By Brandon Hardin, PharmD, MBA, CSP, Clinical Services Manager at Trellis Rx
As a result of the COVID-19 pandemic, patients with asthma, HIV, rheumatoid arthritis, lupus, and other chronic diseases have found it increasingly difficult or even impossible to obtain the specialty medications used to manage their conditions. The primary drivers of these drug access challenges are not necessarily “drug shortages,” but rather allocation restrictions and quantity limits implemented by distributors and health plans respectively. These measures are put in place to ensure therapies believed to be effective in treating COVID-19 are not stockpiled and are available if needed.
We know that being unable to access vital specialty medications causes confusion and frustration for patients. Many don’t understand why they can no longer access the medications they have been taking for many years. Others worry their disease will flare-up or relapse if their new medication isn’t effective. As a result, providers must not only rapidly determine alternative therapy options but also provide additional counseling to their patients – even as they themselves deal with the impact of COVID-19 on their practice.
This is where health system specialty pharmacy teams can reinforce the value they offer providers by ensuring continuity of care for patients impacted by drug access issues. For example, clinical pharmacists can step in to collect patient-reported outcomes, monitor the effectiveness of new therapies, and quickly communicate this information to providers. Pharmacy liaisons can also provide vital support by helping ensure patients can quickly start their new therapy regimen. Their ability to proactively find financial assistance for patients transitioning to new specialty medications will prove even more important in these stressful times.
To help other health system specialty pharmacy teams work through these issues, I asked my colleagues for their advice on how we can help care teams and patients navigate the drug access challenges.
Recommendations for Helping Patients & Providers Navigate Drug Shortages During COVID-19
- Take responsibility for sharing patient care guidelines published by medical associations: This may seem obvious, but by simply sharing the latest patient care guidelines from the relevant medical associations, clinical pharmacists can serve as a trusted partner to providers. My colleague Brandon Newman, PharmD, CSP, MHCM, explains: “This situation is rapidly evolving, so care teams need support staying informed. By keeping up-to-date on new evidence and recommendations, clinical pharmacists can help providers determine the best way to manage patients’ therapy regimens during this crisis.”
To make it easy for pharmacists to access the latest information, our team created a resource list featuring patient care guidelines published by medical and professionals associations.
- Provide regular updates on drug shortages and supply chain challenges: Embedded pharmacists can also assist care teams by providing regular updates on drug shortages. Given their strong relationships with drug manufacturers and suppliers, clinical pharmacists are often the first to learn about drug allocation and distribution issues, including quantity limits and supply chain delays. They can leverage this information to help specialists proactively develop alternative therapy regimens.
I asked Jennifer Rubinstein, PharmD, CSP, who serves as a clinical pharmacist at Legacy Health (Portland, OR), for her opinion: “When I found out about a projected shortage of a specialty drug commonly prescribed to our pediatric rheumatology patients, I quickly worked with providers to determine other therapy options. We identified another medication patients can administer at home, which keeps them from having to come into the hospital for infusions during this time.”
In addition to contacting your local pharmaceutical sales representatives, we recommend using the American Society of Health System Pharmacist’s Drug Shortages Tracker to stay up-to-date on drug shortages information.
- Proactively track disease-specific metrics and patient-reported outcomes: Clinical pharmacists can also help providers assess the effectiveness of alternative therapies by identifying and tracking disease-specific metrics. When asked to for his perspective, Brandon Newman shared: “Having strategies to ensure patients are achieving desired therapeutic results on their new medications is critical. Pharmacists are well-positioned to collect patient-reported outcomes over the phone during the COVID-19 public health crisis, and they can leverage this information to help care teams proactively identify patients that need interventions or additional support.”
Clinical pharmacists can find examples of disease-specific metrics in this article.
- Over-communicate with your patients: Patients prescribed alternative therapies as a result of drug shortages will always need additional counseling to be successful on their therapy regimen. Given the additional circumstances patients are facing right now, they need even more support than usual. Clinical pharmacists and specialty pharmacy liaisons are well-positioned to address these needs. By frequently checking in with patients over the phone, specialty pharmacy team members can answer questions and provide additional counseling to help patients manage side effects and ensure patients adhere to their therapies. They can also proactively remove any obstacles to providing refills in a timely manner.
Daniel Jude, PharmD, CSP, AAHIV, a Clinical Pharmacist at North Memorial Health (Minneapolis, MN) shared: “We must remember to practice active listening and demonstrate empathy during this situation. This is a challenging time for everyone, but especially for patients who are having to change their therapy regimens due to drug shortages during COVID-19.”
We hope your health system specialty pharmacy team find these recommendations helpful as you help patients and providers navigate drug shortages during COVID-19. You can access additional resources to support your health system specialty pharmacy team during the coronavirus pandemic here. If you have any additional recommendations or questions, please contact us.