HSSP Pharmacists Demonstrate Substantial Cost Avoidance in Specialty Medication Use

A new analysis from Vanderbilt Health's Specialty Pharmacy program reveals that pharmacist interventions in specialty medication management resulted in substantial direct cost savings.¹ By guiding medication discontinuations, dose adjustments, and therapeutic switches, pharmacists were able to avoid between $129,705 and $162,133 in medication-related costs each month, according to the poster featured at The Academy of Managed Care Pharmacy (AMCP) Nexus, held October 14-17 in Las Vegas, Nevada.

The single-center, retrospective study focused on the role of health system specialty pharmacy (HSSP) pharmacists in identifying opportunities to modify or discontinue expensive specialty medications to reduce unnecessary spending while ensuring safe and effective treatment. The primary goal was to evaluate the economic impact of these pharmacist-led interventions and document the associated cost savings.

The primary goal was to evaluate the economic impact of these pharmacist-led interventions and document the associated cost savings.

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The study included 91 patients with a median age of 53 years (IQR, 27-65). Most of the patients were White (84%) and had insurance coverage through Medicare (42%) or commercial plans (48%), followed by Medicaid (25%). Specialty pharmacists reviewed patient records to identify instances where medication interventions were necessary. These interventions fell into 3 categories: discontinuations, dose changes, and therapeutic switches. The likelihood that the pharmacist’s recommendation directly influenced the decision was scored based on a 3-tier probability model: “not likely,” “possible,” or “likely.”

Impact of HSSP on Cost Avoidance

Out of 113 identified interventions, 21% of cases were excluded as the outcomes were determined not to be related to pharmacist input. The remaining 79% were evaluated, with the majority classified as dose changes (57 cases), followed by switches (23 cases) and discontinuations (9 cases).

Pharmacist involvement resulted in significant cost avoidance across various medications. The highest savings were observed with:

• Emicizumab-kxwh (Hemlibra): $73,187
• Ustekinumab (Stelara): $23,865
• Etanercept (Enbrel): $19,033
• Adalimumab (Humira): $17,653
• Secukinumab (Cosentyx): $10,386

Cost avoidance also varied by clinical setting, with the largest savings occurring in hematology clinics ($73,773), followed by rheumatology ($45,330) and pediatric gastrointestinal/irritable bowel syndrome (GI/IBD; $16,519).

Pharmacists flagged medication issues for a variety of reasons, including weight-based dose adjustments, patient nonadherence, and adverse effects. A significant portion of interventions aimed to manage medication due to ineffectiveness or patient intolerance, with switches being particularly common in response to adverse effects. Office visits, medication refill assessments, and patient calls were the primary methods through which pharmacists identified the need for intervention.

Implications for Hemophilia Treatment

Long-term data from earlier this year highlighted the safety and efficacy of emicizumab for patients with hemophilia A without factor VIII inhibitors.² Emicizumab has shown sustained effectiveness years after initiation, with no new safety concerns reported from the HAVEN 3 and 4 trials, which supported the therapy's FDA approval in 2018. This subcutaneous bispecific monoclonal antibody mimics FVIII and requires dosing every 1 to 4 weeks, unlike traditional intravenous factor replacement therapies.

The study followed 191 participants for a median of 248.1 weeks, finding a significant decrease in the mean annualized bleed rate from 2.0 to 0.9. Although 98% of participants experienced adverse events—mostly mild, such as injection-site reactions—no serious events were linked to the treatment. Improvement in joint health correlated with lower bleed rates, enhancing patients' quality of life. A high number of participants opted to continue with emicizumab after the trials, underscoring its long-term benefits in bleed prevention and safety, as well as the treatment's necessity to this patient population.

The Role of HSSP Pharmacists

The current study emphasizes the critical role that HSSP pharmacists play in optimizing specialty medication regimens.¹ By carefully monitoring patient outcomes and adjusting therapy as needed, pharmacists contribute not only to improved clinical outcomes but also to substantial health care cost savings. These findings may help justify expanded roles for pharmacists in specialty settings, potentially extending beyond traditional prescription filling to more active participation in patient management and cost-containment strategies.

The authors suggest that health systems can further benefit from leveraging pharmacists to review and manage high-cost specialty drugs, ensuring both clinical efficacy and financial stewardship.

References

1. Perciavalle K, Edelman M, Zuckerman A, et al. Pharmacist involvement in specialty medication discontinuations and dose changes. Poster presented at: AMCP Nexus; October 14-17, 2024; Las Vegas, NV.

2. Kaltwasser J. Long-term data demonstrate emicizumab safety, efficacy in hemophilia A. AJMC^®. April 16, 2024. Accessed October 25, 2024. https://www.ajmc.com/view/long-term-data-demonstrate-emicizumab-safety-efficacy-in-hemophilia-a