Impact of Health System Specialty Pharmacy Services in an Affiliated Digestive Disease Center

Purpose: Specialty medications account for 50% of the total drug cost in the United States; a 36% increase from 2015. By 2020, this could reach $400 billion with specialty medications accounting for up to 65% of annual spend. As the cost of healthcare continues to rise, Health System Specialty Pharmacies (HSSPs) have the opportunity to improve quality of care and contain patients’ cost through an integrated specialty pharmacy program. HSSPs have developed integrated models to support transitions of care but the direct impact on access to treatment and disease state outcomes is not well established. The primary objective of this study is to evaluate the impact of a specialty pharmacist on the ability to access direct antiviral therapy in patients with HCV.

Methods: A retrospective cohort study was conducted within the Ertan Digestive Disease Center for patients who visited the clinic pre and post implementation of a specialty pharmacist. Patients were excluded if they were less than 18 years of age, were co-infected with HIV and HBV, and/or if they were not prescribed direct acting antiviral therapy. The primary outcome of this study was to determine the impact of a specialty pharmacist on time to treat for patients with HCV. Secondary endpoints included proportion of patients achieving sustained virologic response, the proportion of drug-drug interactions (DDIs) appropriately managed, and time to treat by insurance type.

Results: The study included a total of 200 patients (100 in each study arm). ). Median time to treat was significantly reduced in the post-implementation group (median (21 days (4,190)) compared to the pre-implementation group (30 days (2,258)) [p <0.001, Mann Whitney-U test]. There was no significant difference in the proportion of patients achieving sustained virologic response between pre-implementation (87 out of 91 patients) and post-implementation (93 out of 94 patients). However, the management of DDIs in post-implementation (53 out of 53 patients) was significantly different compared to pre-implementation (19 out of 46 patients) groups (χ2=25.087, p<0.001). The sub-analysis for time to treat by pharmacy prescription benefits showed statistical significance for patients in time to treat for patients who had commercial [p=0.017, Mann Whitney-U test] and Medicare prescription benefits [p <0.001, Mann Whitney-U test]. There was no statistical difference for patients who had Medicaid prescription benefits. A second sub-analysis for time to treat for fibrosis score showed there was no statistically significant difference in time to treat for fibrosis score F0-F2, but there was a statistical difference in time to treat for patients with fibrosis score of (F2-F3) - F4 [p=0.001, Mann Whitney-U test].

Conclusion: The implementation of an integrated specialty pharmacist has the potential to improve transitions of care by shortening the time to treat and management of DDIs. Through this study, the implementation of specialty pharmacist showed a statistically significant reduction in time to treat for patients with HCV who were initiation DAA therapy. Future multi-institutional study with a larger sample size may be able to detect improvement in treatment outcomes such as sustained virologic response with implementation of a specialty pharmacist.