{"title":"在神经病学诊所内整合高质量的专业药房服务,以改善药物获取和负担能力","authors":"Brandon Newman, A. Hickman, Kathryn M. Edwards","doi":"10.1080/21556660.2019.1658302","DOIUrl":null,"url":null,"abstract":"Abstract Background: The cost of medications has been an upfront topic in the public, with 24% of patients reporting difficulty with affordable access, and specialty medications contribute to those concerns through an increase in price by 57% since 2014. Specialty pharmacy services (SPS) were implemented into a neurology clinic to assist with medication coverage and affordability. Aims: To assess the impact of integrating high touch SPS within a neurology clinic by measuring migraine medication affordability. Methods: The dispensing data for patients (1) filling a Calcitonin Gene-Related Peptide (CGRP) receptor antagonist (CGRPra) and/or onabotulinumtoxin A (Ona A) for migraine through the onsite specialty pharmacy, and (2) being treated through the SPS-affiliated neurology clinic was gathered and analyzed for medication cost coverage and patient financial responsibility. The study endpoints were to observe a minimized patient copay and assess the amount of $0 copays after the initiation of the clinic-based SPS. Results: For the CGRPra group, the SPS were able to reduce the patient responsibility to 2% of the medication cost, and more than 25% of the CGRPra dispenses had a $0 copay. For the Ona A group, comparing January 2018 to January 2019 showed a 185% increase in vials dispensed on pharmacy benefits and a patient responsibility of < 1% medication cost in January 2019 vs 19% in January 2018. The median copay went from $150 in January 2018 to $0 in January 2019. No vials in January 2018 had $0 copays, 20 did in January 2019. Measuring 6 months before SPS were started and 6 months after, the Ona A had similar results as the January comparison, with an increase of 188% dispensed through the pharmacy and the same median copays, $150 vs $0. The number of vials with $0 copay increased from four before SPS to 112 6 months after SPS was integrated. In addition, through the SPS reimbursement audits and benefit verification for Ona A billing, the Ona A reimbursement is projected to increase by $325,000 over 3 years due to switching Medicaid Ona A patients to bill through pharmacy benefits. Conclusions: The implementation of high touch SPS in a clinic can benefit patients through prescription coordination and price mitigation. Through the SPS, patients were responsible for only 2% of the CGRPra cost and < 1% of the Ona A cost. The SPS were able to verify which insurance branch was preferred for Ona A, which helped mitigate patient copays and improved facility financials for Ona A through upfront reimbursement through the preferred method of pharmacy benefits.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4000,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658302","citationCount":"0","resultStr":"{\"title\":\"Integrating high touch specialty pharmacy services within a neurology clinic to improve medication access and affordability\",\"authors\":\"Brandon Newman, A. Hickman, Kathryn M. Edwards\",\"doi\":\"10.1080/21556660.2019.1658302\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Abstract Background: The cost of medications has been an upfront topic in the public, with 24% of patients reporting difficulty with affordable access, and specialty medications contribute to those concerns through an increase in price by 57% since 2014. Specialty pharmacy services (SPS) were implemented into a neurology clinic to assist with medication coverage and affordability. Aims: To assess the impact of integrating high touch SPS within a neurology clinic by measuring migraine medication affordability. Methods: The dispensing data for patients (1) filling a Calcitonin Gene-Related Peptide (CGRP) receptor antagonist (CGRPra) and/or onabotulinumtoxin A (Ona A) for migraine through the onsite specialty pharmacy, and (2) being treated through the SPS-affiliated neurology clinic was gathered and analyzed for medication cost coverage and patient financial responsibility. The study endpoints were to observe a minimized patient copay and assess the amount of $0 copays after the initiation of the clinic-based SPS. Results: For the CGRPra group, the SPS were able to reduce the patient responsibility to 2% of the medication cost, and more than 25% of the CGRPra dispenses had a $0 copay. For the Ona A group, comparing January 2018 to January 2019 showed a 185% increase in vials dispensed on pharmacy benefits and a patient responsibility of < 1% medication cost in January 2019 vs 19% in January 2018. The median copay went from $150 in January 2018 to $0 in January 2019. No vials in January 2018 had $0 copays, 20 did in January 2019. Measuring 6 months before SPS were started and 6 months after, the Ona A had similar results as the January comparison, with an increase of 188% dispensed through the pharmacy and the same median copays, $150 vs $0. The number of vials with $0 copay increased from four before SPS to 112 6 months after SPS was integrated. In addition, through the SPS reimbursement audits and benefit verification for Ona A billing, the Ona A reimbursement is projected to increase by $325,000 over 3 years due to switching Medicaid Ona A patients to bill through pharmacy benefits. Conclusions: The implementation of high touch SPS in a clinic can benefit patients through prescription coordination and price mitigation. Through the SPS, patients were responsible for only 2% of the CGRPra cost and < 1% of the Ona A cost. The SPS were able to verify which insurance branch was preferred for Ona A, which helped mitigate patient copays and improved facility financials for Ona A through upfront reimbursement through the preferred method of pharmacy benefits.\",\"PeriodicalId\":15631,\"journal\":{\"name\":\"Journal of Drug Assessment\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2019-09-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1080/21556660.2019.1658302\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Drug Assessment\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1080/21556660.2019.1658302\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Drug Assessment","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/21556660.2019.1658302","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Integrating high touch specialty pharmacy services within a neurology clinic to improve medication access and affordability
Abstract Background: The cost of medications has been an upfront topic in the public, with 24% of patients reporting difficulty with affordable access, and specialty medications contribute to those concerns through an increase in price by 57% since 2014. Specialty pharmacy services (SPS) were implemented into a neurology clinic to assist with medication coverage and affordability. Aims: To assess the impact of integrating high touch SPS within a neurology clinic by measuring migraine medication affordability. Methods: The dispensing data for patients (1) filling a Calcitonin Gene-Related Peptide (CGRP) receptor antagonist (CGRPra) and/or onabotulinumtoxin A (Ona A) for migraine through the onsite specialty pharmacy, and (2) being treated through the SPS-affiliated neurology clinic was gathered and analyzed for medication cost coverage and patient financial responsibility. The study endpoints were to observe a minimized patient copay and assess the amount of $0 copays after the initiation of the clinic-based SPS. Results: For the CGRPra group, the SPS were able to reduce the patient responsibility to 2% of the medication cost, and more than 25% of the CGRPra dispenses had a $0 copay. For the Ona A group, comparing January 2018 to January 2019 showed a 185% increase in vials dispensed on pharmacy benefits and a patient responsibility of < 1% medication cost in January 2019 vs 19% in January 2018. The median copay went from $150 in January 2018 to $0 in January 2019. No vials in January 2018 had $0 copays, 20 did in January 2019. Measuring 6 months before SPS were started and 6 months after, the Ona A had similar results as the January comparison, with an increase of 188% dispensed through the pharmacy and the same median copays, $150 vs $0. The number of vials with $0 copay increased from four before SPS to 112 6 months after SPS was integrated. In addition, through the SPS reimbursement audits and benefit verification for Ona A billing, the Ona A reimbursement is projected to increase by $325,000 over 3 years due to switching Medicaid Ona A patients to bill through pharmacy benefits. Conclusions: The implementation of high touch SPS in a clinic can benefit patients through prescription coordination and price mitigation. Through the SPS, patients were responsible for only 2% of the CGRPra cost and < 1% of the Ona A cost. The SPS were able to verify which insurance branch was preferred for Ona A, which helped mitigate patient copays and improved facility financials for Ona A through upfront reimbursement through the preferred method of pharmacy benefits.