Specialty pharmacy and the medication access dilemma

2015 ◽  
Vol 72 (9) ◽  
pp. 695-695 ◽  
Author(s):  
Rebekah L. Hanson
Keyword(s):  
Medication Access ◽  
Specialty Pharmacy

scholarly journals Predicting time to medication access for hematologic malignancies: the impact of an integrated specialty pharmacy and limited distribution drug networks

2019 ◽  
Vol 8 (sup1) ◽  
pp. 45-45
Author(s):  
Autumn D. Zuckerman ◽  
Megan E. Peter ◽  
Samuel Starks ◽  
Matthew Maulis ◽  
Josh Declerq ◽  
...  
Keyword(s):  
Hematologic Malignancies ◽  
Limited Distribution ◽  
Medication Access ◽  
Specialty Pharmacy ◽  
The Impact ◽  
Drug Networks

scholarly journals Impact of Pharmacy Services on Time to Elexacaftor-Tezacaftor-Ivacaftor Initiation

2021 ◽  
Author(s):  
Lauren Roder ◽  
Michelle Simonsen ◽  
Lindsey Fitzpatrick ◽  
Jennifer Loucks ◽  
Jianghua He
Keyword(s):  
Cystic Fibrosis ◽  
Health System ◽  
Retrospective Chart Review ◽  
Pharmacy Services ◽  
Related Complication ◽  
Receptor Modulator ◽  
Medication Access ◽  
Fda Approval ◽  
Specialty Pharmacy ◽  
The Impact

The approval of elexacaftor-tezacaftor-ivacaftor (ELX/TEZ/IVA) expanded highly effective cystic fibrosis transmembrane receptor modulator therapy to approximately 90% of persons age 12 and older with cystic fibrosis. Clinical pharmacists and pharmacy technicians played a key role in planning for ELX/TEZ/IVA initiation prior to FDA approval as well as initiating therapy after approval. This study evaluates the impact of pharmacy services on time to ELX/TEZ/IVA initiation. A retrospective chart review evaluated patients qualifying for ELX/TEZ/IVA at a single health system between October 21, 2019 and April 1, 2020. Patients filling ELX/TEZ/IVA at an integrated health system specialty pharmacy (HSSP) versus an outside specialty pharmacy (SP) started on therapy an average of 10.8 days faster (10.8 days ± 14.0 vs 21.6 days ± 18.8 respectively; p=0.006). More patients filling at a HSSP received ELX/TEZ/IVA within 14 days of the prescription being written compared to outside SPs (82.0% vs 41.4% respectively; p=0.001). Pre-ELX/TEZ/IVA initiation, patients were hospitalized for a CF related complication for an average of 6.26 days (range 0-183) compared to 1.16 days (range 0-91) post-ELX/TEZ/IVA initiation. Lastly, an estimated $134,810 was saved in the 105 patients that were able to fill ELX/TEZ/IVA at a HSSP by initiating drug an average of 10.8 days quicker than outside SPs. The results of this study demonstrate the value of an integrated HSSP model. Further advocacy for inclusion of integrated HSSPs by pharmacy benefit managers is needed to optimize medication access, control costs, and improve patient outcomes for patients receiving care within a health system.

Comparison of rates of adherence to oral chemotherapy medications filled through an internal health-system specialty pharmacy vs external specialty pharmacies

2020 ◽  
Vol 77 (14) ◽  
pp. 1118-1127
Author(s):  
Colleen C McCabe ◽  
Meagan S Barbee ◽  
Marley L Watson ◽  
Alyssa Billmeyer ◽  
Collin E Lee ◽  
...  
Keyword(s):  
Health System ◽  
Multiple Regression ◽  
Patient Adherence ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medication Possession Ratio ◽  
Primary Objective ◽  
Wilcoxon Test ◽  
Tumor Type ◽  
Specialty Pharmacy

Abstract Purpose The primary objective of the study described here was to compare rates of patient adherence to anticancer medications filled at an internal health system specialty pharmacy (HSSP) vs external specialty pharmacies. The primary outcome was the medication possession ratio (MPR), and the secondary outcomes included proportion of days covered (PDC), and time to treatment (TTT). Methods A retrospective chart review was conducted to compare the MPR, PDC, and TTT for patients who received oral anticancer therapy using prescriptions claim data. A t test or Wilcoxon test was used to explore the effect of demographic and other factors on adherence and TTT. A multiple regression model with backward elimination was used to analyze significant factors to identify covariates significantly associated with the outcomes. Results Of the 300 patients screened for study inclusion, 204 patients whose records had complete MPR and PDC data and 164 whose records had TTT data were included in the analysis. There were significant between-group differences in mean MPR and mean PDC with patient use of the HSSP vs external pharmacies (1.00 vs 0.75 [P < 0.001] and 0.95 vs 0.7 [P < 0.001], respectively). Pharmacy type (P = 0.024) and tumor type (P = 0.048) were significantly associated with TTT. Conclusion The multiple regression analysis indicated that oncology patients who filled their anticancer medication precriptions at an internal HSSP at an academic medical center had significantly higher adherence, as measured by MPR and PDC, and quicker TTT than those who filled their prescriptions at an external specialty pharmacy.

