Implementation of an adherence pharmacy referral protocol for patients taking sacubitril/valsartan.

Background: Heart failure is a prevalent disease state associated with limitations in function, hospitalization, and death. The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines recommend medications including sacubitril/valsartan to decrease morbidity and mortality in patients with heart failure. However, if patients are nonadherent to treatment or experience barriers to care, they will forgo these benefits.

Objective: To assess the pharmacy staff compliance rate to a workflow protocol for sacubitril/valsartan prescriptions received by Cleveland Clinic Home Delivery (HD) and Adherence Pharmacy (AP) and determine the nonclinical benefits experienced by the patients enrolled in the protocol.

Methods: At Cleveland Clinic, there are 2 mail-order pharmacies: HD and AP. Both pharmacies offer a variety of benefits and adherence services, with each pharmacy having their own unique services offered. With numerous adherence services provided by both pharmacies, it is likely that patients with heart failure would see clinical and nonclinical benefits, such as cost savings. This project created a triage protocol for patients deemed to experience the most benefit from services offered through AP. The primary endpoint of this project was determining the feasibility of a medication-specific workflow protocol for sacubitril/valsartan prescriptions at HD and AP.

Results: There were 114 qualifying prescriptions per the protocol, and 98 of those prescriptions were appropriately screened by the pharmacy staff, equating to an 86% compliance rate for the primary outcome. Of the 98 patients included in the workflow protocol, prior authorization was completed by pharmacy staff for 41 patients (41.8%), manufacturer copay card was applied for 13 patients (13.3%), 17 patients (17.3%) were enrolled in grant funding programs, and patient assistance program enrollment was initiated for 9 patients (9.2%).

Conclusions: Medication-specific workflows may be a feasible option to implement for pharmacies to ensure the offering of adherence services to patients with high-risk disease states using treatment with expensive, branded medications.