidney transplant patients are initiated on a complicated medication therapy regimen including 6-7 new medications, with each consisting of multiple tablets or capsules. Medication adherence may be difficult due to the complexity of the regimen and non-adherence can lead to an increased risk of rejection. At Yale New Haven Transplant Center (YNHTC), patients are presented with the option to receive their medications through Outpatient Pharmacy Services (OPS), a Yale New Haven Health specialty pharmacy. Aims: The objective of this study is to determine the impact of OPS on patients’ medication adherence. Methods: A retrospective, single center, chart review was conducted of 50 patients who received a kidney transplant at YNHTC between January 2017 and June 2017. Exclusion criteria included patients who were actively enrolled in a research study, deceased within one year of transplant, or had incomplete medical records. Refill data of patients’ prescribed doses of anti-rejection medications (tacrolimus, cyclosporine, mycophenolate and azathioprine) was manually retrieved from pharmacies. Adherence was assessed by calculating the proportion of days covered (PDC) in a 365-day time period. The adherence rate between each drug class was then averaged. The primary outcome was the relationship between the patient’s pharmacy and the adherence rate (PDC). Patients were divided into three groups; patients who use OPS (n = 26), patients who use both OPS and another pharmacy (n = 8), and patients who use another pharmacy only (n = 16). Secondary outcomes included pre-transplant adherence survey, MediSetGo score, and number of post-transplant readmissions (hospital stay greater than 24 hours). Results: PDC ranged between 65.5-100% for OPS (average = 94.8%), 56.5–98.5% for OPS and another pharmacy (average = 83.2%), and 53.5–100% for another pharmacy only (average = 91.8%). The PDC was significantly lower for patients who used OPS and another pharmacy compared to either OPS alone or another pharmacy alone (p = .045). Secondary endpoints studied, such as third-party payer, pre-transplant adherence survey and MediSetGo score, were not found to be related to the PDC. Conclusions: Use of OPS alone did not impact the one-year medication adherence rate of post kidney transplant patients. However, a patient’s medication adherence rate may be related to the use of multiple pharmacies versus one single pharmacy. Further studies to investigate this relationship should be conducted.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658322","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43589277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658321
Vincent Tao, Talia Papiro, Martha Stutsky, M. DelVecchio, S.A.M. Kelly
Abstract Background: Specialty medications represent a growing part of the pharmacological management of chronic disease states such as cystic fibrosis (CF). The management of CF in the pediatric population is complex, as it involves multiple medications and treatment success is largely determined by adherence to the care plan. There is often a delay between prescribing of specialty medications and initiation of therapy in the pediatric CF population. Health-system specialty pharmacy services provide significant benefits when compared to external specialty pharmacies, including direct access to the medical record, collaboration with the healthcare team, continuous patient education and continuity of care. Aims: The objective of this initiative was to assess the impact of Outpatient Pharmacy Services at Yale New Haven Health (OPS), a health system specialty pharmacy, on medication adherence in pediatric patients with CF. Methods: A prospective review of 65 pediatric patients with CF seen by the pharmacist in a health-system CF clinic over 6 months was conducted for medication adherence and compared to a retrospective cohort. Education about the health-system specialty pharmacy services was provided to patients through the following methods: invitation letter, informational pamphlets distributed in clinic and direct education by the clinic pharmacist. A clinic workflow was implemented to streamline the referral process. Primary endpoints include: medication possession ratio (MPR), proportion of days covered (PDC), and percentage of prescriptions sent to and filled by the OPS. Results: A total of 65 pediatric CF prescriptions were written from September 2017 to February 2018, with only 7.7% of the prescriptions sent to OPS prior to implementation of the clinic workflow. The MPR and PDC in this retrospective cohort were 0.85 and 0.75 respectively. From September 2018 to February 2019 the number of prescriptions for all medications written was 304, with 32.9% sent to OPS and a fill rate of 89%. The MPR and PDC for that year were 0.86 and 0.80 respectively. Conclusions: This single-center review that assessed the impact of specialty pharmacy services on pediatric patients with CF in a large health system demonstrated improved and sustained patient medication adherence. The increase in utilization of OPS led to an increase in prescriptions received and filled by the health-system specialty pharmacy.
