Helping Patients Navigate the World of Specialty Pharmacy

Published 01/19/2021
by Kathryn Edwards

Trellis Rx oncology clinical pharmacist, Megan Johnson Rees, R.Ph., PharmD, BCACP, explains challenges patients face with specialty medication affordability and shares a story highlighting how a health system specialty pharmacy can help address barriers. Rees works onsite at Summa Health, where she also serves as the Residency Program Director. Thanks to the Ohio Pharmacists Association for allowing us to share this article, which was originally published in the December 2020 Ohio Pharmacist Journal, Volume 69, No. 12, page 24.

The cost of medications continues to skyrocket and leaves some patients with the difficult decision between paying for their prescriptions, paying their rent or in some instances buying their groceries for the week. In addition to maintenance medications for diabetes or high blood pressure, another domain that is often not thought of is specialty pharmacy. Specialty medications vary depending on the insurance plan that a patient has; however, in general these medications are medications that are high cost and high touch.

Part of my job as a specialty pharmacist is working with patients, providers, and insurance companies to help patients access these medications and ensure optimal care while on therapy. Working in an oncology clinic, cost of therapy is a major concern for all. Recently my clinic had the pleasure of caring for a patient who was new to our practice. She was taking an oral oncolytic and had been stable on the medication for over a year.

During my initial counseling session with her, everything seemed to be in check. However, at the end of our session I always ask about financial strain of taking these medications and assess each patient’s financial situation. This patient seemed confused that I was concerned about the cost of her care, especially since she had been taking this therapy for so long and no one had ever asked her this question before. She then began to tell me that she recently had decided to sell her house and move into a senior living apartment so that she could continue to take her oral oncolytic. She broke into tears telling me the memories that she held in her house with her family and her late husband. She did not want to sell her house, but at the current moment her choice was either stay in her house or continue her life saving therapy. I continued to explain that we assist with securing financial assistance whether that entails grants, patient assistance programs or copay cards. After reliving some of her precious memories, we dove deeper into her financials and found that she was in fact eligible for a grant. After completing the application online, we secured financial assistance for her! This assistance would bring her copays down from $950 per month to $0. In addition, the grant would cover her first copay of the year which would be around $2,500, saving her close to $13,000 per year.

The look on her face was the very reason I do what I do every day. She was extremely grateful for our care and for asking about financials although she had been on therapy for so long. During our last conversation, I learned that she in fact was able to stay in her beloved home and continue to take her medication without worries. Lesson learned: Continue to check in on your patients no matter how long they have been on therapy, you never know the difference you could make.

Read another patient impact story by a Trellis Rx specialty pharmacy liaison to learn more about how an embedded health system specialty pharmacy service can improve specialty medication affordability for patients.