Specialty Pharmaceuticals: Specialty Medications and Prescription Adherence Management

Mr. Allinson is chief executive officer and chief clinical officer of Therigy, LLC.

A recent presentation at the National Community Pharmacists Association annual convention focused on the important topic, “Healthier Patients and a Healthier Bottom Line: Improving Your Pharmacy Practice through Prescription Adherence Management.” This model, developed in 1996 by pharmacist John Sykora, was initiated to manage patients’ prescriptions, as well as managing workflow, inventory, billing, and hours of operation. He discovered that the model reduced stress for the patient and allowed the pharmacist to provide more direct patient care services, such as medication therapy management and disease state management.

In 2008, the National Alliance of State Pharmacy Associations began working with state pharmacy associations to implement the Patient-Centric Model (PCM) in pharmacies nationwide. This new program currently has 50 pharmacies that have agreed to participate. The goal by the end of 2009 is to have approximately 150 pharmacies enrolled, with a total of 3000 patients. As we listened to the 4 speakers describe the process and its success, Pharmacy Times Editor-in-Chief Fred Eckel, RPh, MS, leaned over to me and commented, “I can’t believe we didn’t figure this out years ago.”

What the speakers described was a systematic way to manage a patient’s refills proactively. The heart of the process is to synchronize the patient’s fills to a consistent date. It is suggested that all of the patient’s fills be anchored to the patient’s most expensive product. The patient’s other prescriptions may require a partial fill during the startup month in order to be “lined up” with the anchor prescription. Likewise, new prescriptions added to the patient’s profile may need to be partial-filled so that they can be aligned to the existing prescriptions.

In addition to legend drugs, the pharmacy may also align OTC medications, supplies, durable medical equipment, and other products to the monthly refill process. One phone call to the patient about 7 days prior to when their refills are needed reminds the patient that their refills are due, instructs them when they can be picked up (or delivered) from the pharmacy, and encourages them to order their ancillary products at the same time. Not only the patient’s—but the entire family’s— medications can be lined up to a consistent refill date.

Managing the Medication Profile

This approach provides the pharmacist an opportunity to review the entire patient profile at once and intervene as necessary where therapy problems arise or nonadherence is determined. As the speakers noted, this is a “patient-centric” pharmacy care model as opposed to a drug- or product-centric model.

What does this have to do with specialty medications? Specialty medication( s) are most likely the patient’s most expensive product and should serve as the anchor to the remainder of the patient’s profile. Most patients on specialty therapies have numerous other medications, OTC products, and supplies; thus, the pharmacist can review and manage the entire profile. Pharmacies that specialize in managing just the specialty therapy do not have this holistic view, and they do not have the opportunity to interact personally with the patient on a monthly or more frequent basis.

Clinical Benefits

Some additional clinical and service benefits include the following:

• Improved adherence and persistence

• Decreased gaps in therapy

• Increased opportunity for the patient to seek counseling from the pharmacist

• Increased patient convenience with one trip to the pharmacy

• Support to caregivers who may not have time to monitor complex medication profiles for elderly parents or disabled children

Business Benefits

From a business standpoint, managing specialty products in this manner has the following benefits:

• Workload efficiencies

• Inventory control

• Increased inventory turnover

• Increased patient retention and increased refills per patient

• Better time management and more time for professional services

The most important result of managing your patient’s specialty medications using the PCM is the opportunity to improve clinical, economic, and humanistic outcomes.

If you would like more information about this project, please contact the PCM project manager at 804-285-4431 or e-mail PCM@naspa.us. â–