Panelists Discuss Effective Management and Considerations for Hemophilia A

In a recent Pharmacy Times® clinical forum on hemophilia A, panelists discussed effective management of hemophilia A and considerations for specialty pharmacy.

The panelists started the discussion by addressing how to identify the ideal patient for prophylactic factor VIII.

Atta Chowdhry, director of the hemophilia program and regional director of operations at Amerita Inc, said individuals who are more active are ideal patients for factor VIII. Panelist Natalie Watkins, PharmD, clinical manager at CVS Health, added that patients who self-infuse are also ideal.

The ideal patients for initiation of emicizumab include individuals who are tired of self-infusing and are looking for a more convenience, said Mahdi Al Hallaq, RPh, pharmacist-in-charge at SandsRx. Before the COVID-19 pandemic, there was a trend toward switching patients to emicizumab-kxwh (Hemlibra; Genentech), although he said the pandemic may have interrupted this shift.

“Once the pandemic hit, we saw a halt at BioMatrix in general,” said Kim Epps, PharmD, CSP, vice president and general manager for bleeding disorders at BioMatrix Specialty Pharmacy. “Patients weren’t going to clinic; they were doing virtual visits and they weren’t ready to switch in that environment.”

About 1 or 2 out of every 10 patients per month have a conversation about switching, Hallaq said.

Becca Moorman, PharmD, RPh, said when counseling patients who want to switch medications, pharmacists should remind patients to reach out to their care team whenever they have bleeds, even if they are not as frequent or severe as before starting the medications.

Watkins added that it is important to remind patients and their caregivers to keep factor VIII on hand for any potential emergencies, even if they are close to their local hospital. The panelists also discussed common dosing regimens for emicizumab-kxwh. Chowdhry said receiving treatment every 2 weeks is the most common, although some patients may switch to every-4-week dosing. However, he said patients tend to feel more comfortable with 2-week dosing.

Physicians and pharmacists must also be able to communicate effectively and work closely together, the panelists said, particularly because patients with hemophilia A require close monitoring and collaboration with the care team.

“Having communication and knowing we’re on the same team [is important],” Watkins said. “We want to take care of the patient, but I do know that it’s hard to weed everybody out because not everybody has the patient’s interests at hand, not everybody has the resources to care for this high-touch, high-need patient base.”

In addition to maintaining relationships with other members of the care team, Chowdhry added that building relationships with patients is important.

One way pharmacists can work with patients is by addressing financial barriers, which Moorman said can be especially challenging in the specialty pharmacy space.

“The financial portion is definitely a huge barrier to patients because these products are so expensive and they have a difficult time being able to afford them without the help of copay assistance programs and what extras [they] provide,” Moorman said. “We help them overcome them [by] giving them all the information that they need to sign up for those programs.”

Finally, Watkins said educational programs, especially for infusion-based treatments, are essential for patients. Many patients may struggle with pain management, so there are programs to help with this and to normalize quality of life, Epps said. Some programs can be particularly impactful for pediatric patients who may struggle to balance their treatments in school orother environments.“

We have the 504 [Individualized Educational Plan] to let them know the options they have at schools, but we also do fun things like photography and sewing and singing,” Epps said in the forum.

Epps said these programs helped patients who were not connecting with other individuals with hemophilia A during the pandemic lockdown.