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Anderson B, Snider MJ, Hansen M, Parks C, Bagnola A, Li J, Freimer M, Segal B. Benefit of clinical pharmacists in neurology clinics at an academic medical center. J Am Pharm Assoc (2003) 2024; 64:492-498.e1. [PMID: 38246272 DOI: 10.1016/j.japh.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/24/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Patients with neurologic diseases have complex medical needs and may benefit from the addition of clinical pharmacists in their care. OBJECTIVES This study aimed to describe integration and benefit of clinical pharmacists in neuroimmunology and neuromuscular clinics at an academic medical center. METHODS This retrospective chart review evaluated patients initiated on a neurology medication for a neuroimmunology or neuromuscular disease state before and after pharmacist integration in neurology clinics. The primary outcome measured access to an initially prescribed neuroimmunology or neuromuscular medication within 90 days of prescription. Secondary outcomes included access to an initially prescribed or alternative neurology medication owing to insurance requirements within 90 days, time from initial prescription to start, and description of pharmacist involvement. RESULTS There were 101 patients in the pregroup and 101 patients in the postgroup. The percentage of patients with confirmed initially prescribed medication access at 90 days increased in the postgroup compared with the pregroup (87.1% vs. 72.5%, respectively, P = 0.014). For secondary outcomes, the percentage of patients who started on an initially prescribed or alternative neuroimmunology or neuromuscular medication within 90 days also increased in the postgroup compared with the pregroup (90.0% vs. 73.3%, respectively, P = 0.004). Additional pharmacist involvement occurred in 64 patients (63.4%) in the postgroup and included prior authorization approval assistance, drug information support, and medication liaison interventions, with an average of 4.7 pharmacist interventions at each pharmacy-led encounter. CONCLUSION The addition of pharmacists into neuroimmunology and neuromuscular clinics improved operational access to medications for neuroimmunology and neuromuscular conditions. In addition, pharmacists were able to assist with multiple areas of patient care including medication education, monitoring, and serving as a medication liaison. This study supports continuing to offer clinical pharmacy services in neuroimmunology and neuromuscular departments and may support the addition of clinical pharmacists into neurology services at other institutions.
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Gutenschwager DW, Patel A, Soyad AT, Patel S, Szandzik EG, Kelly B, Smith ZR. Provision of ambrisentan from a health-system specialty pharmacy affiliated with a pulmonary hypertension Center of Comprehensive Care. Am J Health Syst Pharm 2024; 81:66-73. [PMID: 37611180 DOI: 10.1093/ajhp/zxad191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE This descriptive report describes the process used to obtain access to providing ambrisentan from a health-system specialty pharmacy (HSSP) affiliated with a pulmonary hypertension Center of Comprehensive Care, develop a pulmonary arterial hypertension (PAH) care team at the HSSP, and characterize medication adherence and access metrics. SUMMARY PAH is a rare disease treated with several specialty medications requiring intensive monitoring. Historically, specialty medications used to treat PAH have been provided by only select specialty pharmacies due to restricted drug distribution channels. It is recommended that patients with PAH receive their care at centers with expertise in the diagnosis and management of this disorder, but the HSSPs at these expert centers are unable to provide specialty PAH medications. The current care model for PAH leads to patients receiving their medical and pharmaceutical care from separate entities. This descriptive report describes a multidisciplinary team's approach to gaining access to providing ambrisentan and developing a disease state care team within an established HSSP. After implementing this service, specialty pharmacy metrics were assessed, including proportion of days covered (PDC), time to first fill, patient contact rate, Risk Evaluation and Mitigation Strategy (REMS) program compliance, time to prior authorization (PA) approval, rate of optimal adherence (PDC of >80%), and PA renewal rate, to demonstrate a proof-of-concept HSSP model for PAH. In this model, the HSSP was able to demonstrate high-quality specialty pharmacy metrics with regard to medication adherence, medication access, and REMS program compliance. CONCLUSION The development of a PAH care team to provide ambrisentan at an existing HSSP was associated with high adherence rates, efficient and reliable medication access, and REMS program compliance.
