Pharmacists Are Key to Managing Access Challenges in Specialty Pharmacy

In an interview with Pharmacy Times, Denise Scarpelli, PharmD, MBA, vice president and chief pharmacy officer at the University of Chicago, discussed her presentation at the American Society of Health-System Pharmacists (ASHP) 2023 Summer Meeting. Scarpelli’s session discussed the current state of specialty pharmacy and the importance of focusing on the patient journey.

Q: What is pharmacists’ involvement in improving access to specialty pharmacy medications?

Denise Scarpelli, PharmD, MBA: I think when it comes to access, the pharmacist knows exactly, depending on the drug, who has access. If it's a limited distribution drug, they also have spent years doing this, have learned what the payers’ requirements are, they might have contacts at those specialty pharmacies if it has to be handed over.

In health system specialty [pharmacies], pharmacists really work on owning that patient and making sure that patient gets the drug. But they try to do all the work up front and then hand it over. So, it makes it as simple as possible that once it's handed over to the other specialty pharmacy, if they can't fill it, that specialty pharmacy just has to fill and get it to the patient. Hopefully that health system pharmacy can fill them, which I think most can fill about 30% to 50% that they received. It's a quick turnaround, we get all the [patient assistance programs] in place, then we arrange for delivery or pickup, and then we call them before it's due. So, we're making sure that that patient stays on the drug and, you know, stays adherent. And if they're not, finding out why and following up with them to see what adverse effects they're having, or any issues or not-positive outcomes that the pharmacist can help them with.

Q: What are some opportunities for the pharmacy workforce to make a difference in patient care?

Denise Scarpelli, PharmD, MBA: I think in the pharmacy world, I think depending on if you're a pharmacy technician or a pharmacist, it’s really helping that patient navigate the new world. And it's not only specialty—I'm seeing non-specialty drugs that require prior authorization, really restricted networks. And I think depending on where that patient presents, we should all be helping that patient navigate that. I think a lot of individuals that are in the health care system as a pharmacist or technician says, “Oh, this requires a prior authorization” and hands that script back. The patient just goes home and decides not to take it. [The patient doesn’t] know what that means. No one explained this to [them]. So really taking the time to explain to that patient what a prior authorization means. Maybe the pharmacy has initiated the prior authorization and they're waiting. Explain that to the patient. I see a lot of patients tell me, “I need to get my drug filled because they said it wasn't covered or needed preauthorization.” Well, did you ask them to start it? Did you ask your provider to start it? Maybe they have. Have you followed up to see if it's approved? So, I think no matter what avenue you're joining, you're coming into the pharmacy, we should be there to help that patient navigate that. Because it's not only specialty drugs; it's all drugs that are becoming more difficult to fill. And then even payers or their copays are even getting higher and sometimes patients may not be able to afford it. And maybe they picked up one refill, but they may not get the next refill, so we see a lot of adherence issues with patients. Are we following up with that patient [and] why they didn't continue on their therapy? Is it cost, is it access? Where our hospital is located, they call it a pharmacy desert, so a lot of the retailers have moved out of the area. A lot of our patients don't have access even to non-specialty drugs. So, we really try to help those patients—we can mail it to you, we can have a courier bring it to you. But we're seeing patients’ disease states worsen because they're not getting a drug therapy. So, when I think about from the pharmacy profession, we should try to have as many pharmacists as possible work alongside that provider to be embedded in clinic to really help that patient either from an access, affordability, or just even understanding their treatment.

Q: How can pharmacists and other pharmacy staff advocate for patients?

Denise Scarpelli, PharmD, MBA: I think from an advocacy standpoint, we have to tell our legislators what's happening, you know, especially with high copays or patients being underinsured or uninsured, and really in areas where there's a pharmacy desert, right? You know, we're the only ones there. How do we help those patients get access to drugs that are more affordable? I think health care costs continue to rise. I think health care systems themselves are faced with financial challenges that limit the amount of resources they're able to provide for their patients. But I think, you know, pharmacists and pharmacy technicians need to be the ones out there explaining what they're seeing every day. We're the ones seeing that patient that can't afford those high copays or the patient that is taking a pill every other day to stretch that therapy out. We're the closest to that patient when it comes to their drug regimen. So, we really have to share that and making sure people understand a lot of the health care issues that are happening out there. It’s all really drug related, and it really comes down to access and affordability.

But I think, too, from a pharmacist and technician standpoint, they need to be the ones that ask those questions to the patient. And a lot of times patients are very proud, and they don't want to say that [they] can't afford it. But we have to be able to say, hey, there might be a copay card, there might be a trial card, we can switch to a maybe more affordable drug for you. Just because the doctor prescribed this very expensive drug doesn't mean it might be your only option. So, I think, you know, having that pharmacist–patient relationship or even a technician and explaining that to them, you're able to pull more information out of that patient to be able to help them get the right therapy to control their disease state.