Autumn Zuckerman, Pharm.D., AAHIVP, BCPS, CSP; Jacob Jolly, Pharm.D., CSP; Nisha Shah, Pharm.D.; Ryan Nix, Pharm.D.; Elizabeth Cherry, Pharm.D.; Matthew Phillips, Pharm.D.; Rebecca Yoon, Pharm.D.; Nicholas Brakefield, Pharm.D.; Tara Kelley, Pharm.D., MMHC, CSP
Vanderbilt Specialty Pharmacy, Nashville, TN
Purpose
Specialty therapy has advanced the treatment of complex diseases. However, access to and benefit from therapy depends on successful navigation of a convoluted process. Vanderbilt Specialty Pharmacy (VSP) fosters an innovative, high-touch care model to support patients through their healthcare journey.
Program Description
Recognizing the value of integrated services, VSP established its model in 2011. Today, the specialty pharmacy teams, comprised of specialty pharmacists and certified pharmacy technicians, are embedded in 23 outpatient specialty clinical areas. In 2015, VSP developed a health outcomes and research program to measure value and improve patient care using sound research. These research findings demonstrate how the integrated model conveys benefit to patients, caregivers, providers, and the institution.
Program Experience
Customer satisfaction. High patient satisfaction is evidenced by our consistent net promotor scores above 90 [Zitter survey]. Providers and staff rate themselves as ‘extremely satisfied’ with our team, with a 9.74/10 ‘likeliness to refer’ rating. Moving beyond stakeholder satisfaction, our model delivers tangible improvements in quality. Several studies demonstrate our expertise in navigating access, cost and initiation barriers.
Access. Our average time to shipment is 2.8 days, exceeding the industry average of 10 to 15 days. In the neurology clinic, access time to pimavanserin decreased from 24.5 days to 3 days after integration. In the hematology clinic, median access time was 3 days for VSP compared to 6 days for external pharmacies (OR=6.5, p<0.001).
Cost. Our patients benefit from our financial assistance program. For fiscal year 2016, our efforts resulted in a $5,811,640 cost savings to patients through copay and other patient assistance programs.
Initiation. Of 315 PCSK9i prescriptions, 96% resulted in patient access and 91% in treatment initiation. Among patients prescribed HCV treatment, 97% started therapy, compared to real-world reports that 37% of all patients prescribed treatment initiate therapy.1,2
Adherence and persistence. Our adherence rates exceed industry standards, with average adherence of 93% for all patients (November 2016-November 2017). Our patients also achieve high rates of treatment completion. For HCV therapy, 97% of patients successfully completed treatment, in contrast to real-world studies which report a discontinuation rate of 8.1%.3 For teriparatide, patients were 62% more likely to complete treatment and 49% less likely to discontinue treatment after completing 12 months.
Innovation. Our commitment to advance the field drives our efforts in telemedicine, collaborative practice agreements, and development of quality metrics. Also, we host an annual research summit to foster innovation, collaboration and disseminate research knowledge and tools to the community.
Conclusion
The outcomes detailed above quantify the exemplary care we provide to our patients and the benefits we convey to our healthcare partners as well as the field of specialty pharmacy.
References:
- Clough B, Afdhal N, Milligan S, Slotnik J. TRIO-Health Real-World Evidence: Hepatitis C Treatment Demand & Non-Starts. http://www.natap.org/2017/HCV/TrioHealthTroutGroupHepC. PD: TRIO-Health;2017.
- Zuckerman A, Douglas A, Nwosu S, Choi L, Chastain C. Increasing success and evolving barriers in the hepatitis C cascade of care during the direct acting antiviral era. PLOS ONE. 2018;13(6): e0199174.
- Brennan TA LA, Shrank W. Analysis of "real-world" Sovaldi (sofosbuvir) use and discontinuation rates. 2014.