Sonya Collins
The last 10 to 15 years have seen approvals of many new specialty and biologic drugs for neurological conditions. Often, these medications work faster than older traditional immunosuppressing medications, but optimum outcomes depend on starting the right medication as soon as possible.
While time is of the essence, specialty medications can come with additional hurdles. Foremost, providers need to get approval from the patient’s insurance. Research published online on January 19, 2024, in JAPhA finds that pharmacists embedded in a neurology clinic may help patients clear these hurdles faster and improve overall access to neurology treatment.
“This study can help support the use of clinical pharmacists in neurology clinics and also, potentially be a roadmap for other institutions that may want to continue to expand ambulatory care pharmacy services,” said Bethany Anderson, PharmD, lead author on the study and a clinical pharmacist at Cleveland Clinic.
Pharmacists helped patients start treatment sooner
Researchers carried out a retrospective chart review of patients started on a first or alternative medication for a neuroimmunology or neuromuscular condition before (pre-group) and after (post-group) pharmacists were integrated into the clinic. The study compared access between the two groups to initially prescribed medications and alternative medications within 90 days of prescription. The researchers examined the charts of 101 patients in the pre-group and 101 patients in the post-group.
Just over 87% of patients in the post-group started the initially prescribed medication within 90 days of prescription—up from just over 72% in the pre-group. Ninety percent of patients in the post-group started either the initial or alternative medication within 90 days compared to a little over 73% in the pre-group.
Nearly 64% of patients in the post-group had additional pharmacist involvement, which could include prior authorization approval assistance, drug information support, and medication liaison interventions, with an average of 4.7 pharmacist interventions at each pharmacy-led encounter.
Pharmacists overcome barriers
Many of the medications seen in the researchers’ chart reviews require prior authorizations or come with other prerequisites that must be met before patients can start treatment.
In the clinic, pharmacists helped coordinate vaccinations and baseline labs required prior to initiating therapy. They assessed and addressed abnormal labs and drug–drug interactions. They ensured patients completed step therapy when required. Pharmacists counseled patients on what might ultimately become lifelong therapy, educated them on proper administration, and helped them weigh the pros and cons of the options available to them when applicable. They made sure physicians’ orders were followed to get the treatment to the patient sooner.
“There’s a lot of coordination between staff doing the prior authorization and the provider who prescribed the drug, and that’s where we come in—right in the middle,” said Melissa Snider, PharmD, coauthor of the study and associate director of ambulatory care in the department of pharmacy at The Ohio State University Wexner Medical Center.
Interventions by pharmacists that helped expedite initiation of therapy may in some cases be seen as critical to care or even lifesaving.
“Patients with a recent MS relapse are not protected against another relapse until they have started a disease-modifying therapy. Patients with neuromyelitis optica spectrum disorder (NMOSD) can relapse at any time, which may result in permanent disability like vision loss and paralysis,” said Margaret Hansen, PharmD, a specialty practice pharmacist in neurology at the Ohio State University Wexner Medical Center.
But the benefits pharmacists can bring to ambulatory care clinics aren’t limited to neurology, Anderson said.
“Pharmacists could be considered in other clinics, especially those with a lot of specialty medications and medications that require a lot of education and monitoring.” ■