Role and Impact of a Clinical Pharmacy Team at an Inflammatory Bowel Disease Center.

Background: There is limited literature describing the role of a clinical pharmacy team within a tertiary academic inflammatory bowel disease (IBD) center. The goal of this paper is to describe and showcase the clinical and operational impact of an integrated clinical pharmacy team. Methods: This was a retrospective study evaluating the referral outcomes for all patients referred to University of Chicago Medicine Specialty Pharmacy for self-administered advanced IBD therapies covered by prescription insurance from October 1, 2020 to October 31, 2021. Results: A total of 1800 referrals were received for advanced IBD therapies. Prior authorizations (PAs) were required and submitted for 1700 referrals. Of those 1700 PA submissions, 297 (17%) were denied by insurance. To overturn the denials, 344 appeals, including second-level appeals and external reviews, were submitted. Manufacturer patient assistance programs were obtained for 69 patients. From the 1800 referrals, 98% of patients were successfully started on the intended therapy. Clinically, there were 2141 pharmacist-initiated interventions by 2 IBD pharmacists. The most common interventions were prevention in interruption of therapy and providing patient education. Conclusions: Clinical pharmacy teams are well positioned to streamline care within a tertiary academic IBD center. Their unique skillset and ability to provide high yield medication access supports the use of this model as a best practice in IBD centers.

Adherence to self-administered biologic disease-modifying antirheumatic drugs across health-system specialty pharmacies.

PURPOSE: Adherence to self-administered biologic disease-modifying antirheumatic drugs (bDMARDs) is necessary for therapeutic benefit. Health-system specialty pharmacies (HSSPs) have reported high adherence rates across several disease states; however, adherence outcomes in rheumatoid arthritis (RA) populations have not yet been established. METHODS: We performed a multisite retrospective cohort study including patients with RA and 3 or more documented dispenses of bDMARDs from January through December 2018. Pharmacy claims were used to calculate proportion of days covered (PDC). Electronic health records of patients with a PDC of <0.8 were reviewed to identify reasons for gaps in pharmacy claims (true nonadherence or appropriate treatment holds). Outcomes included median PDC across sites, reasons for treatment gaps in patients with a PDC of <0.8, and the impact of adjusting PDC when accounting for appropriate therapy gaps. RESULTS: There were 29,994 prescriptions for 3,530 patients across 20 sites. The patient cohort was mostly female (75%), with a median age of 55 years (interquartile range [IQR], 42-63 years). The median PDC prior to chart review was 0.94 (IQR, 0.83-0.99). Upon review, 327 patients had no appropriate treatment gaps identified, 6 patients were excluded due to multiple unquantifiable appropriate gaps, and 420 patients had an adjustment in the PDC denominator due to appropriate treatment gaps (43 instances of days' supply adjusted based on discordant days' supply information between prescriptions and physician administration instructions, 11 instances of missing fills added, and 421 instances of clinically appropriate treatment gaps). The final median PDC after accounting for appropriate gaps in therapy was 0.95 (IQR, 0.87-0.99). CONCLUSION: This large, multisite retrospective cohort study was the first to demonstrate adherence rates across several HSSPs and provided novel insights into rates and reasons for appropriate gaps in therapy.