This quality improvement project evaluated a pharmacist driven lymphocyte monitoring dashboard for patients with multiple sclerosis (MS) on fumarates. The dashboard alerted pharmacists to 8 patients with lymphopenia in the month following implementation. All alerts resulted in chart review and pharmacist interventions were documented for 2 patients. Pharmacist survey responses demonstrated pharmacist satisfaction with the dashboard and an improved ability to monitor non-HSSP patients.

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 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 case series identified patients with multiple sclerosis whose lymphocyte counts were stable on dimethyl fumarate, and then subsequently developed lymphopenia after switching to diroximel fumarate, prompting its discontinuation.

It is unexpected that patients with stable lymphocytes on one fumarate would experience significant changes when switching to another fumarate; however, this was being observed in clinical practice. We wanted to identify the frequency and severity of lymphopenia after switching from dimethyl fumarate to either diroximel fumarate (DRF) or monomethyl fumarate (MMF). Our study determined that patients switching to DRF were more likely to have decreased lymphocyte counts post switch compared to MMF.

This study examined the association between patient characteristics and patient-reported outcomes for patients prescribed specialty medications from rheumatology or multiple sclerosis clinics in two HSSPs for 3,677 patients over 30 months. Patients reporting tolerability issues or lower perceived effectiveness were more likely to report a missed dose.

This study evaluated patient-reported outcomes (PROs) and pharmacist interventions in patients serviced by VSP in various clinical conditions. In patients with MS specifically, we found that 98% of patients reported no adverse effects, 90% reported no missed doses, and 98% reported their medication worked "good" or "excellent." Pharmacist interventions were commonly related to adherence, safety monitoring, and adverse effects. PROs can be useful to drive meaningful pharmacist interventions.

This multisite, prospective, cohort study of patients with MS evaluated patient-reported outcomes, pharmacists' actions, and DMT adherence/persistence. Patients reported low rates of impacted productivity, hospitalization, and relapse due to MS. Pharmacists commonly provided medication education and actions to ensure DMT safety and adherence. Patients had a high rate of adherence (median PDC 88%) and persistence (86% at 12 months). Findings support positive outcomes for HSSP patients.

This study of patients with RMS and ≥3 fills of DMT from a health-system specialty pharmacy evaluated DMT persistence. The probability of remaining persistent for 3 years was 0.51. Non-persistent patients mostly switched to a new DMT (39%), discontinued the DMT (26%) discontinued, or transferred care to a new specialty pharmacy or provider (27%). Specialty pharmacists played a key role in DMT transitions and initiated 7% of DMT discontinuations and 36% of DMT switches.

Vanderbilt Specialty Pharmacy (VSP) embeds pharmacists within an outpatient MS clinic to provide medication management and address barriers to adherence. We found an average adherence rate of 94% as measured by proportion of days covered (PDC), with 89% of all VSP patients achieving the industry standard of 80% PDC. Additionally, results indicate that ensuring financial assistance and low out-of-pocket costs are associated with high adherence to DMT within an integrated specialty clinic.