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Transitions in Sites of Care
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| Pediatric inflammatory bowel disease |
Patient diagnosed with Crohn’s disease while admitted to the hospital and prescribed adalimumab |
Secured approval from Pharmacy and Therapeutics Committee for inpatient administration of first induction dose Performed benefits investigation, completed access requirements for approval, and obtained financial assistance for outpatient therapy prior to treatment initiation Provided medication counseling and coordinated scheduling of teaching appointment for remaining induction dose Communicated discharge and follow-up plans to inpatient team Coordinated maintenance prescription sent to preferred specialty pharmacy
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| Hepatitis C |
Patient started on glecaprevir/pibrentasvir inpatient following liver transplant and needed therapy to continue without interruption at discharge |
Coordinated most appropriate treatment regimen with inpatient team and managed drug/drug interactions prior to starting glecaprevir/pibrentasvir Performed benefits investigation, completed access requirements for approval, including emergent appeal with peer-to-peer review, and ensured outpatient medication affordability prior to starting as an inpatient Communicated and executed discharge procurement process to patient, family, and inpatient team Coordinated clinic follow-up for safety and efficacy monitoring
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| Psoriatic arthritis |
Patient receiving etanercept was admitted to a rehabilitation facility that did not carry any specialty medications |
Communicated medication orders and plan with physician and nursing staff at the facility Arranged delivery of the patient’s medication to be sent from the specialty pharmacy to the rehabilitation facility
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Transition in Provider Types
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| Juvenile idiopathic arthritis |
Pediatric patient receiving adalimumab moved of state |
Coordinated with patient and new provider’s office to ensure continuation of adalimumab treatment Transferred the current prescription to a new pharmacy that is contracted to fill specialty medications for the patient’s insurance plan and new provider’s office Provided bridge therapy with samples until the refill could be obtained, due to the external pharmacy’s delay in filling adalimumab
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| Oncology/Hematology |
External provider changed antifungal prophylaxis from posaconazole to fluconazole on a patient with ongoing venetoclax therapy for acute myeloid leukemia. Patient notified pharmacist. |
Communicated drug interaction with provider and prepared prescription for a dose increase of venetoclax per FDA recommendation; the provider accepted the recommendation and increased the dose
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| Hepatitis C |
Ledipasvir/sofosbuvir prescription received from gastroenterologist for patient prescribed oxcarbazepine by psychiatrist. Significant drug/drug interaction exists between these two medications, potentially resulting in virologic failure of ledipasvir/sofosbuvir |
Performed medication reconciliation at initial counseling and identified drug-drug interaction Notified gastroenterology, psychiatry, and patient of interaction Developed plan with psychiatrist to wean patient off oxcarbazepine and start lamotrigine Communicated with all parties monthly until plan completed and patient ready to start treatment with ledipasvir/sofosbuvir
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Transitions Among Specialty Medications
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| Rheumatoid arthritis |
Patient well-controlled on abatacept 750 mg IV every 4 weeks relocated to 2 h away from clinic and started to miss or be tardy for infusions |
Discussed with provider and advised patient to transition to abatacept 125 mg SubQ injection weekly at home Performed benefits investigation, completed access requirements for approval, and obtained financial assistance Reviewed injection technique with patient including when to administer first subcutaneous injection based on last infusion date
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| Multiple sclerosis |
Patient needed to transition from natalizumab (IV infusion) to fingolimod (PO) |
Performed benefits investigation, completed prior authorization and subsequent appeal Completed drug interaction and comorbidity screen to assess appropriateness of therapy Counseled patient regarding all aspects of the medication Coordinated baseline laboratory and testing requirements with patient and reviewed results to evaluate therapy appropriateness Submitted SRF to manufacturer Assisted in coordinating the FDO for fingolimod so that patient could initiate medication within 12 weeks of discontinuing natalizumab Verified patient successfully completed FDO without any significant adverse effects Sent copay assistance information and confirmed SRF to specialty pharmacy, and ensured first medication fill was delivered to patient
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| Oncology/Hematology |
Patient needed to transition from bortezomib (SubQ) to ixazomib (PO) |
Performed benefits investigation, completed access requirements for approval, and obtained financial assistance Counseled patient
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Transitions in Financial Coverage
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| Psoriatic arthritis |
Patient’s arthritis symptoms were well controlled on secukinumab, but the patient became unemployed and lost insurance and pharmacy coverage |
Counseled the patient on manufacturer patient assistance program Coordinated patient and prescriber to complete required paperwork Submitted forms to manufacturer patient assistance program Coordinated medication delivery from manufacturer patient assistance program pharmacy
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| Ankylosing spondylitis |
Patient was stable on golimumab 50mg SubQ monthly and received manufacturer copay card for medication. After retiring from her job, the patient transitioned from commercial insurance to Medicare, and was thus ineligible to use manufacturer copay card, resulting in an out-of-patient copayment of >$1000/month |
Assessed patient for potential assistance through foundations and patient assistance programs Reviewed the patient’s new insurance and discovered she now had traditional Medicare A and B with a supplement Transitioned the patient from golimumab SubQ to IV as it would be more affordable
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| Pediatric inflammatory bowel disease |
Pediatric IBD patient prescribed adalimumab. Clinic protocol was to receive first adalimumab induction dose in clinic for teaching and monitoring. Patient was unable to fill medication through the integrated specialty pharmacy due to insurance requirements. |
Called insurance and received an override to fill adalimumab starter kit at the integrated specialty pharmacy so medication could be administered in clinic Scheduled induction teaching appointment with family Provided counseling and observed the first dose Monitored the patient to ensure no adverse reactions occurred Ensured maintenance dose was sent to specialty pharmacy mandated by insurer and provided information on copay assistance through manufacturer
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| Hepatitis C |
Patient diagnosed with hepatitis C was prescribed 12-week course of glecaprevir/ pibrentasvir. Medication was required to be filled through an external pharmacy. During the treatment course, patient had difficulty refilling medication due to high cost and contacted the integrated specialty pharmacist for assistance. |
Contacted specialty pharmacy dispensing the medication and discovered additional financial assistance was needed for a refill of the medication to be affordable. Secured patient access to additional grant funds Communicated financial assistance with external specialty pharmacy to update the patient’s copayment amount
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