Specialty Pharmacy and the Vulnerable Patient from the Health-System Perspective

Transcription

1 Specialty Pharmacy and the Vulnerable Patient from the Health-System Perspective JoAnn Stubbings, BSPharm, MHCA Assistant Director, Specialty Pharmacy Services September 9, 2014

2 OBJECTIVES Describe the patient population at UI Health. Address specialty pharmacy as a component of the ambulatory care pharmacy department. Identify ways that a local, health-system based specialty pharmacy can improve medication access for a vulnerable population.

3 UI HEALTH SYSTEM 495 bed academic health center 4,000 employees >60 outpatient clinics 7 health sciences colleges 12 Federally Qualified Health Centers (Mile Square Health Center) 1 million patient encounters annually The State s only health system

4 OUR COMMUNITY Primary service area population 516,572 University of Illinois Community Assessment of Health Needs Community Health Assessment Report. Available at: sity_of_illinois_community_assessment_of_health_needs_(ui- CAN).html

5 OUR COMMUNITY

6 UI HEALTH AMBULATORY CARE PHARMACIES FOCUS ON MEDICATION ACCESS Discharge Services Medication Therapy Management TeamRX 7 outpatient pharmacies 35 registered pharmacists 25 clinical pharmacists 11 reimbursement specialists Transplant Medication Access Coordinated Refills IDOC/ Telemedicine Medication Assistance Program Wood Street Pharmacy Dermatology Pharmacy Taylor Street Pharmacy Mile Square Health Center Oncology Clinic Pharmacy University Village Pharmacy Outpatient Care Center Pharmacy Specialty Pharmacy Infusion Services

7 SPECIALTY PHARMACY One or more of the following characteristics High cost per unit Used to treat complex chronic and/or life threatening disease May be biologic (derived from living organisms) Require special handline, storage or administration Involve a significant degree of patient education, monitoring, and management Require safety monitoring such as Risk Evaluation and Mitigation Strategies (REMS) Approximately 50% of all late-stage pipeline drugs currently in development may be considered specialty medications.

8 PATIENTS SERVED Oncology Transplant HIV/AIDS GI/Rheumatology/Sarcoids Growth Hormone Liver/Hepatitis C Multiple Sclerosis PAH Sickle Cell Disease Womens Health Medicaid Managed Care 16% Commercial Insurance 17% Percent of Specialty Prescriptions Medicare Part D 32% Illinois Medicaid 35%

9 THE PHARMACIST-DIRECTED INTEGRATED SPECIALTY PHARMACY PRACTICE MODEL (SPPM) AT UI HEALTH Specialty Clinics - - Interdisciplinary (physicians, nurses, pharmacists, physician assistants) - Diagnosis, treatment, education and training - Medication reconciliation - Self-injection training - Start of therapy protocols - Therapeutic drug monitoring and reporting of adverse events - Letters of medical necessity (if necessary) - Data collection and reporting - Follow up Specialty Pharmacy Call Center - 24/7 pharmacist availability - Pharmacy technicians, student pharmacists, and pharmacists - Benefit verification - Prior authorizations - Appeals - Medication Assistance - Case management/refill management - Monthly scripted telephone calls to patient with elevation to pharmacist and documentation in EMR - Copayment Assistance - Medication adherence monitoring and counseling - Data collection and reporting Outpatient Pharmacies - Pharmacy technicians, student pharmacists, and pharmacists - Multi-medcation access and management (TeamRX) - Dispensing - Delivery or pick up (refrigerated courier delivery via Superior Mobile Health)

10 ADVANTAGES OF THE SPPM Integrated with complex care management Use of the electronic medical record (EMR) for documentation, communication, reporting, and data collection Standardized but flexible enough to serve our community Potential for improved access and outcomes

