Specialty pharmacist integration into an outpatient neurology clinic improves pimavanserin access

Introduction

Access to pimavanserin, the only Parkinson disease–related psychosis treatment approved by the FDA, is restricted by insurance requirements, a limited distribution network, and high costs. Following initiation, patients require monitoring for safety and effectiveness. The primary objective of this study was to evaluate impact of specialty pharmacist (SP) integration on time to insurance approval. Additionally, we describe a pharmacist-led monitoring program.

Methods

This was a single-center, retrospective study of adults prescribed pimavanserin by the neurology clinic from June 2016 to June 2018. Patients receiving pimavanserin externally or through clinical trials were excluded. Pre- (June 2016 to December 2016) and post-SP integration (January 2017 to June 2018) periods were assessed. Proportional odds logistic regression was performed to test association of approval time with patient characteristics (age, gender, insurance type) postintegration. Interventions were categorized as clinical care, care coordination, management of adverse event, or adherence.

Results

We included 94 patients (32 preintegration, 62 postintegration), 80% male (n = 75) and 96% white (n = 90) with a mean age of 73 years. Median time to approval was 22 days preintegration and 3 days postintegration. Higher rates of approval (81% vs 95%) and initiation (78% vs 94%) were observed postintegration. Proportional odds logistic regression suggested patients with commercial insurance were likely to have longer time to approval compared with patients with Medicare/Medicaid (odds ratio 7.1; 95% confidence interval: 1.9, 26.7; P = .004). Most interventions were clinical (51%, n = 47) or care coordination (42%, n = 39).

Conclusion

Median time to approval decreased postintegration. The SP performed valuable monitoring and interventions.

Impact of specialty pharmacist integration on time to medication access for pimavanserin

Background: Patient access to pimavanserin treatment, an antipsychotic agent used to treat Parkinson’s disease-related psychosis, is limited by insurance approval and navigating a limited distribution network. Once initiated, safety and efficacy monitoring is needed to ensure adherence and clinical benefit.

Aims: To determine the impact of specialty pharmacist integration on time to pimavanserin access. A secondary objective is to describe pharmacist interventions related to pimavanserin.

Methods: This was a single-center, retrospective cohort study with a pre–post design. Patients prescribed pimavanserin through the center’s neurology clinic during May 2016 through July 2018 were included. An electronic chart review was performed to collect data for patient demographics (age, race, gender), insurance information (type, prior authorization process), and pharmacist interventions. The primary outcome was defined as time to medication access (in days) between the initial intent to treat and insurance approval. Univariate analysis and multiple logistic regression were performed to assess the associations between medication access time and pharmacist integration.

Results: Ninety-four patients met inclusion criteria. Patients were mostly male (80%) and Caucasian (96%). Median age was 74 years. Baseline demographics between the pre- and post-integration cohorts were similar. Pre-integration, 33 patients were prescribed pimavanserin, with 82% attaining insurance approval and 79% starting therapy. Post-integration, 61 patients were prescribed pimavanserin, with 95% attaining insurance approval and 93% starting therapy. Median time to access decreased following integration (3 days compared to 24.5 days). Patients prescribed pimavanserin pre-integration had a 23-fold increase in odds of experiencing a longer time to access compared to post-integration (OR = 23; 95% CI = 8–69; p < 0.001). In addition, patients with non-commercial insurance were more likely to have a shorter medication access time compared to patients with commercial insurance. The pharmacist performed at least one intervention for 85% of patients, including medication counseling (n = 58) and interventions to improve clinical care (n = 120) and medication access (n = 135).

Conclusions: Integration of a specialty pharmacist decreased time to pimavanserin access and facilitated pharmacy interventions to ensure safety and efficacy of use. Additional research is needed to evaluate the impact of faster medication access on clinical outcomes.