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Affiliation(s)
| | - Anand Patel
- Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA
| | - Amanda T Soyad
- Clinical Pharmacy Services, Pharmacy Advantage, Rochester Hills, MI, USA
| | - Sweta Patel
- Clinical Pharmacy Services, Pharmacy Advantage, Rochester Hills, MI, USA
| | | | - Bryan Kelly
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Zachary R Smith
- Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA
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Shah NB, Zuckerman AD, Hosteng KR, Fann J, DeClercq J, Choi L, Cherry L, Schwartz DA, Horst S. Insurance Approval Delay of Biologic Therapy Dose Escalation Associated with Disease Activity in Patients with Inflammatory Bowel Disease. Dig Dis Sci 2023; 68:4331-4338. [PMID: 37725192 DOI: 10.1007/s10620-023-08098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/26/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Dose escalation of self-injectable biologic therapy for inflammatory bowel diseases may be required to counteract loss of response and/or low drug levels. Payors often require completion of a prior authorization (PA), which is a complex approval pathway before providing coverage. If the initial PA request is denied, clinic staff must complete a time and resource-intensive process to obtain medication approval. AIMS This study measured time from decision to dose escalate to insurance approval and evaluated impact of approval time on disease activity. METHODS This was a single-center retrospective analysis of adult patients with IBD prescribed an escalated dose of biologic therapy at an academic center with an integrated specialty pharmacy team from January to December 2018. Outcomes included time to insurance approval and the association between approval time and follow-up C-reactive protein (CRP) and Short Inflammatory Bowel Disease Questionnaire (SIBDQ) scores. Associations were tested using linear regression analyses. RESULTS 220 patients were included, median age 39, 53% female, and 96% white. Overall median time from decision to dose escalate to insurance approval was 7 days [interquartile range (IQR) 1, 14]. Approval time was delayed when an appeal was required [median of 29 days (IQR 17, 43)]. Patients with a longer time to insurance approval were less likely to have CRP improvement (p = 0.019). Time to insurance approval did not significantly impact follow-up SIBDQ scores. CONCLUSION Patients who had a longer time to insurance approval were less likely to have improvement in CRP, highlighting the negative clinical impact of a complex dose escalation process.
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Affiliation(s)
- Nisha B Shah
- Vanderbilt University Medical Center, 784 Melrose Avenue, Nashville, TN, 37211, USA
| | - Autumn D Zuckerman
- Vanderbilt University Medical Center, 784 Melrose Avenue, Nashville, TN, 37211, USA.
| | - Katie R Hosteng
- Vanderbilt University Medical Center, 784 Melrose Avenue, Nashville, TN, 37211, USA
| | - Jessica Fann
- Vanderbilt University Medical Center, 784 Melrose Avenue, Nashville, TN, 37211, USA
| | - Josh DeClercq
- Vanderbilt University Medical Center, 784 Melrose Avenue, Nashville, TN, 37211, USA
| | - Leena Choi
- Vanderbilt University Medical Center, 784 Melrose Avenue, Nashville, TN, 37211, USA
| | - Laura Cherry
- Vanderbilt University Medical Center, 784 Melrose Avenue, Nashville, TN, 37211, USA
| | - David A Schwartz
- Vanderbilt University Medical Center, 784 Melrose Avenue, Nashville, TN, 37211, USA
| | - Sara Horst
- Vanderbilt University Medical Center, 784 Melrose Avenue, Nashville, TN, 37211, USA
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Hvisdas C, Goode N, Lee K, Kim D, Silvey M, Kasbekar N. Leveraging ambulatory care pharmacist expertise in medication appeals to overcome access barriers: A descriptive report. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Christopher Hvisdas
- Department of Pharmacy Penn Presbyterian Medical Center University of Pennsylvania Health System Philadelphia Pennsylvania USA
| | - Natalie Goode
- Department of Pharmacy Penn Presbyterian Medical Center University of Pennsylvania Health System Philadelphia Pennsylvania USA
| | - Kevin Lee
- Department of Pharmacy Penn Presbyterian Medical Center University of Pennsylvania Health System Philadelphia Pennsylvania USA
| | - Diane Kim
- Department of Pharmacy Penn Presbyterian Medical Center University of Pennsylvania Health System Philadelphia Pennsylvania USA
| | - Michael Silvey
- Department of Pharmacy Penn Presbyterian Medical Center University of Pennsylvania Health System Philadelphia Pennsylvania USA
| | - Nishaminy Kasbekar
- Department of Pharmacy Penn Presbyterian Medical Center University of Pennsylvania Health System Philadelphia Pennsylvania USA
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Rissardo JP, Durante Í, Sharon I, Fornari Caprara AL. Pimavanserin and Parkinson's Disease Psychosis: A Narrative Review. Brain Sci 2022; 12:1286. [PMID: 36291220 PMCID: PMC9599742 DOI: 10.3390/brainsci12101286] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 10/18/2023] Open
Abstract
Pimavanserin (PMV) is the first approved drug for treating hallucinations and delusions in Parkinson's disease (PD) psychosis. Psychosis is one of the leading causes of nursing home placement in people with PD. Furthermore, hallucinations are a more frequent cause of institutionalization than motor disability or dementia related to PD. The management of PD psychosis involves antipsychotic medications. Most of the drugs in this class directly block dopamine D2 receptors, leading to significantly worsening motor symptoms in patients with PD. The most commonly used medications for managing PD psychosis are quetiapine, clozapine, and PMV. This literature review aims to study pimavanserin's history, mechanism, clinical trials, and post-marketing experience. PMV is a potent 5-HT2A receptor antagonist/inverse agonist. Moreover, this drug can interact with 5-HT2C receptors. We calculated some physicochemical descriptors and pharmacokinetic properties of PMV. Eight clinical trials of PMV and PD psychosis are registered on ClinicalTrials.gov. Only four of them have complete results already published. Meta-analytic results showed that PMV efficacy is inferior to clozapine. However, PMV has a significantly lower number of side-effects for managing psychosis in PD. Medicare database assessment revealed 35% lower mortality with PMV compared to other atypical antipsychotics. Moreover, sensitive statistical analysis demonstrated that PMV is a protective factor for the risk of falls in individuals with PD.
