This study evaluates health-system specialty pharmacy (HSSP) pharmacists' roles in medication discontinuations, switches, and dose changes, focusing on cost avoidance. HSSP pharmacists intervene to ensure safe and effective use of specialty medications, preventing unnecessary costs. Pharmacists successfully avoided $129,705 - $162,133 in direct costs through their interventions. These findings support the employment and role of pharmacists in HSSPs, extending beyond prescription filling.

This study evaluated the specialty pharmacist's role in medication access, treatment monitoring, and reducing maribavir waste. Pharmacists facilitated maribavir access by obtaining timely insurance prior authorizations (median = 1 day) and intervened to reduce 28 fills across 94 dispenses to avoid waste. Maribavir quantity was reduced in 10 dispenses during the final treatment course, based on CMV levels and time until next lab appointment, which resulted in $119,517 - $149,396 in avoided costs.

This study compared the number, type, and time spent on interventions for patients filling non-MS neurology specialty medications at IHSSPs versus non-IHSSP pharmacies. IHSSP patients experienced greater variety and frequency of clinical interventions, including a third of interventions related to therapy changes which could impact patient outcomes. Financial assistance recommendations were more necessary for non-IHSSP patients.

This primer describes the structure of copay accumulator, copay maximizer, and alternative funding programs used by payers and self-employers to shift costs for high-priced specialty medications. The primer uses a patient case throughout to highlight the unique structure of these programs and their impact on patient affordability and access.

This study evaluated the out-of-pocket (OOP) costs of LCPT vs IR-Tac in kidney transplant patients, including the use of financial assistance, and found that at an institution with patient assistance grants, patients are less likely to have high out of pocket costs with LCPT compared to those prescribed IR-Tac.

This Viewpoint paper describes programs that employers, health plans, and other payers are using to reduce their own spending on specialty drugs including copay accumulator and maximizer programs and alternative funding programs.

This study found that health system specialty pharmacist interventions in MS can lead to substantial direct and indirect cost avoidance-up to $156,265 within a 6-month time frame. Most costs were avoided directly by preventing the dispensing of inappropriate therapies and indirectly by preventing additional health care utilization.

This study quantified VSP pharmacists’ work performed to facilitate specialty medication education, access, adherence, and persistence for patients who do not use VSP. Across 3 clinics over 5 months, pharmacists performed 1,645 actions for 714 non-VSP patients, equating to 375 hours and $30,429.48 in estimated pharmacist compensation. Lack of visibility in the patient journey and increased workload on providers and health systems is created when payers and manufacturers lockout IHSSPs.

Because MedB billing error fines can be costly for pharmacies dispensing high-cost medications, identifying common errors and training staff can be useful and financially prudent. The aim of this quality improvement project was to retrain certified pharmacy technicians (CPhTs) on common monthly billing errors and evaluate changes in error rates and potential fines.

This study highlights how specialty pharmacists with access to patient medical records were able to postpone requesting oral anticancer medication refills for patients with upcoming follow-up and sufficient medication on hand. Therapy was discontinued or changed in 98% of postponed requests accounting for over $750,000 in costs avoided based on AWP-20% pricing.