Since the start of the COVID-19 pandemic, the need for telemedicine at the specialty pharmacy has increased, bringing specialty pharmacists closer to patients than ever before and making it possible for them to establish stronger bonds with patients while continuing to coordinate their treatment and support their care.1
Specialty pharmacies have developed teams to provide remote services, including medication therapy management (MTM), and offer guidance on medication administration, storage, adverse effects (AEs), etc. For their part, technicians offer teleservices pertaining to insurance claims and their submission. Technology also allows team members to investigate financial aid that may be available through manufacturers and state programs for patients who have difficulties with co-pays and/or out-of-pocket (OOP) costs to keep their expenses down and eliminate this barrier to adherence.
Technology makes prescription processing quicker as well, which can shorten the time it takes for patients to receive medications and so decrease time to treatment initiation. It also makes for more effective monitoring of treatment adherence via assessments and surveys and swifter updating of patient profiles. This means that pharmacists can intervene more quickly when there are adherence problems, counsel patients about missed doses, and determine whether outreach to the physician is necessary.
Pharmacy Times: Call for Papers
Pharmacy Times Oncology EditionTM and Pharmacy Times Health-System EditionTM are seeking to expand our current coverage offerings to include peer reviewed research on clinical topics and treatment of different disease states.
The publications are seeking to focus on a wide range of therapeutic categories in the oncology and health-system pharmacy space to educate readers and translate innovative clinical discoveries into improved health outcomes for patients. This new focus on clinical research seeks to accelerate adaptation of new therapeutics, techniques, and technologies from the publication’s pages to the clinical setting.
The clinical manuscripts sought will examine different treatments for and management of the different disease states and pharmacologic interventions. Of particular interest are papers that highlight the role of the pharmacist within the overall health care team and provide insight into the impact pharmacists have on patient outcomes. These submissions will be peer-reviewed and published in upcoming editions of Pharmacy Times Oncology Edition and Pharmacy Times Health-System Edition.
Some clinical topics of interest include:
- Antimicrobial Stewardship
- HIV and Pre-exposure Prophylaxis
To send in research paper submissions or if you have any questions, please email Davy James (djames@pharmacytimes.com) or Alana Hippensteele (ahippensteele@mjhlifesciences.com).
In short, telemedicine allows specialty pharmacists to meet patients where they are, literally and figuratively, and help cancer care teams in particular identify and combat issues relating to social determinants of health. Opportunities to address patient concerns about their treatment, its progress, and other issues as they arise enable pharmacists to take a more active role in the patients’ treatment and care journey.
Analysis at Specialty Pharmacy
In a 2019 retrospective analysis of patients with pulmonary arterial hypertension at Vanderbilt Specialty Pharmacy (VSP), integrated telemedicine collaboration across care teams was shown to improve adherence. Investigators measured adherence using proportion of days covered (PDC), or total days covered by medication fills, divided by the total number of days for which the provider had prescribed the medication.2
Tadalafil (Adcirca; Eli Lilly) and sildenafil (Revatio; Pfizer) were monitored between January 1, 2014, and December 31, 2016, and results showed that overall PDC at VSP was 96% (SD, 0.092), with 94% of patients achieving a PDC of 80% or more. Furthermore, many patients were able to obtain some form of financial assistance via manufacturer co-pay assistance or grants.2
Notably, investigators did not make a distinction between high OOP co-pays and adherence because patients’ OOP costs were lower because of VSP’s ability to apply co-pay assistance to prescriptions. Results from other studies, however, have shown that patients with higher co-pays have lower adherence rates than those with relatively lower ones.2 In addition, the prescriptions were not on autofill but instead required that patients speak with a member of the pharmacy staff.
Eliminating Barriers to Treatment
Telemedicine can greatly affect, and sometimes eliminate, barriers to treatment for vulnerable populations such as those who are immunocompromised, those with physical disabilities that make in-person appointments difficult, or those who face stigma because of disease state or other factors. Patients with cancer are an example of a population that would benefit from these services.
During the pandemic, oncologists sought to change medication administration routes from intravenous to oral whenever possible2 and thus decrease the need for patients to travel to receive chemotherapy infusions3 and protect them from further risk of infection. Thanks to this shift, patients have been able to save not only time but the travel costs associated with cancer treatment. They no longer need to make themselves available for all-day clinic appointments that may require commuting to a nearby city or state.3
Oral oncolytics have been particularly beneficial for patients in rural locations, easing their treatment burden. In addition, if patients with cancer in nonurban areas can access home nursing services, such services can be scheduled during telemedicine MTM assessments, alleviating the strain on patient schedules, finances, and overall well-being.3
Telemedicine in Practice
Specialty pharmacists at AllianceRx Walgreens Pharmacy use telecommunication to counsel patients on initial medication fills. During this session, the pharmacist can review proper administration, storage, AEs, and disease outcome monitoring. If patients report AEs or adherence issues, pharmacists can provide additional counseling or reach out to an oncologist to inform them that their intervention is needed.