{"title":"Impact of health-system specialty pharmacy services on medication adherence in pediatric patients with cystic fibrosis","authors":"Vincent Tao, Talia Papiro, Martha Stutsky, M. DelVecchio, S.A.M. Kelly","doi":"10.1080/21556660.2019.1658321","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658321","url":null,"abstract":"Abstract Background: Specialty medications represent a growing part of the pharmacological management of chronic disease states such as cystic fibrosis (CF). The management of CF in the pediatric population is complex, as it involves multiple medications and treatment success is largely determined by adherence to the care plan. There is often a delay between prescribing of specialty medications and initiation of therapy in the pediatric CF population. Health-system specialty pharmacy services provide significant benefits when compared to external specialty pharmacies, including direct access to the medical record, collaboration with the healthcare team, continuous patient education and continuity of care. Aims: The objective of this initiative was to assess the impact of Outpatient Pharmacy Services at Yale New Haven Health (OPS), a health system specialty pharmacy, on medication adherence in pediatric patients with CF. Methods: A prospective review of 65 pediatric patients with CF seen by the pharmacist in a health-system CF clinic over 6 months was conducted for medication adherence and compared to a retrospective cohort. Education about the health-system specialty pharmacy services was provided to patients through the following methods: invitation letter, informational pamphlets distributed in clinic and direct education by the clinic pharmacist. A clinic workflow was implemented to streamline the referral process. Primary endpoints include: medication possession ratio (MPR), proportion of days covered (PDC), and percentage of prescriptions sent to and filled by the OPS. Results: A total of 65 pediatric CF prescriptions were written from September 2017 to February 2018, with only 7.7% of the prescriptions sent to OPS prior to implementation of the clinic workflow. The MPR and PDC in this retrospective cohort were 0.85 and 0.75 respectively. From September 2018 to February 2019 the number of prescriptions for all medications written was 304, with 32.9% sent to OPS and a fill rate of 89%. The MPR and PDC for that year were 0.86 and 0.80 respectively. Conclusions: This single-center review that assessed the impact of specialty pharmacy services on pediatric patients with CF in a large health system demonstrated improved and sustained patient medication adherence. The increase in utilization of OPS led to an increase in prescriptions received and filled by the health-system specialty pharmacy.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43889420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658331
R. Brook, M. Sax, J. A. Carlisle, J. Smeeding
Abstract Background: Specialty medicines continue to increase as a percentage of spending with biologics representing a large portion of specialty spending. Health plans expect to adjust their formularies to maximize expected savings from biosimilars. Objectives: A better understanding of health plan management of specialty pharmacy (SP), SP products and biosimilars. Methods: Online survey of health plan executives on: roles and plan information, specialty pharmacies and specialty pharmaceuticals, expected biosimilar coverage/restrictions/copays. Results were compared with prior surveys (changes >2% reported). Results: Survey completed by 85 respondents: 42.9% were senior officers, 13.1% regional, 8.3% payor specific, 1.2% therapeutic area specific; 36.9% worked for healthplans, 13.1% PBMs, 9.5% IDNs, 2.4% PPOs/IPAs, 1.2% Government. Plans were national = 29.9%, regional = 24.7% or local = 22.1% and cover multiple member types: commercial (58.6% = FFS, 77.8% = HMO/PPO), Medicaid (Traditional = 27.8%, HMO/PPO = 72.3%), Medicare (71%, PDP-only = 51%), Employer/Self-funded = 79% and IDN (43.6%, 340B Qualified = 43.8%); 45.6% reported the plan’s PBM as their SP provider and providers were restricted by 58% ↓23% with plans restricting products: 58% to those under contract, 11.6% for those available through multiple SPs, 10.1% allow any SP handling a product and 4.4% carving out their SPs. Compared with last year, providers shifted approximately 6% from independents to internally provided and currently 45.6% are PBM owned, 38.2% health plan owned, 25% independent and 13.2% hospital/IDN owned. SP products continue to move from fixed to percentage copays with more plans determining by group and benefit design. Plans covered clinician-administered products under the medical benefit (36.8%↓7.3%), 2.9% under the pharmacy benefit; the remainder used price and plan design. Biosimilar use expected for all reference product indications 58.8%↓5.7%, 31.4%↓13.5% will restrict to approved indications and 9.8% will use indication as the basis for copay. 10%↓15% expect the biosimilar to be the only product available, copays are expected to be discounted off the innovator 58%↓10.1% and 32%↓4.9% to vary based on approval timing. Biosimilar education provided through: different copays = 64.7%, prescriber and patient mailings (76.5%↓4.2% + 58.8%), prescriber and patient calls (51%↓10.6% + 27.5%↑4.1%). Biosimilar savings are expected to be 63.5% this year; in 5 years, 66% of savings are expected to be greater than 20%. Conclusions: Costs associated with specialty pharmacies and specialty pharmacy products have shifted and are expected to grow with some relief coming from biosimilars.
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