11 CASE STUDY #1 IG, 58 y/o HF diagnosed with Hepatitis B and rheumatoid arthritis in Patient is a dual eligible (Medicare + Medicaid) who lives on the west side of Chicago. Received etanercept from specialty pharmacy and entecavir from retail pharmacy. Liver Clinic recommended one month treatment with entecavir before starting etanercept. Clinical pharmacist at UI Health Rheumatology Clinic received refill request from specialty pharmacy for etanercept. Reviewed refill history with entecavir and discovered patient was not adherent with Hepatitis B treatment. Pharmacist recommended all necessary monitoring labs. Patient was counseled on adherence with entecavir. Etanercept was not refilled until patient was adherent with Hepatitis B medication for one month per Liver Clinic recommendations. UI Health Specialty Pharmacy now coordinates and monitors medications for Hepatitis B and rheumatoid arthritis.

12 CASE STUDY #2 JS is a 41 year old AAM diagnosed with rheumatoid arthritis in 2014, was managed with adalimumab through Aetna Better Health. Patient lost Aetna Better Health because he qualified for Medicare on 8/1/2014. When UI Health Specialty Pharmacy Services attempted to refill the patient s prescription, the loss of insurance was noted. Patient was contacted and he stated that he switched insurance and he filled the application for part D and he is waiting. Meanwhile, patient stated that he may be relapsing and needs the refills, but he has no prescription insurance coverage. Bridge therapy was dispensed to the patient at no charge. Patient continued therapy while the insurance issue is being resolved.

13 FROM AN OPERATIONAL MODEL TO RESEARCH Adherence Treatment and safety guidelines Medication Patient satisfaction Access Time to access Barriers Hanson RL, Gannon MJ, Khamo N, Sodhi M, Orr AM, and Stubbings JA. Improvement in safety monitoring of biologice response modifiers after the implementation of clinical care guidelines by a specialty pharmacy service at an academic health system. JMCP 19(1); 2013: Hanson RL, Habibi M, Kharm N, Abdou S, and Stubbings JA.. Integrated clinical and specialty pharmacy practice model for management of patients with multiple sclerosis. Am J Health-Syst Pharm 71; 2014:

14 ADHERENCE TO MEDICATION SAFETY GUIDELINES 320 unique patient orders for biologic response modifiers in 2011 and 2012 There was a statistically significant improvement in compliance with four laboratory tests (TB, HBSAg, CBC, LFT) after implementation of safety guidelines. Hanson RL, Gannon MJ, Khamo N, Sodhi M, Orr AM, and Stubbings JA. Improvement in safety monitoring of biologice response modifiers after the implementation of clinical care guidelines by a specialty pharmacy service at an academic health system. JMCP 19(1); 2013:

15 MEDICATION ADHERENCE Benchmark goal of 90% medication possession ratio (total days supply/total days in possession) Hanson RL, Habibi M, Kharm N, Abdou S, and Stubbings JA.. Integrated clinical and specialty pharmacy practice model for management of patients with multiple sclerosis. Am J Health-Syst Pharm 71; 2014:

16 PATIENT SATISFACTION 100 adult patients surveyed who received a doctor s prescription for at least 3 months for a specialty medication for RA/GI or MS. 50 patients received their prescription from UI Health, the other 50 received their prescription from other pharmacies (CVS/Caremark, Walgreens, ExpressScripts, Accredo, Briova, Walmart, etc.) UI Health Non- UI Health Completed surveys The pharmacist explains your [medication] in a way you can understand clearly. How well does your specialty pharmacy communicate with your doctor? ( excellent rating) 98% 79% 84% 38% If it wasn't for the doctor talking to pharmacy, I would still be fighting with my insurance - it was a big relief for me. Together, they seem to know everything I need and when I need it.

17 ACCESS The overall goal is to determine the impact of a pharmacist-directed integrated specialty pharmacy practice model (SPPM) on patient access to specialty medications. Time to access Barriers

18 CONCLUSION A health-system based specialty pharmacy model at UI Health may offer advantages to vulnerable patients by improving access to medication. The model offers integration, flexibility, and improved communication among providers and patients. Research is being conducted to demonstrate the value of the model and disseminate to similar health systems.