Background/Purpose: Biologic medications are commonly utilized to treat pediatric rheumatic diseases.  Being high-cost, most third-party payors require dispensing through a specialty pharmacy.  Common challenges with this system include delayed or missed medication shipment, adult-trained pharmacists and difficulty communicating with representatives. In March 2015, our health system opened their own specialty pharmacy, available to a certain subset of patients based on insurance coverage. The Rheumatology Clinic aimed to improve medication delivery timeliness, patient satisfaction, and hospital stewardship via collaboration with our institution’s Specialty Pharmacy (SP) when appropriate and applicable.

Methods: Throughout the last year, the rheumatology team increased utilization of the SP through a multidisciplinary approach.  The office manager identified potential patients and communicated with the SP pharmacist to gauge eligibility.  Providers were notified of eligible patients and discussed the SP in clinic with families when appropriate. Providers and/or nursing staff communicated with the SP pharmacist to verify eligibility and expedite processing.  The SP pharmacist initiated the prior authorization process and contacted family to enroll the patient.  Surveys were distributed by the SP to analyze patient and family satisfaction and collect feedback.

Results: From August 2018 to August 2019, the number of rheumatology patients utilizing our health system SP increased from 2 to 67.  On average, 13.6 days elapsed between the day the order was placed and when the medication was dispensed, compared to a national average of 3-6 weeks.¹ When 59 families were asked if their medications were delivered on time, 98.3% answered “yes, definitely”.  All families who had previously attempted to call the SP answered positively when asked if it was easy to contact someone if they had questions, with 96.4% saying “yes, definitely”. In rating their specialty pharmacy experience, (0-10), 96.6% selected 10, and 3.4% selected 9.  $1,176,557 of new net revenue was generated by rheumatology patients utilizing the SP in fiscal year 2019.

Conclusion: The number of patients benefited by the superior service of our health system SP has risen steadily over the last year, leading to high patient satisfaction and financial benefits for the hospital. The revenue generated from this initiative helped secure approval for a new clinical pharmacist position in rheumatology, further benefitting our patients. The rheumatology team plans to continue this initiative by actively working as a multidisciplinary team to identify eligible patients.  Future goals include having our SP recognized by other third-party payors, enabling more families to qualify for this service and receive the timely, patient-focused care.

1. 2018-19 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Adam J. Fein, Ph.D. Drug Channels Institute – October 2018.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/collaboration-between-rheumatology-clinic-and-specialty-pharmacy-to-positively-impact-patient-experience-and-hospital-stewardship/