infusion model?

Senior Director, National Payer Sales and Account Management, Pharmacy Services AllianceRx Walgreens Prime

Limited distribution drugs (LDDs) are high-touch medications to which only a handful of specialty pharmacies have access. Because these medications usually have specific requirements, pharmaceutical manufacturers may choose to limit distribution of the drug to only a few specialty pharmacies. Pharmaceutical manufacturers choose a specialty pharmacy as a trusted partner because of its ability to support patients throughout their treatment journey.

Payors benefit from having one partner for all their specialty pharmacy needs. For payors, a specialty pharmacy’s broad access to LDDs means they will likely have the following: • End-to-end solutions. LDD access allows a specialty pharmacy to meet most of the specialty needs of its clients. For example, if the pharmacy does not have access to a product, it can work directly with the manufacturer to attempt to gain access on behalf of the patient. • Rapid access to medications. Because there is no delay or expense related to third-party

suppliers, payors can quickly access hard-tofind medications. Being part of an exclusive or narrow distribution network can allow pharmacies to have expedient contract additions to its payors. In addition, specialty pharmacies that have deep relationships with pharmaceutical manufacturers can begin discussions early about the specialty drug pipeline and how quickly patients can access drugs once available on the market. • Greater patient satisfaction. Central and local pharmacies operating under singular clinical programs allow for a consistent patient experience aimed at driving adherence and improving overall treatment experience. • Reduced costs. When a specialty pharmacy manages the full drug therapy needs of patients, its pharmacists and nurses can support possible medication issues, such as side effects, that could lead to nonadherence. In turn, those patients who remain on their drug regimen provide a healthier membership to the payor, potentially reducing overall costs. • Actionable insights. Specialty pharmacies can provide their payors regular reports outlining utilization and spending of all medications, including LDDs. Many specialty pharmacies offer real-time access to critical information through proprietary client data and insights tools. These tools can often visually transform a payor’s current business data into interactive insights, enabling the payor to best evaluate its overall payor strategy and respond to patient needs and market trends.

Ana Cavanaugh, RPh, MBA, is the senior director of National Payer Sales and Account Management, Pharmacy Services, at AllianceRx Walgreens Prime.

For strategies on how specialty pharmacies can help payors meet their goals, see expanded version at www.specialtypharmacycontinuum.com.

Boston—“If your institution, department or program does not have a home infusion setup for your oncology patients, you need to start working on it.”

That was the message from Laure DuBois, PharmD, BCOP, pharmacy clinical coordinator at the University of Kansas Medical Center, in Kansas City, discussing the increasing trend toward siteof-care management at a session at the 2022 annual meeting of the Hematology/ Oncology Pharmacy Association.

“At our institution, we first observed this with Aetna wanting to transfer patients on PD-L1 [programmed death ligand-1] inhibitors to home infusion by self-injection or the physician’s office,” Dr. DuBois said. “These policies are increasingly in place for many supportive care medications, as well as some targeted therapies.”

Dr. DuBois said their hospital leaders were convinced to start a home infusion program when they were shown that they could keep and treat patients rather than send them to nationwide home infusion companies. “You can start by targeting easier supportive agents, like denosumab [Prolia, Amgen], IVIG [IV immune globulin], antibiotics and leuprolide, and then consider moving to treatments like rituximab [Rituxan, Genentech/Biogen], eculizumab [Soliris, Alexion] and pembrolizumab [Keytruda, Merck].”

A crucial step is integrating a new home infusion program into the electronic health record (EHR), she said. “When we first started this, we had problems. Epic is our EHR and does not have a good platform for home infusion, so we started with a separate electronic ordering system. The doctors then couldn’t tell if the orders they had sent to home infusion were being fulfilled, so I hit the brakes and built home infusion as its own department in our EHR. The doctors are now able to use these order sets, make supportive care plans and treatment plans for home infusion, and then release the prescription to the home infusion pharmacy, after which they can see everything that happens.”

Dr. DuBois and her team included all supportive care medications that could be added to the plan as prescriptions, with all prescribing information built out, and then created advanced order groups in the EHR. “The physician could then select what medications they were prescribing a patient for home infusion and add them into the plan,” she said. “We also set up take-home prescriptions for an emergency kit to be kept at home, including all possible medications needed for line care and reactions. They were filled and left at the patient’s house during the first infusion.”

Dr. DuBois offered a few recommendations from experience:

Reach out to the patient. The home infusion department should call the patient the day after a home-based therapy is supposed to be administered. “If the patient says they haven’t yet administered their pegfilgrastim, I’ll sit on the phone with them until they have,” she said.

visits by 24 to 48 hours. “Initially, we tried to set up the first home infusion of pembrolizumab in the afternoon following a morning physician visit,” she said. “But then, if the physician decided to hold therapy after the visit, we had already sent the drug to the house. Now we allow at least 48 hours from physician visit to infusion to allow for dose changes and held therapy.”

ing. This may require patients to record their weight at home as a second check, Dr. DuBois noted. “With a drug like trastuzumab [Herceptin, Roche], for example, we are comfortable with the patient doing a weight check at home, and the pharmacist asks them for their recorded weight before filling the prescription,” she said.

Prioritize patient comfort. This is particularly important with more active therapies such as pembrolizumab and trastuzumab, Dr. DuBois stressed, adding that it is also important to help patients feel comfortable with the home infusion process. “We have established a warm handoff process from the hospital-based infusion nurse to the home nurse during the hospital visit, where the home nurse meets the patient and explains what the home infusion process will look like,” she said. “Because safety checks in the hospital setting aren’t always done in the patient’s room, they may not have seen them before. So, when the home nurse calls the hospital pharmacist to do that check, the patient may be concerned that it’s because something is wrong or they aren’t sure what they’re doing. We now make sure to educate the patient that these are the same safety checks we always do.”

restrictions. “With some of our new IVIG patients, we have gotten a site-ofcare denial for hospital infusion right away,” Dr. DuBois said. “We obviously don’t like to have the first dose in the home due to the possibility of unexpected reactions, so we will fight for a one-time exception to make sure they will tolerate the drug before sending it to the home.”