Practice Pearl 2: Medical Utilization Evaluation of Patients With AML

Experts discuss the identification and Medical Utilization Evaluation of patients with newly diagnosed acute myeloid leukemia.

Katie Culos, PharmD, BCOP: Let’s go back a little bit to your formulary management and the increase in all the new agents and adding them to formulary. Is this a situation, after you add new drugs to your formulary, in which you routinely conduct medication utilization evaluations or have routine audits of your treatment pathways?

Amanda Brahim, PharmD, BCOP, BCPS, BCACP: Historically, that was something where when we identified a problem, we would conduct a medication-use evaluation. Over the last 2 years, we’ve shifted that mentality and made it a more proactive approach to MUEs [medication utilization evaluations]. So, what we do, especially when we have drugs—–for example, gemtuzumab ozogamicin, when it came back to market is that we recognized that as potentially a high-risk drug. As it came back to market, and as we were going through the approval process with P&T, we decided proactively to conduct a medication-use evaluation at about a year. What we’re doing with some of the newer agents, because they’re both high cost and high risk, and sometimes, as Yehuda mentioned, they’re being approved on phase 2 clinical data by the FDA, we do set out with the mindset of conducting a medication use evaluation, either at a set point of the number of treated patients or at 6 months to a year.

In addition to that, we do have a once-a-year…pathway adherence audit, where we, for example for our AML pathway, pick a number of patients, a percentage, and we follow through from the moment of diagnosis to see how well we’re adhering to the pathway that we’ve set out ourselves. Based on that analysis, we go back and see whether we are not adherent to our pathway because new evidence has come out? Do we need to adjust our pathway? Or, was this simply a deviation based on specific clinical indications for that patient? It’s really interesting to see, because we put a lot of effort into the creation of the pathway. We want to make sure that we’re adhering to it, and, if we’re not, that those reasons for nonadherence will lead us to somehow make an intervention either by changing the pathway or providing some re-education.

Yehuda Deutsch, MD: I think this has created a lot more work in the P&T MUE-type of evaluations, which is a great thing. For many, many years, for 30 to 40 years, there really was no major change in therapies, maybe just a more supportive type of care, and that was something that needed to be improved on. Over the last couple of years, we have so many new medications, and the P&T committees, that the MUEs are now so important. It’s really a great blessing that we have in treating AML patients now.

Katie Culos, PharmD, BCOP: Great. If a new drug comes on the market, how quickly do you guys adjust your treatment pathways?

Amanda Brahim, PharmD, BCOP, BCPS, BCACP: Yehuda will usually text me the moment the FDA approval is official, and he’ll ask me, ‘When can we get this?’ It doesn't come to market that quickly, but we do try to move on things rather quickly. Again, it’s exciting in AML and other hematologic malignancies but it’s a rapidly evolving field, so we feel that it’s important to be able to evaluate with as much evidence as possible, as soon as possible, and make this therapy available to our patients as soon as we can.

Katie Culos, PharmD, BCOP: Yehuda, outside of the P&T committee, do you…have a leukemia group that will meet prior to those P&T committees that help advise on the treatment pathways?

Yehuda Deutsch, MD: Our service has many physicians and practitioners who are really dedicated and love treating patients with leukemia. We’re pretty much always either involved in clinical trials, medications that might be getting FDA approved, or other types of research. We’re always excited when there are new potential medications to use on our patients, and we routinely discuss these, whether it’s in tumor board or other meetings. We also have these pathway meetings and clinical standard practice meetings, where we discuss these and try to determine what medications we should be pursuing.