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Affiliation(s)
- Jamir Pitton Rissardo
- Medicine Department, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | - Ícaro Durante
- Department of Medicine, Federal University of Fronteira Sul, Passo Fundo 99010-121, Brazil
| | - Idan Sharon
- NewYork-Presbyterian Brooklyn Methodist Hospital, New York, NY 11215, USA
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Peter ME, Zuckerman AD, Cherry E, Schlundt DG, Bonnet K, Shah N, Kelley TN. Exploring healthcare providers’ experiences with specialty medication and limited distribution networks. PLoS One 2022; 17:e0273040. [PMID: 35969591 PMCID: PMC9377589 DOI: 10.1371/journal.pone.0273040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
Integrated health-system specialty pharmacies (IHSSP) have shown high medication access, adherence, and provider satisfaction. The goal of this study was to explore healthcare providers’ experiences with specialty medications distributed via Limited Distribution Networks (LDN) that do not include IHSSPs. We investigated healthcare providers’ perceived impact of LDNs on clinic workflow, clinical practice, and patient outcomes. Interviews and focus groups were conducted with fourteen healthcare providers from four outpatient specialty clinics at an academic health system with an IHSSP. Qualitative analysis using an iterative inductive/deductive approach of coded transcripts was used to identify themes. Participants discussed requirements and barriers to communicating with insurance providers, drug manufacturers, and external pharmacies; time and effort required to navigate LDNs and impact on workload and clinic workflow; financial awareness of medication costs and methods for communication about financial information with patients; and advocating for patients to ensure access to necessary therapy and avoid missed doses or treatment lapse. Participants reported barriers to navigating LDNs that can interfere with clinic workflow and patient care. IHSSPs may reduce clinic burden by helping patients access, afford, and remain on therapy.
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Affiliation(s)
- Megan E. Peter
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Autumn D. Zuckerman
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Elizabeth Cherry
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - David G. Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Nisha Shah
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Tara N. Kelley
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Zuckerman AD, Whelchel K, Kozlicki M, Simonyan AR, Donovan JL, Gazda NP, Mourani J, Smith AM, Young L, Ortega M, Kelley TN. Health-system specialty pharmacy role and outcomes: A review of current literature. Am J Health Syst Pharm 2022; 79:1906-1918. [PMID: 35916907 DOI: 10.1093/ajhp/zxac212] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting 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 Specialty medications can have life-altering outcomes for patients with complex diseases. However, their benefit relies on appropriate treatment selection, patients' ability to afford and initiate treatment, and ongoing treatment optimization based on patient response to therapy. Mounting research demonstrates the benefits of the health-system specialty pharmacy (HSSP) in improving specialty medication access, affordability, and outcomes. The purpose of this rapid review is to describe the currently reported role and function of HSSP pharmacists and outcomes reported with use of the HSSP model, and to identify gaps in the literature where more information is needed to better understand the HSSP model and outcomes. SUMMARY Current literature describes the role of HSSP pharmacists in facilitating patient access, affordability, and initiation and maintenance of specialty medications. Though it is clear HSSP pharmacists are involved in treatment monitoring, often through utilizing the electronic health record, more information is needed to elucidate the frequency, method, and extent of monitoring. Despite several valuable continuity of care services reported to be provided by HSSPs, the breadth and degree of standardization of these services remains unclear. There is minimal literature describing HSSP education and research involvement. HSSPs have reported significant benefits of this patient care model, as demonstrated by higher adherence and persistence; better clinical outcomes; financial benefits to patients, payers and the health system; better quality of care; higher patient and provider satisfaction with services, and highly efficient specialty pharmacy services. More literature comparing clinical and diagnosis-related outcomes in HSSP versus non-HSSP patients is needed. CONCLUSION HSSPs provide comprehensive, patient-centered specialty medication management that result in improved care across the continuum of the specialty patient journey and act as a valuable resource for specialty clinics and patients beyond medication management. Future research should build on the current description of HSSP services, how services affect patient outcomes, and the impact HSSP network restrictions.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lauren Young
- University of Tennessee Medical Center, Knoxville, TN, USA
| | | | - Tara N Kelley
- Vanderbilt University Medical Center, Nashville, TN, USA
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Owens W, Dial H, DeClercq J, Choi L, Zuckerman A, Shah NB, Johnson K. Specialty Pharmacy Integration and the Role of an Advanced Certified Pharmacy Technician in Prescription Cannabidiol Access. J Am Pharm Assoc (2003) 2022; 62:1830-1835. [DOI: 10.1016/j.japh.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/07/2022] [Accepted: 07/17/2022] [Indexed: 10/17/2022]
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Droxidopa management by an integrated health-system specialty pharmacy team. J Am Pharm Assoc (2003) 2022; 62:1904-1911. [DOI: 10.1016/j.japh.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022]
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