PCN208 Association of Quality of Life with Oncology Medication Adherence in Cancer Patients on the Service of a Specialty Pharmacy

2021 ◽  
Vol 24 ◽  
pp. S58
Author(s):  
R. Burruss ◽  
V. Arikian ◽  
K. Oleru ◽  
T. Traurig ◽  
M. Stranz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Medication Adherence ◽  
Cancer Patients ◽  
Specialty Pharmacy

scholarly journals Absolute Insurer Denial of Direct-Acting Antiviral Therapy for Hepatitis C: A National Specialty Pharmacy Cohort Study

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Charitha Gowda ◽  
Stephen Lott ◽  
Matthew Grigorian ◽  
Dena M Carbonari ◽  
M Elle Saine ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hepatitis C ◽  
The United States ◽  
Public And Private ◽  
Commercial Insurance ◽  
Direct Acting Antiviral ◽  
Insurance Type ◽  
Specialty Pharmacy ◽  
Direct Acting ◽  
Over Time

Abstract Background Despite the availability of new direct-acting antiviral (DAA) regimens, changes in DAA reimbursement criteria, and a public health focus on hepatitis C virus (HCV) elimination, it remains unclear if public and private insurers have increased access to these therapies over time. We evaluated changes in the incidence of absolute denial of DAA therapy over time and by insurance type. Methods We conducted a prospective cohort study among patients who had a DAA prescription submitted from January 2016 to April 2017 to Diplomat Pharmacy, Inc., which provides HCV pharmacy services across the United States. The main outcome was absolute denial of DAA prescription, defined as lack of fill approval by the insurer. We calculated the incidence of absolute denial, overall and by insurance type (Medicaid, Medicare, commercial), for the 16-month study period and each quarter. Results Among 9025 patients from 45 states prescribed a DAA regimen (4702 covered by Medicaid, 1821 Medicare, 2502 commercial insurance), 3200 (35.5%; 95% confidence interval, 34.5%–36.5%) were absolutely denied treatment. Absolute denial was more common among patients covered by commercial insurance (52.4%) than Medicaid (34.5%, P < .001) or Medicare (14.7%, P < .001). The incidence of absolute denial increased across each quarter of the study period, overall (27.7% in first quarter to 43.8% in last quarter; test for trend, P < .001) and for each insurance type (test for trend, P < .001 for each type). Conclusions Despite the availability of new DAA regimens and changes in restrictions of these therapies, absolute denials of DAA regimens by insurers have remained high and increased over time, regardless of insurance type.

Pre-pandemic mental health and disruptions to healthcare, economic and housing outcomes during the COVID-19 pandemic: evidence from 12 UK longitudinal studies

2021 ◽  
pp. 1-10
Author(s):  
Giorgio Di Gessa ◽  
Jane Maddock ◽  
Michael J. Green ◽  
Ellen J. Thompson ◽  
Eoin McElroy ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychological Distress ◽  
Longitudinal Studies ◽  
Health Inequalities ◽  
Economic Activity ◽  
Odds Ratio ◽  
Working Hours ◽  
Household Composition ◽  
Data Sets ◽  
Medication Access

Background The COVID-19 pandemic has disrupted lives and livelihoods, and people already experiencing mental ill health may have been especially vulnerable. Aims Quantify mental health inequalities in disruptions to healthcare, economic activity and housing. Method We examined data from 59 482 participants in 12 UK longitudinal studies with data collected before and during the COVID-19 pandemic. Within each study, we estimated the association between psychological distress assessed pre-pandemic and disruptions since the start of the pandemic to healthcare (medication access, procedures or appointments), economic activity (employment, income or working hours) and housing (change of address or household composition). Estimates were pooled across studies. Results Across the analysed data-sets, 28% to 77% of participants experienced at least one disruption, with 2.3–33.2% experiencing disruptions in two or more domains. We found 1 s.d. higher pre-pandemic psychological distress was associated with (a) increased odds of any healthcare disruptions (odds ratio (OR) 1.30, 95% CI 1.20–1.40), with fully adjusted odds ratios ranging from 1.24 (95% CI 1.09–1.41) for disruption to procedures to 1.33 (95% CI 1.20–1.49) for disruptions to prescriptions or medication access; (b) loss of employment (odds ratio 1.13, 95% CI 1.06–1.21) and income (OR 1.12, 95% CI 1.06 –1.19), and reductions in working hours/furlough (odds ratio 1.05, 95% CI 1.00–1.09) and (c) increased likelihood of experiencing a disruption in at least two domains (OR 1.25, 95% CI 1.18–1.32) or in one domain (OR 1.11, 95% CI 1.07–1.16), relative to no disruption. There were no associations with housing disruptions (OR 1.00, 95% CI 0.97–1.03). Conclusions People experiencing psychological distress pre-pandemic were more likely to experience healthcare and economic disruptions, and clusters of disruptions across multiple domains during the pandemic. Failing to address these disruptions risks further widening mental health inequalities.

