ASHP Specialty Pharmacy Patient Journey Example
ASHP Specialty PharmacyBest Practices &Patient Journey Example
Specialty Pharmacy Overview “4 S’s”vvSPACEvvvvSTAFF vvvOperates in sq. ft. facilityEquipped to scale rapidly to meet clientstrategic growth needsLicensed to ship to 49 states D.C.Accredited by URAC and ACHCCSP Certified Clinical PharmacistsSP disease state expertsPharmacy financial coordination &billing expertiseTech-In-Training ProgramDedicated data analyst teamvvvvvvvvEMR visibility, documentation, &communicationHIPAA-compliant Virtual VisitPharmacist EducationHIPAA-compliant Two-Way TextMessaging PlatformSYSTEMSMMIT Non-PBM SP Patient ChoiceAward FinalistDisease state specific patientmanagement programsPrior auth coordinationAdjustable hours to meet client needs24/7 Access to SP pharmacistSERVICE
Specialty Pharmacy Where We Currently ServiceLicensed in 49states and DCCurrently, shipto 44 statesand DCXValidated coldchain process inmultiple USregions
Specialty Pharmacy The Patient Journey1Initial PatientEngagement2New PatientConsultation3PatientFollow-Up
Specialty Pharmacy Patient Case11/16/20James is a 36yo M diagnosed with PsA andis switching therapies from MTX to Taltz. James New to specialty pharmacy New to biologics & injectables Commercial insurance Worried about cost Taltz Rx sent to Specialty Pharmacy
Specialty Pharmacy Initial Patient Engagement11/16/20James is a 36yo M diagnosed with PsA and isswitching therapies from MTX to Taltz. Access Team Checks in-network & PA requirements Pulls/Requests EMR chart notes Facilitate PA submission Initial Prescription Review Missing induction Rx Places in RPH clarification queue Provides welcome call & explain SP process Enrolls James in text messaging platform Pharmacist Team Calls prescriber to discuss induction Rx
Specialty Pharmacy Access Team & Pharmacist Consult DetailsAccess Team TaskNormalPrescriptionUrgent PrescriptionTest Claim ProcessedWithin 1 DaySame DayPrescriber Notification- Chart notes required- Non-contracted SPWithin 1 DaySame DayPatient IntroductionWithin 1 DaySame DayPatient Assistance Achieved 10 millionPA Submission ProcessInitiatedWithin 1 DaySame DayMedian Turn-Around TimeClean Rx2 daysPA MonitoringAt Least Every 2 DaysEverydayCopay/Foundation AssistanceApproval4 daysAt Least Every 2 DaysEverydayMedian Turn-Around TimeIntervention RxInitial Patient Outreach(if unable reach)98.%At Least Every 2 DaysEverydayPrimary Adherence Rate(Patients with PA approved)Patients that Received New PatientConsult100%At Least Every 2 DaysEverydayPatients Enrolled in PMP90%*Prescriber Contacted after 3 attemptsPharmacist Consult Outreach(if unable reach)*Prescriber Contacted after 3 attempts2019 Access Team & Pharmacist Consult MetricsPA started same day received98%PA Approval Rate96%Copay Assistance Facilitation Offered100%*Excludes clinic-administered medicationsEXAMPLE METRICS
Specialty Pharmacy PA & Copay Assistance Follow-up11/18/20James is a 36yo M diagnosed with PsA and isswitching therapies from MTX to Taltz. Access Team PA approved Messages patient Confirms patient wants copay assistance Facilitates copay card enrollment Reduced Copay 75 à 5 Messages patient new copay Pharmacist will reach out within 1 day forassessment & provide education Induction and maintenance Rx already clarified
Specialty Pharmacy The Patient Journey1Initial PatientEngagement2New PatientConsultation3PatientFollow-Up
Specialty Pharmacy New Patient Assessment & Education11/18/20James is a 36yo M diagnosed with PsA and isswitching therapies from MTX to Taltz. Pharmacist Team Reviews chart notes/med list/Rx Messages patient to identify consultcommunication preference Video (preferred) or telephone Patient confirms video capability Pharmacist sends virtual visit link
Virtual Pharmacyv Remote pharmacistvideo visit with patient toensure safe medication planv New patient assessmentv Self-injection educationusing training devicesv Personal virtual face-to-faceexperienceTelepharmacy Visitsv Delivering a seamless flow from a Provider visit to virtual pharmacist assessment &patient education is a service differentiator for Specialty Pharmacy patients.v This service strategy demonstrates our agility to ease the way of our patients, andensure they are adequately prepared for their new medication.
