Unique clinic-pharmacy collaboration benefits hepatitis C patients

A trained and accessible pharmacy team can not only improve patient outcomes, but also improve efficiency in healthcare delivery, according to a new study published in the Journal of the American Pharmacists Association.

A Walgreens Center for Health & Wellbeing Research study looked at a collaboration between Piedmont Healthcare’s hepatitis C specialty clinic and a Walgreens local specialty pharmacy. The study showed that a high proportion (94%) of hepatitis C patients who were prescribed direct-acting antiretrovirals (DAAs) were able to achieve the primary outcome goal, sustained virologic response (SVR), even though many patients had advanced liver disease, previous treatment failure, or previous liver transplants.

Delpino

“The relationship developed between a hepatology clinic and a community-based hepatitis C specialized pharmacy enabled a collaboration that minimized delay in hepatitis C (HCV) therapy, reduced insurance denials, and allowed patients to access high-cost hepatitis C medications with a very low out-of-pocket expense,” says study co-author Ambrose Delpino, PharmD, AAHIVP, senior manager, Patient Care and Advocacy, Walgreens.

“Furthermore, through the proactive support patients received from their provider, Piedmont, and their trained Walgreens specialty pharmacy team, patients were able to cure their chronic hepatitis C infection at a very high rate,” says Delpino. “With healthcare becoming increasingly specialized, innovative ways are needed to improve communication between different healthcare professionals and encourage collaboration in a patient-centered way.”

Delpino and colleagues retrospectively looked at a joint clinic-pharmacy database constructed from patients who were treated for HCV with DAAs over a two-year period from 2013 to 2015. The patients were treated by providers at a single-center hepatology clinic and received their medication from a nearby Walgreens pharmacy that specializes in hepatitis C. Outcomes assessed included time-to-therapy, SVR, insurance appeals, and copay assistance amount. 

“Our pharmacy administered a proactive program consistent with all Walgreens hepatitis C specialized pharmacies-of which we have approximately 100 across the country-to ensure patients had affordable access to therapy and were able to complete therapy,” he says. “Based on the retrospective analysis outcomes were generated examining the time to treatment initiation, out of pocket cost for patients, and overall cure rates.”  

More findings

Other study findings include:

·      Despite the high cost of these treatments, 151 of 154 patients with copay information available had an out-of-pocket expense of less than $20 per month.

·      Although Delpino says the researchers can’t identify causality due to the study design, there appears to be value in minimizing treatment delays once the decision is made to prescribe HCV therapy. The results showed a decrease in cure rates for patients with time-to-treatment of 30 days or more. 

·      Although 81% of patients required prior authorization, approximately 71% received their medications within 10 days.

·      Even though hepatitis C patients in this study often had advanced disease, this real-world evidence found similar SVR rates to those published in clinical trials.

·      The relationship and trust built over time between the Walgreens pharmacy team and Piedmont was critical to the successful outcomes demonstrated in this study.

Four tips for health execs

Based on study, Delpino, offers four recommendations for healthcare executives:

1.   Be open to collaborations. “Not only within your enterprise but also with external partners who have expertise in an area of need for assistance,” Delpino says. “Encourage your teams to also keep an open mind and seek out these external collaborations when there is an opportunity to create incremental value by working together.” 

2.   Align goals. When seeking out these collaborations, it is important to align on goals of the collaboration from the onset (i.e., efficiently and cost-effectively cure more people living with HCV). 

3.   Provide structure. “Provide enough structure to the programs your healthcare professionals are implementing to ensure high-quality care and consistency but also enough freedom for them to develop innovative ways to meet the needs of their patients,” Delpino says. 

4.   Know what it is that your patients/customers want and need. “From there, focus all of your available time and resources only on programs and services that meet those needs,” he says.