Hospital Specialty Pharmacy Programs Offers Personalized Support – and Hope – to Patients

Published 06/13/2019
by Kathryn Edwards

“When I called the patient, she immediately began to sob. ‘I really thought I was at the end of my road.’ The relief in her voice was amazing.”

The out-of-pocket cost of therapy can cause unnecessary and unwanted stress for patients undergoing treatment for cancer. The average cost of cancer care in the U.S. is $150,000, and patients with cancer are over 2.5 times more likely to declare bankruptcy than people without cancer.1

Health systems can lift some of this burden by integrating clinic-based pharmacists and pharmacy liaisons into patients’ care teams to provide personalized, proactive support with specialty medications. Among other benefits, clinic-based specialty pharmacy teams help patients secure financial assistance to make therapy more affordable.

An on-site pharmacy liaison at one of our partner health systems recently shared a story that illustrates the difference financial assistance can make for patients. The liaison was supporting a patient who had tried every therapy indicated for her diagnosis with no results. Since there were no treatment options left, the patient made the very difficult decision to transition to hospice care. However, she began to feel better after stopping chemotherapy, so she returned to the health system for additional testing in hopes of identifying another treatment option.

Fortunately, the testing revealed a genetic mutation indicated for a targeted oral chemotherapy for a different diagnosis. The patient’s doctor decided to write a prescription for this off-label indication, and the pharmacy liaison immediately took action to secure approval from the patient’s health plan. As the pharmacy liaison expected, the health plan denied coverage – even after two appeals and a peer-to-peer consultation between the physician and insurance company.

Since the pharmacy liaison knew insurance approval was unlikely, she also started exploring alternative ways the patient could access the treatment after receiving the prescription. One option she pursued was the manufacturer’s free drug program.

When she called the manufacturer to ask if they allowed off-label use for the free drug program, she was surprised that they were willing to consider the patient given her situation. The pharmacy liaison called the patient and explained that, while there were no guarantees, she would apply for free drug on the patient’s behalf. She had the patient complete the necessary paperwork and then submitted the application.

After two weeks, the pharmacy liaison learned that the patient was approved to participate in the free drug program. She immediately told the patient’s pharmacist and doctor, who was ecstatic and gave her a high-five. When the pharmacy liaison called the patient, the patient immediately began to sob and express her gratitude.

When asked what this experience meant to her, the pharmacy liaison shared that “hearing the relief in the patient’s voice was amazing.” She added, “Working in cancer care can be challenging, but this experience was so uplifting!”

The patient has since begun treatment and her health is improving. She continually thanks the specialty pharmacy team for caring enough to ensure she has the clinical and financial support she needs every step of her journey.

By offering clinic-based specialty pharmacy services, health systems can ensure all patients with cancer and other complex conditions receive high-touch, personalized care that makes them feel as supported as this patient did.

Read another patient impact story or watch one of our team members share a patient impact story in this video.

  1. http://us.milliman.com/uploadedFiles/insight/2017/cost-burden-cancer-care.pdf