Penn Specialty Pharmacy Program mypennpharmacy bringing the Pharmacy to Patients Richard F Demers, MS, RPh, FASHP Chief Administrative Officer Ambulatory Pharmacy Services University of Pennsylvania Health System Philadelphia, PA
Introduction and Overview of UPHS 2
University of Pennsylvania Health System Hospital of the Penn Presbyterian Pennsylvania Hospital University of Pennsylvania Medical Center 3
University of Pennsylvania Health System 2016 Facts and Figures 4
University of Pennsylvania Health System Awards and Recognition 5
The Medication Use Cycle: Patient Focus Patient Admitted Medications Reconciled Re-Admitted Medications Ordered New Treatments The program gives us the ability to impact patient medication use and possible readmissions by filling one of the gaps in the medication use cycle. Discharged My Penn Pharmacy 6
Traditional Outpatient Drug Therapy Model Outpatient drug therapy today is mostly reactive in nature Patient Patient self reports problems with drug therapy Patient manages refills and coordinates drug therapy Flow of information is unidirectional Provider Pharmacy 7
Penn Specialty Pharmacy Practice Model 8
Ambulatory Pharmacy Retail Pharmacy Specialty Pharmacy Hosp. & Home Infusion Therapy 9
Integrated Pharmacy Care The goal of the program is to improve Access and Adherence to Medication Therapies to all patients for specialty and non-specialty medications Hospital Discharge Concierge Home Specialty Pharmacy Retail Specialist General Medicine 10
Penn Specialty Pharmacy Program Launched January 2014 Team of 20+ staff members providing services in 10+ specialties Prior Authorization Technicians Copay Assistance Technicians Clinical Pharmacists Ambulatory Clinical Pharmacy Specialists URAC Accreditation in 2016 11
Penn Specialty Pharmacy Program Centralized Coverage Services Prior authorization Copay assistance Decentralized Patient Care Ambulatory clinical pharmacists Medication delivery to clinic Service Line Teams Integration with electronic medical record Focus on medication therapy management 12
Penn Specialty Pharmacy Clinical Pharmacist Outpatient Clinic Specialty Pharmacy - Value Proposition Integrated, health system based specialty pharmacy allows for improved quality of care, increase patient volume, and a new source of revenue for health systems Physician evaluation: new order Physician follow-up appointments EPIC Provide teaching and education Dispense medication to patient Ongoing therapy monitoring EPIC Review of Benefits Prior Authorization Financial Assistance Appeals Coordinate First Fill & Delivery to Clinic Ongoing Management & Data Collection R. Demers 13
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Specialty Pharmacy Outcomes & Data 15
Bringing the Pharmacy to Patients Approximately 2,500 prescriptions (specialty and non-specialty) are delivered to patients in the inpatient and outpatient clinic settings. 3000 mypennpharmacy Deliveries (Ambulatory and Inpatient) 2500 2000 1500 1000 500 0 Jan-14 May-14 Sep-14 Jan-15 May-15 Sep-15 Jan-16 May-16 Sep-16 16
Reducing the Time Until Therapy Initiation The program is able to significantly reduce the time to specialty pharmacy therapy initiation because of integration with the electronic medical record and provider practices Oncology Prior Authorization Data October 2015 May 2016 Approval Percentage 87% Time To Determination 1.98 days 17
Reducing the Time Until Therapy Initiation The program is able to significantly reduce the time to specialty pharmacy therapy initiation because of integration with the electronic medical record and provider practices Days Until Therapy Initiation - HCV Clinic Time from Order Until Medication Received by Patient Penn Specialty Pharmacy Outside Specialty Pharmacy 8 days 27 days* *prior to pharmacy performing prior authorization 18
Ensuring Access and Adherence Clinical Pharmacists in ambulatory practices provide ongoing medication management activities and work in collaboration with providers to help provide proactive solutions to barriers involving non-adherence. As a result, adherence rates are significantly greater than the marketplace average. Service Line Medication Adherence Rates GI 97% Hepatitis C 96% Dermatology 92% Hematology/Oncology 92% HIV 91% Transplant 88% Multiple Sclerosis 84% 19
Ensuring Access and Adherence Since January 2014, the program has obtained over $3.5 million in copay assistance $4,000,000 Patient Assistance Dollars Obtained $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 $0 Jan-14 Apr-14 Jul-14 Oct-14 Jan-15 Apr-15 Jul-15 Oct-15 Jan-16 Apr-16 Jul-16 Oct-16 20
Provider Feedback Penn providers have indicated that health system specialty pharmacy access has patient care implications Therapeutic alternatives are allowing for flexibility in prescribing patterns For outpatient therapies we cannot access, providers have said they may: Use an intravenous medication instead of an oral medication Switch to a different oral medication that Penn can access within the therapeutic class 21
Patient Centered Outpatient Care Pharmacists at each location address the need for integrated outpatient care and proactive medication management Clinic New medication education Adverse effect counseling Patient Specialty Pharmacy Service Patient Access Medication Therapy Management Outpatient Pharmacy Product Distribution Data Reporting 22
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