Filling prescriptions at health-system specialty pharmacies (HSSPs) can reduce primary medication nonadherence (PMN) rates and improve patient outcomes, according to research presented at the ASHP Midyear 2024 Clinical Meeting & Exhibition, in New Orleans (poster 7-013).
The authors reported that patients with prescriptions sent to non-HSSPs were 60% more likely to fail to adhere to their medication than those who had prescriptions sent to HSSPs.
Adherence gaps are not uncommon when starting specialty medications, noted study author Autumn Zuckerman, PharmD, BCPS, CSP, the director of specialty pharmacy at Vanderbilt University Medical Center (VUMC), in Nashville, Tenn.
She and her colleagues gathered data from 1,467 patients prescribed specialty medications from Vanderbilt Health System oncology (n=787; 53.6%), inflammatory disease (n=574; 39.1%) and multiple sclerosis clinics (n=106; 7.23%). The PMN rates for those who had their prescriptions filled at VUMC or non-HSSPs were, respectively, 6% and 10% (P=0.027).
Although this difference was smaller than expected, in was statistically significant, said Dr. Zuckerman, a member of the Pharmacy Practice News editorial advisory board. She outlined several ways that the VUMC Specialty Pharmacy model lowers PMN rates:
- Pharmacists are integrated into each specialty clinic to support the full patient journey from medication selection to access, monitoring and optimization.
- VUMC specialty pharmacists have access to electronic health records to help complete insurance requirements.
- Pharmacists leverage their relationships with patients to identify and address barriers to treatment initiation.
This close relationship with patients may explain why the difference between PMN rates at VUMC and non-HSSPs was lower than expected. Dr. Zuckerman explained that in many clinical areas (such as oncology), VUMC pharmacists help patients access and afford treatment regardless of where they fill their prescriptions, likely bringing down the overall PMN rates.
Evaluating patient data also enabled the VUMC team to identify opportunities for improvement. The most common reason that patients did not start treatment was that they chose not to. This led Dr. Zuckerman to note that “we have room to improve shared decision-making prior to prescribing.” By contrast, the most common reason treatment was not initiated among those who sought prescriptions from non-HSSPs was that their medications were not approved by insurance.
Dr. Zuckerman and her team plan to continue their efforts to improve PMN rates by building a dashboard to identify patients who have prescriptions sent to external pharmacies that do not get filled promptly. This will enable them to identify and address any patient delays to starting treatment.
This article is from the March 2025 print issue.