Alternative funding programs (AFPs) remove costly drugs from insurance coverage, forcing patients to seek alternative sources. This multisite study showed AFPs delay specialty medication access, reduce likelihood of therapy initiation, and increase treatment gaps and adverse outcomes compared to traditional pharmacy benefits. Non-AFP patients accessed therapy 3.8x more often and 3.4x faster (8 vs. 32 days). AFP patients were 47x more likely to have a treatment gap.

This study describes the frequency of insurance changes and prior authorization burden during the first 6 months of 2024 in patients treated with specialty medications for IBD. 13.8% of patients experienced insurance change with most changes occurring in January (55%). Patients with insurance changes had 5.5 times greater odds of requiring more PAs than those without changes (p0.0001). Insurance changes impacted more than one in eight patients with IBD established on specialty therapy.

The purpose of this study was to determine the impact of expanding belzutifan access to VSP on time to first fill from treatment decision, number of gaps in therapy after initiation, and adherence. Patients who filled once VSP gained access to dispense belzutifan, initiated treatment more quickly, had fewer treatment gaps, and improved adherence compared to those who began treatment before VSP gained access to belzutifan. These findings support prior studies showing HSSPs outperform non-HSSPs

This study aims to characterize the use of DAT in IBD and the specialty pharmacist role in medication access. The median time to medication approval was 11 (1-24) days. Patients with Medicare (Hazard ratio [HR] 5.0, p=0.003) and UC (HR 3.5, p=0.046) were significantly more likely to receive DAT approval sooner, compared to patients with commercial insurance and CD, respectively. Patients will be followed through 9 months to assess clinical outcomes and healthcare utilization.

his study evaluated biosimilar switches and patient outcomes (adverse events, worsening symptoms or flares, and dose escalations) in rheumatology or IBD patients who switched to an adalimumab biosimilar. Biosimilars were well-tolerated during the first 3 months of therapy with a low number of patients experiencing worsening of symptoms or flares. Many patients stable on adalimumab originator who switched to an adalimumab biosimilar required subsequent switches within 3 months.

This study evaluated baseline symptoms and disease characteristics in pediatric patients prescribed dupilumab for EoE, factors affecting time to insurance approval, and pediatric patient response to dupilumab for EoE in the first year following dupilumab initiation. Median time to approval was 2 days versus 22 days if initially denied. Patients with dysphagia at baseline were less likely to be denied. Dupilumab demonstrated high rates of clinical, histological and endoscopic improvements.

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.

There is a growing number of specialty medications with requirements that exceed standard characteristics, newly defined as "ultra-complex." This article details ultra-complex specialty medications, and strategies implemented by VSP to maintain an optimal patient journey. Ultra-complex specialty medications provide unprecedented therapeutic advancements but demand multidisciplinary resources to reach the desired therapeutic goals, which make health systems an ideal management setting.

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.