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.

The purpose of this quality improvement project was to implement a transparent, streamlined process of managing patients with IBD receiving specialty medications that have complex dosing regimens with IV to SubQ routes of administration. This was achieved by implementing an EHR flowsheet for patient management and care coordination between infusion and specialty pharmacy staff.

This dual site retrospective study evaluated deutetrabenazine for the treatment of HD chorea at doses above current FDA approval. Deutetrabenazine >48 mg daily appears safe and well tolerated in patients with uncontrolled HD chorea, though no significant change in total maximal chorea score was found. Psychiatric changes were less commonly reported at doses >48 mg/day, but extrapyramidal symptoms were more common. The median PDC was 0.99 and only 2 patients discontinued due to AEs.

This study described the care coordination process and patient outcomes from decision to treat with ustekinumab through initiating subcutaneous (SQ) injection. Prescriptions filled with Vanderbilt Specialty Pharmacy (VSP) had 2.5 times higher odds of being shipped in the appropriate window compared to non-VSP with 56% dose-escalated during the first year. This study shows ustekinumab initiation and escalation in the first year can be a lengthy process requiring a high level of care coordination.

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.

This study examines the time to hGH medication insurance approval, determine whether time to approval was associated with patient factors, and evaluate whether time to hGH initiation impacts patient growth. Indication for hGH treatment, insurance, a requirement for additional testing, and method of medication coverage were associated with time to approval. Time to hGH initiation did not impact patient growth one year post decision to treat.

This study evaluated the treatment of HCV using DAAs in pediatric patients using an integrated specialty pharmacy model. The model was effective in navigating patients through the treatment cascade of care to SVR. Additional pharmacist contacts were needed for 45% of patients unable to swallow the dosage form at the initial clinic evaluation. Linkage to care following initial clinc evaluation remains a challenge especially in those age 0-5 years.

This study evaluated reasons for and rates of primary medication nonadherence to specialty DMARDs in patients with RA referred to an integrated health systems specialty pharmacy

This multi-phased survey aggregated data to describe clinical services provided by health-system specialty pharmacies (HSSPs). Results demonstrate that HSSPs are a clinical and educational resource for specialty clinics and have developed robust patient care services that encompass the patient journey from before specialty medication selection through treatment monitoring and optimization.

The objective of this study was to characterize the HCV cascade of care in a bridge clinic setting and identify barriers to HCV treatment in this population. This study demonstrated that several challenges and barriers exist to engage patients in HCV care in a bridge clinic model, and more strategies should be identified to engage patients and link them to care.