Improving Adherence and Outcomes in Specialty Pharmacy: A Real-World Case Study

Host:

• Ken Perez, Vice President, Healthcare Policy and Government Affairs

Guest Experts

• Sarah Kester, PharmD, Pharmaceutical Program Manager, Omnicell Specialty Pharmacy Services
• Matt Manning, PharmD, Senior Director of Operations, Health Systems, Omnicell Specialty Pharmacy Services

Episode Highlights

Q: What does an advanced clinical adherence monitoring program entail and what does the Omnicell Specialty Pharmacy Services team do to impact adherence to XIFAXAN?

Sarah Kester:The process for our team starts at the very beginning of the lifecycle of the prescription. In a typical big box or PBM pharmacy scenario, when a prescription for XIFAXAN is received and prior authorization (PA) is needed, then the pharmacy would send that insurance rejection back to the provider and basically do nothing until they hear back from the provider that the prescription has been approved. Meanwhile, the patient languishes without their medication.

When you send your prescription to your health-system-owned pharmacy, as soon as we receive the referral and it's determined that a PA is needed, the pharmacy goes right to work on completing the PA. Our team members are very well versed in the requirements for PAs and we have a PA approval rate of over 92%.

Once your PA is approved, then our clinical team takes over and we contact the patients. We provide them with in-depth counseling, check for any drug interactions, and educate the patient on the medication and desired outcomes for treatment.

After the initial counseling and delivery of the medication, we continue to perform clinical follow up on a monthly basis for each patient. Seven to ten days before their refill is due, follow up calls are made to every patient. At that time, we monitor for side effects, efficacy of the medication, and any hospitalizations the patient may have experienced. We also provide monthly reminders that the patient should be on this medication for long-term maintenance and should not stop unless directed by their provider. We provide 36 months of follow up for the patient as part of our partnership with Bausch

Q: Now Sara, what benefits do you see from this intensive follow up with patients?

Sarah Kester: Our most important finding is the increase in days on therapy for our patients versus the national average. The average days on therapy for all XIFAXAN patients is around 5.4 months. However, patients that participate in our program are on therapy for about 9 months.

What's the importance of a patient getting a few more months of treatment? Quite simply, it results in patients living longer, having a better quality of life, and staying out of the hospital.

One of my favorite stories involves a patient who started on our program after being prescribed XIFAXAN after an episode of hepatic encephalopathy. This episode of HE resulted in him losing his driving privileges. When we started out, we had to speak with his caregiver because his cognitive deficit was too great for him to speak with us directly. But, after getting him established on treatment, his symptoms abated and now we're able to speak with him. He was even able to start driving again and every month he mentions that when we do our follow up. Getting his freedom to be independent back was such a great experience for him.

Q: Let's take this up a level. Patient adherence is just one of the many challenges associated with operating a specialty pharmacy and optimizing results. Matt, what are some other common core challenges that impact specialty pharmacies and how can health systems ensure they are positioned for success?

Matt Manning:There are a lot of considerations when it comes to launching and scaling a specialty pharmacy and we're energized to support health systems and position them for success. Let's start with manufacturer relations. Manufacturer limited drug distribution can be a huge barrier for a new specialty pharmacy. Many drugs today are distributed through a limited network of pharmacies at the discretion of the manufacturer. These drugs could be limited for a variety of different reasons — whether it's REMS considerations, storage considerations, or cost.

I recently read that 48% of the specialty pharmacy pipeline consists of products aimed to treat orphan disease states. When you include Oncology, that number is 80%. Those are the hallmark disease states that are going to be challenging to get access to. A new specialty pharmacy will need to validate its operation, providing manufacturers with confidence that they possess the capabilities and expertise necessary to handle their drug and serve patients.

Omnicell Specialty Pharmacy Services wants to ensure you gain ...