Impact of specialty pharmacist integration on time to medication access for pimavanserin

Abstract

Background: Patient access to pimavanserin treatment, an antipsychotic agent used to treat Parkinson’s disease-related psychosis, is limited by insurance approval and navigating a limited distribution network. Once initiated, safety and efficacy monitoring is needed to ensure adherence and clinical benefit. Aims: To determine the impact of specialty pharmacist integration on time to pimavanserin access. A secondary objective is to describe pharmacist interventions related to pimavanserin. Methods: This was a single-center, retrospective cohort study with a pre–post design. Patients prescribed pimavanserin through the center’s neurology clinic during May 2016 through July 2018 were included. An electronic chart review was performed to collect data for patient demographics (age, race, gender), insurance information (type, prior authorization process), and pharmacist interventions. The primary outcome was defined as time to medication access (in days) between the initial intent to treat and insurance approval. Univariate analysis and multiple logistic regression were performed to assess the associations between medication access time and pharmacist integration. Results: Ninety-four patients met inclusion criteria. Patients were mostly male (80%) and Caucasian (96%). Median age was 74 years. Baseline demographics between the pre- and post-integration cohorts were similar. Pre-integration, 33 patients were prescribed pimavanserin, with 82% attaining insurance approval and 79% starting therapy. Post-integration, 61 patients were prescribed pimavanserin, with 95% attaining insurance approval and 93% starting therapy. Median time to access decreased following integration (3 days compared to 24.5 days). Patients prescribed pimavanserin pre-integration had a 23-fold increase in odds of experiencing a longer time to access compared to post-integration (OR = 23; 95% CI = 8–69; p < 0.001). In addition, patients with non-commercial insurance were more likely to have a shorter medication access time compared to patients with commercial insurance. The pharmacist performed at least one intervention for 85% of patients, including medication counseling (n = 58) and interventions to improve clinical care (n = 120) and medication access (n = 135). Conclusions: Integration of a specialty pharmacist decreased time to pimavanserin access and facilitated pharmacy interventions to ensure safety and efficacy of use. Additional research is needed to evaluate the impact of faster medication access on clinical outcomes.

Low continuation of antipsychotic therapy in Parkinson disease – intolerance, ineffectiveness, or inertia?

“…These symptoms are common in PD, especially in later disease stages, and cause significant caregiver distress [ 11 , 55 , 56 ]. Pimavanserin may be less likely to be used for behavioral management, as U.S. prescribers must provide medical documentation of psychosis as the reason for use [ 57 ]. If similar clinical documentation was required for all AP prescribing, the unmet need for management of behavioral and sleep disorders would become more evident, as would potentially inappropriate AP use.…”

Low Persistence of Antipsychotic Therapy in Parkinson Disease – Intolerance, Ineffectiveness, or Inertia?

“…prescribers must provide medical documentation of psychosis as the reason for use. [53] If similar clinical documentation was required for all AP prescribing, the unmet need for management of behavioral and sleep disorders would become more evident, as would potentially inappropriate AP use. Future prospective studies will examine the frequency with which AP therapy is being used (in part or whole) for PD-related behavioral disturbances and measure clinical and safety outcomes associated with these off-label, potentially contraindicated uses.…”

Low rates of primary medication nonadherence in patients prescribed oral oncology agents across health system specialty pharmacies

“…The short time to medication access seen in population of patients that filled medication at an HSSP aligns with previous research demonstrating that HSSP integration leads to fast specialty medication access. 5,[7][8][9][10][11][12][13][14][15][16][17]28 The least common reasons for PMN was unaffordable copay or that the treatment was no longer appropriate. HSSP team members help patients obtain access to the treatment through prior authorizations and/or financial assistance obtained through foundations or manufacturer programs.…”

“…2 Integration with providers, clinics, and other services within the health system enables HSSPs to often overcome common barriers to access while meeting the needs of manufacturers and payers. [5][6][7][8][9][10][11][12][13][14][15][16][17] HSSPs have also demonstrated the ability to ensure patients can afford high-cost specialty therapies, which may be a particularly pressing concern for cancer treatments as most patients are Medicare beneficiaries that do not qualify for manufacturer assistance. 6,9,12,[18][19][20][21][22] By collaborating with other health system services, such as social workers and financial advisors, HSSPs provide comprehensive care that ensures patients can access, afford, and initiate specialty medications in a timely manner.…”