Specialty pharmacist integration into an outpatient neurology clinic improves pimavanserin access

Abstract

Introduction Access to pimavanserin, the only Parkinson disease–related psychosis treatment approved by the FDA, is restricted by insurance requirements, a limited distribution network, and high costs. Following initiation, patients require monitoring for safety and effectiveness. The primary objective of this study was to evaluate impact of specialty pharmacist (SP) integration on time to insurance approval. Additionally, we describe a pharmacist-led monitoring program. Methods This was a single-center, retrospective study of adults prescribed pimavanserin by the neurology clinic from June 2016 to June 2018. Patients receiving pimavanserin externally or through clinical trials were excluded. Pre- (June 2016 to December 2016) and post-SP integration (January 2017 to June 2018) periods were assessed. Proportional odds logistic regression was performed to test association of approval time with patient characteristics (age, gender, insurance type) postintegration. Interventions were categorized as clinical care, care coordination, management of adverse event, or adherence. Results We included 94 patients (32 preintegration, 62 postintegration), 80% male (n = 75) and 96% white (n = 90) with a mean age of 73 years. Median time to approval was 22 days preintegration and 3 days postintegration. Higher rates of approval (81% vs 95%) and initiation (78% vs 94%) were observed postintegration. Proportional odds logistic regression suggested patients with commercial insurance were likely to have longer time to approval compared with patients with Medicare/Medicaid (odds ratio 7.1; 95% confidence interval: 1.9, 26.7; P = .004). Most interventions were clinical (51%, n = 47) or care coordination (42%, n = 39). Conclusion Median time to approval decreased postintegration. The SP performed valuable monitoring and interventions.

Exploring healthcare providers’ experiences with specialty medication and limited distribution networks

“…In our study, participants expressed that communication barriers were reduced when a drug could be dispensed by the IHSSP. This qualitative data corroborates previous findings showing that access time is significantly longer for specialty medications with LDNs compared with non-limited distribution, and that medication access time is reduced after the IHSSP is included in the LDN for multiple sclerosis, hematology, and neurology clinics [ 10 – 12 ]. Conversely, when a LDN that excluded the IHSSP was imposed, one health system found delays in drug acquisition and more variable and unreliable medication delivery times [ 2 ].…”

“…This is the first known study to qualitatively explore healthcare providers' experiences with LDNs and investigate how LDNs influence providers, patients, and clinics. This study builds on previous reports that demonstrate the impact of LDDs on time to medication access, health system expenses, administrative and financial burden for clinics, and fragmentation in care [1][2][3][10][11][12]. Understanding specialty providers' perspectives on the perceived impact of LDNs is necessary for specialty pharmacy stakeholders to help improve efficient, equitable treatment for all patients.…”

“…Previous research has described high medication access and adherence in patients who fill medication from an IHSSP compared with limited distribution drugs filled from an external pharmacy [9][10][11][12]. Healthcare providers rate higher satisfaction with IHSSPs than external [13].…”

Pimavanserin and Parkinson’s Disease Psychosis: A Narrative Review

“…Table 4 was adapted from the study of Dashtipour et al [ 65 ]. It is worth mentioning that US prescribers of PMV must provide medical documentation of psychosis and the reason for its indication, which can sometimes affect the use of PMV for behavioral management [ 66 ].…”

Leveraging ambulatory care pharmacist expertise in medication appeals to overcome access barriers: A descriptive report

“…Livezey and colleagues assessed the median time to approval for a limited distribution specialty agent and illustrated the benefit of integrating a clinical pharmacist to address medication access in a small sample of neurology patients. 9 This report included results of nine appeals pre and post specialty pharmacy integration. Appeals were successful in 75% (n = 4) of patients before pharmacy integration and in 100% (n = 5) of patients after pharmacy integration.…”