High-Touch Specialty Pharmacy Services Improve Migraine Medication Access and Affordability

The underlying purpose of a study presentation that won the Top Poster Award at the 2019 National Association of Specialty Pharmacy Annual Meeting and Expo in Washington, DC, was to assess whether high-touch, clinic-based specialty pharmacy services could positively affect the affordability of self- and provider-administered migraine medications for patients.

Two principal factors prompted the study and subsequent poster:

• The game-changing nature of calcitonin gene-related peptide receptor antagonist (CGRPra) and onabotulinumtoxin A (Ona A) medications for migraine treatment
• The realization that high drug costs continue to burden patients, as shown by 24% of patients reporting difficulty with affordable medication access¹

The primary objective for the team at Trellis Rx, a health-system specialty pharmacy services partner, was to minimize patient co-pay burden for CGRPra and Ona A prescriptions that are run through pharmacy benefits. Secondary objectives included assessing the number of dispenses with a $0 co-pay and measuring growth in the number of Ona A 100-mg vials run through pharmacy benefits.

BACKGROUND

The study took place at a health system’s general practice neurology clinic. In spring 2018, the health system launched an inhouse specialty pharmacy program that integrated a pharmacist and pharmacy liaisons into the clinic.

The clinic-based team is responsible for supporting providers and patients through in-person medication education, financial assistance, insurance authorizations, and more. The team quickly recognized not only the need patients had for financial assistance with migraine medications, but also the opportunity to more effectively manage approvals for office-administered medications (such as Ona A) on patients’ medical or pharmacy benefits. So, they chose to study the measurable impact of their tasks, which included patient history and insurance review, an assessment of payer requirements, patient counseling, and benefits assessment.

METHODS

The study’s inclusion criteria centered on patients treated for migraine with a CGRPra and/or Ona A who filled their prescription with the on-site specialty pharmacy. Exclusion criteria were incomplete dispensing data or that the prescription came from a non—health system provider. Of 138 patients studied, 61 filled with Medicare Part D, 55 filled with private insurance, and 22 filled with Medicaid.

Dispensing data were collected from the specialty pharmacy between January 2018 and January 2019. Because the clinic did not prescribe CGRPra medications until July 2018, after initiation of specialty pharmacy services, no control data exist for CGRPra.

However, Ona A analysis compared the 6 months before initiation of Ona A management services (February 2018-July 2018) with the 6 months after initiation (August 2018-January 2019). To account for insurance coverage changes due to patients meeting deductibles and out-of-pocket maximums throughout the year, the study also compared January 2018 with January 2019 data to better measure program effect.

STUDY RESULTS

The Ona A data reveal encouraging cost and volume trends. Comparison of January 2018 with January 2019 shows:

• A decrease in the total patient out-of-pocket costs from 19% to <1%
• A decrease in the average co-pay from $207.27 to $9.20
• A decrease in the median co-pay from $150 to $0
• A 185% increase in the volume of Ona A vials dispensed from 13 vials to 37
• An increase in vials dispensed with $0 copay from 0 to 20

Looking at the 6-month periods before versus after specialty pharmacy services integration, the Ona A data further show:

• A decrease in the total patient out-of-pocket costs from >10% to <1%
• A decrease in the average co-pay from $127.32 to $10.97
• A decrease in the median co-pay from $150 to $0
• A 188% increase in the volume of Ona A vials dispensed from 56 to 161
• An increase in the vials dispensed with $0 co-pay from 7% to 70%

Coordination of financial assistance by the clinic-based specialty pharmacy team appears to have been a primary driver of these results. No patients received financial assistance before specialty pharmacy service implementation. In contrast, financial assistance covered 8% of total medication cost in January 2019 and 6% of total mediation cost in the 6-month post specialty pharmacy implementation study period.

Although there are no “before” and “after” data for CGRPra medications, the study found that the use of financial assistance lowered total patient out-of-pocket costs to 2% of medication cost. The mean and median copays were $10 and $3, respectively.

CONCLUSIONS

Based on the data, the study concluded that integrating high-touch specialty pharmacy services into a neurology clinic can benefit patients through prescription coordination and co-pay mitigation. The positive impact on medication affordability seems clear, even for drugs accessible at retail pharmacies, such as CGRPras. It illustrates a benefit of aligning all parties—providers, patients, and payers&mdash;toward better care for patients.

Moreover, the on-site specialty pharmacy team increased its number of Ona A prescriptions. Overall, the team’s up-front verification of preferred insurance benefits (pharmacy or medical) helped reduce patient co-pays, streamlined provider processes, and improved facility financials

Reference

• Kamal R, Cox C, McDermott D. “What are the recent and forecasted trends in prescription drug spending?” Peterson-Kaiser Health System Tracker. 2019. Feb 20, 2019. https://www.healthsystemtracker.org/chart-collection/recent-forecasted-trends-prescription-drug-spending/#item-start.