Specialty Pharmacy New Patient Assessment & Education11/18/20James is a 36yo M diagnosed with PsA and isswitching therapies from MTX to Taltz. Pharmacist Team Pharmacist & James begin virtual visit Patient Assessment PMH, comorbidities, labs, prior tx Current symptoms baseline QOL Medication reconciliation Therapy appropriateness/DUR Ability to self-administer Patient motivation & treatment goals
Specialty Pharmacy New Patient Assessment & Education11/18/20James is a 36yo M diagnosed with PsA and isswitching therapies from MTX to Taltz. Pharmacist Team Patient Education Administration/injection technique Dosing schedule/missed doses Adherence recommendations Side effect management Storage/disposal/handling precautions Safety precautions/warnings Therapy outcomes/expectations Disease state education Vaccination recommendations
Specialty Pharmacy Delivery & Resource Coordination11/18/20James is a 36yo M diagnosed with PsA and isswitching therapies from MTX to Taltz. Pharmacist Team Final Onboarding Coordination Enrolled in SP PMP 11/19/20 delivery Welcome packet PsA disease state handout Taltz handout Manufacturer kits/pamphlets Useful external resources Sharps container/alcohol swabs Package tracking e-mail sent
Specialty Pharmacy The Patient Journey1Initial PatientEngagement2New PatientConsultation3PatientFollow-Up
Specialty Pharmacy Refill Coordination12/11/20James is a 36yo M diagnosed with PsA and isswitching therapies from MTX to Taltz. Call Center Team Refill Coordination Text message refill questionnaire Delivery address confirmation Delivery date confirmation – 12/15/20 Shipping instructions Ancillary supplies needed Package tracking e-mail sent
Specialty Pharmacy Text Messaging Platform – Refill Coordination
Specialty Pharmacy Text Messaging Platform Pilot OutcomesvvvvTwo-way text messagingAbility to send videos, links, documents, formsAvailable for text, email, appBranching logicPharmacy Outcome (N 515)Pre-TextingPost-TextingMean Patient Response Time68.6 hours32.1 hours*Mean Adherence Rate (using MPR)0.900.94*Outbound Refill Calls100%31%*N/A4.6/5Patient Satisfaction with Twistle* p-value 0.001
Specialty Pharmacy SP Follow-Up Assessment12/14/20James is a 36yo M diagnosed with PsA and isswitching therapies from MTX to Taltz. Pharmacist Team Patient Re-assessment Chart review Adherence evaluation Symptom & QOL evaluation Changes in health status Medication reconciliation /- DI Check Side effect evaluation On-going monitoring parameters Progress toward therapy goals On-going patient education
Specialty Pharmacy Pharmacist Interventions12/14/20James is a 36yo M diagnosed with PsA and isswitching therapies from MTX to Taltz. Pharmacist Team During re-assessment: Adverse effects identified URI symptoms Recommendation: Urgent care visit Hold next injection until URIresolved Prescriber call to discussrecommendation Recommendation Accepted Continue monitoring monthly2020 Q1 RPH InterventionsRX clarificationsNew Patient educationMedication stopped/on holdTherapy Appropriateness evaluatedDrug interaction checkDrug interaction identifiedMed Rec performedLabs evaluatedLabs not ordered/abnormalMed stability/disposal concernMajor ADR ManagementAdherence Concern/CounselingMinor ADR ManagementAdministration issueUnmanaged symptomsProvider/Clinic QuestionsDelivery/Product issuesPregnancy issuesConcomitant Tx issueFinancial/PA issuesEfficacy ConcernsTx not appropriateDuplicate TxImmunization RecommendationSigns/Symptoms of 4835614312136912822
Specialty Pharmacy Call Center and Clinical Pharmacist Team DetailsCall Center/Clinical Pharmacist Team Task2019 Call Center/Clinical Pharmacist Team MetricsRefill Reminder OutreachAt least 3 days prior to next fill dateAverage Speed to AnswerRefill Reminder FrequencyHep C/Oncology/TXP every 3 daysOther Therapies every 7 daysCall Abandonment RateRefill Reminder AttemptsHep C/Oncology/TXP 4 attemptsOther Therapies 3 attemptsPrescriber Refill RequestsWithin 1 week of last refill dispensePhone messages checkedAt least every 90 minutesText message responsesWithin 1 day*Prescriber Contacted after 3 attemptsPharmacist Follow-upFrequencyPharmacist Follow-UpOutreach (if unable reach)*Prescriber Contacted after 3 attemptsCustomized Based on Condition,Medication, Patient Needs,& Pharmacist Clinical JudgementAt least monthly20 seconds2%Median Refill Turn-Around Time1 daySecondary Adherence Rate (PDC) - Overall Hepatitis C Autoimmune Conditions Multiple Sclerosis Oncology94%98%92%93%92%Inflammatory Patient QOL Improvement1.8Average Net Promoter Score85Average Pharmacist Intervention/Assessment1.7Estimated Intervention Cost AvoidanceEstimated Intervention Cost Avoidance perPMP-enrolled PatientEXAMPLE METRICS 1 million 250
Specialty Pharmacy Disease State-Specific Clinical Assessment Example