Impact of a hospital specialty pharmacy in partnership with a free-standing care coordination organization on time to delivery and receipt of oral anticancer drugs.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 43-43
Author(s):  
Melissa Parsons Beauchemin ◽  
Morgan RL Lichtenstein ◽  
Rohit R. Raghunathan ◽  
Sahil D Doshi ◽  
Cynthia Law ◽  
...  
Keyword(s):  
Care Coordination ◽  
Multivariable Analysis ◽  
Cancer Center ◽  
Free Standing ◽  
Delivery Date ◽  
Anti Cancer ◽  
Before And After ◽  
Specialty Pharmacy ◽  
Insurance Data ◽  
To Receive

43 Background: Most oral anti-cancer drugs (OACD) prescriptions require extensive coordination between providers and payers, which can delay drug receipt. Specialty pharmacies are intended to facilitate communication between multiple entities to deliver OACDs with increased efficiency. In 2018, our cancer center partnered with Shields Health Solutions (SHS), a freestanding organization providing care coordination to implement a hospital-based specialty pharmacy. We evaluated the rate of failed drug receipt (FR) and time to drug receipt (TTR) before and after specialty pharmacy implementation. Methods: We prospectively collected data on all new OACD prescriptions for adult oncology patients at a large, urban cancer center from 1/1/2018 to 12/31/2019. In fall 2018, a specialty pharmacy was opened to facilitate drug procurement for patients. We collected patient demographic, clinical, and insurance data, OACD name, date prescribed, delivery date, and interactions with payers and financial assistance groups. For prescriptions received, TTR was the number of days from OACD prescription to patient receipt of the drug. FR was defined as failure to receive a prescribed OACD. We excluded OACD prescriptions for a washout period of two months during pharmacy initiation. We used multivariable logistic regression to examine factors associated with TTR > 7 days and FR before and after specialty pharmacy implementation. Results: In total, 883 patients were prescribed 1145 new OACDs. The majority of prescribed drugs were targeted treatment (56%, N = 646) and 72% (N = 819) required prior authorization (PA). Of all prescriptions, 86% (N = 999) were successfully received with an overall median TTR of 7 days. Adjusted analyses showed that patients were more likely to receive their drugs in less than 7 days after specialty pharmacy implementation (OR: 1.4 95% CI 1.04 – 1.81), p = 0.03). In an unadjusted analysis, patients were more likely to receive their initial medications after specialty pharmacy implementation, compared to before specialty pharmacy implementation (89% vs. 84%, p = 0.04). Multivariable analysis showed a trend toward more patients receiving drugs after specialty pharmacy implementation (OR: 1.42, 95% CI 0.98 – 2.03, p = 0.06). Conclusions: The implementation of a hospital-based specialty pharmacy in partnership with SHS decreased TTR. This difference is in part attributable to improved care coordination and communication. A centralized approach may improve overall efficiency due to fewer clinical practice disruptions.

A pharmacist-managed virtual consult service to improve tuberculosis screening

2021 ◽  
Author(s):  
Veranika Sasnovskaya ◽  
Lisa M Kumor ◽  
JoAnn Stubbings ◽  
Aimee Chevalier
Keyword(s):  
Adverse Events ◽  
Safety Management ◽  
Consult Service ◽  
Practice Model ◽  
Tuberculosis Screening ◽  
Serious Adverse Events ◽  
Pharmacy Benefit ◽  
Serious Infections ◽  
Biologic Response ◽  
Specialty Pharmacy

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe a pharmacist-managed virtual consult service practice model to improve medication safety in a population of rheumatology patients and evaluate its initial impact on guideline compliance. Summary Optimal pharmacologic care of patients with rheumatologic conditions often revolves around the use of specialty medications such as self-injectable biologics and infused therapies, including biologic response modifiers (BRMs), nearly all of which carry risks of serious adverse events due to their immune-suppressive properties. Possible adverse events include serious infections such as reactivation of tuberculosis (TB) and viral hepatitis B (HBV). This articles describes a pharmacist-managed virtual consult service introduced by a large university-affiliated health system in 2018 to integrate clinical, specialty pharmacy, and therapeutic infusion services for proactive medication and safety management for patients with rheumatologic conditions requiring specialty or infused medications. During a 4-month evaluation period, 157 referrals were sent to the consult service; of 137 consults included in the analysis, 42% were for self-injectable biologic medications, 28% were for intra-articular injections, 26% were for infusions, and 4% were for oral specialty medications. Forty-one percent of the pharmacy benefit consult orders required an intervention prior to submission of prior authorization requests. Most interventions (61%) were clinical in nature and involved the pharmacists ensuring that necessary laboratory work, clinical disease activity scoring, or radiographic imaging were completed prior to submission of the consult results for insurer approval. Conclusion National rates of HBV screening and TB screening for patients prescribed BRMs continue to be suboptimal. The pharmacist-managed virtual consult service is a novel practice model to increase the screening rate to 100% to ensure the safety and appropriate monitoring of patients who are starting or continued on these complex medications.

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