Specialty Pharmacy Disease State-Specific Reportable Clinical OutcomesInflammatory Conditions§ Inflammatory ConditionType§ Prior Treatments§ DMARD Status§ TB Status§ Hepatitis B & C Status§ BSA Affected (Derm)§ Morning Stiffness (Rheum)§ Pain Score (Rheum)§ Work Productivity &Impairment§ Patient Global Assessmentof Disease State Activity§ IBD-related hospitalizations§ IBD-related ER visitsHIV§§§§Prior TreatmentsCD4 CountInfectionsPatient Global Assessmentof Disease State ActivityMS subtypePrior TreatmentsVitamin D StatusDepression Status/SeverityMS RelapsesUnmanaged MS SymptomsWork Productivity &Impairment§ Patient Global Assessmentof Disease State Activity§ MS-related hospitalizations§ MS-related ER visits§§§§§§§Hepatitis C§§§§§§§GenotypeCirrhosis StatusPrior Treatment StatusReinfection StatusTreatment DurationSVR12Discontinuation reasonTransplantOral OncologyMultiple SclerosisCancer TypePrior Treatment StatusInfectionsCancer-relatedhospitalizations§ Cancer-related ER visits§§§§Transplant TypePrior ions§ Transplant-related ER visits§§§§All ConditionsPAHPrior TreatmentsWHO Functional ClassSymptom SeverityUnmanaged PAH SymptomsREMS requirementsPatient Global Assessmentof Disease State Activity§ PAH-related hospitalizations§ PAH-related ER visits§§§§§§PCSK9 Inhibitors§ LDLReported by Condition§§§§§§§§§§§§Height & WeightMPR/PDCMissed Doses past monthNon-Adherence ReasonsClinical InterventionsClinical InterventionOutcomesAdverse EventsHospitalizationsER VisitsTherapy EffectivenessSP PMP EnrollmentAssessment Duration
Patient Care Opportunities Health Plan Collaboration ExampleCOVID-19 Pandemicv Multiple Asthma/Allergy Clinics closedv Patients had nowhere to receive Xolairinjectionsv FDA released Xolair self-administrationexceptionv Created Xolair Home Administration protocolv Health plan collaborationv Screen Xolair patientsv Ensure medical billing was managedappropriatelyv Convert Xolair vial PAs to pre-filled syringesv Virtual/telephonic patient counseling andadministration training sessionv Epinephrine status/need evaluationv Added EpiPens to SP inventoryv Patient/caregiver anaphylaxis managementeducation
Specialty Pharmacy PA & Copay Assistance Follow -up 11/18/20 James is a 36yo M diagnosed with PsAand is switching therapies from MTX to Taltz. Access Team PA approved Messages patient Confirms patient wants copay assistance Facilitates copay card enrollment Reduced Copay
The ASHP Accreditation Standard for Specialty Pharmacy Practice reflects contemporary best practice for specialty pharmacy. The accreditation process is designed to be easy to understand, flexible, and consultative in nature and can be tailored to different models of care. The accreditation focuses on optimal care delivery through evaluation of:
Fraser-Johnston Light Commercial ASHP 122000 Y *EF-10 & FF-10 Fraser-Johnston Light Commercial ASHP 144000 Y BA-12 Fraser-Johnston Light Commercial ASHP 164000 Y BA-15 Fraser-Johnston Light Commercial ASHP 24400 - 47000 Y BUP024-048 . Brand Name Model Name Product Type Capacity (Btu/H) ARI Certified/Listed Model Number .File Size: 646KB
ASHP Guidelines on Handling Hazardous Drugs ASHP published its first guidance on hazardous drugs (HDs) in 1983 as part of the 1983-84 ASHP Practice Spotlight: safe handling of cytotoxic drugs.1,2 This was followed by techni-cal assistance bulletins (TABs) in 1985 and 1990, and the ASHP
87 Rutgers, The State University of New Jersey Ernest Mario School of Pharmacy 17 88 South University School of Pharmacy 18 89 Sullivan University College of Pharmacy and Health Sciences 19 90 University of Connecticut School of Pharmacy 20 91 University of Florida College of Pharmacy 21 92 University of Georgia College of Pharmacy 22
The ASHP Standard for Certification as a Center of Excellence in Medication-Use Safety and Pharmacy Practice addresses the following primary areas: Placement of Pharmacy Department within the Health System 1. Organizational Relationships 2. Team-Based Care The Pharmacy Department and its Services 3. Leadership and Management
For most BCBSAZ members, specialty copay tiers (A, B, C, or D) apply. Tier Description A Specialty Medications, Low Cost Share B Specialty Medications, Moderate Cost Share C Specialty Medications, Moderately High Cost Share D Specialty Medications, Highest Cost Share Plans may include specialty medications at varying cost share tiers. Questions?
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Animal Fun Challenge Pack . Fold the paper plate in half. 2. Trace the elephant's outline on one side. 3. Colour or paint the elephant (not the tusk). 4. Cut out the elephant making sure not to cut the folded edge except for the shaping at each end. 5. Carefully cut out the paper plate section between the legs leaving the edge of the paper plate connecting the legs to make the rocker. (This .
