Livezey Sabrina, Shah Nisha B, McCormick Robert, DeClercq Josh, Choi Leena, Zuckerman Autumn D
Clinical Pharmacist, Neurology, Vanderbilt University Medical Center, Nashville, Tennessee,
Pharmacist, Health Outcomes and Research, Vanderbilt University Medical Center, Nashville, Tennessee.
Ment Health Clin. 2021 May 12;11(3):187-193. doi: 10.9740/mhc.2021.05.187. eCollection 2021 May.
Access to pimavanserin, the only Parkinson disease-related psychosis treatment approved by the FDA, is restricted by insurance requirements, a limited distribution network, and high costs. Following initiation, patients require monitoring for safety and effectiveness. The primary objective of this study was to evaluate impact of specialty pharmacist (SP) integration on time to insurance approval. Additionally, we describe a pharmacist-led monitoring program.
This was a single-center, retrospective study of adults prescribed pimavanserin by the neurology clinic from June 2016 to June 2018. Patients receiving pimavanserin externally or through clinical trials were excluded. Pre- (June 2016 to December 2016) and post-SP integration (January 2017 to June 2018) periods were assessed. Proportional odds logistic regression was performed to test association of approval time with patient characteristics (age, gender, insurance type) postintegration. Interventions were categorized as clinical care, care coordination, management of adverse event, or adherence.
We included 94 patients (32 preintegration, 62 postintegration), 80% male (n = 75) and 96% white (n = 90) with a mean age of 73 years. Median time to approval was 22 days preintegration and 3 days postintegration. Higher rates of approval (81% vs 95%) and initiation (78% vs 94%) were observed postintegration. Proportional odds logistic regression suggested patients with commercial insurance were likely to have longer time to approval compared with patients with Medicare/Medicaid (odds ratio 7.1; 95% confidence interval: 1.9, 26.7; = .004). Most interventions were clinical (51%, n = 47) or care coordination (42%, n = 39).
Median time to approval decreased postintegration. The SP performed valuable monitoring and interventions.
匹莫范色林是美国食品药品监督管理局（FDA）批准的唯一一种用于治疗帕金森病相关精神病的药物，但由于保险要求、有限的分销网络和高昂的成本，其获取受到限制。开始用药后，患者需要进行安全性和有效性监测。本研究的主要目的是评估专科药师（SP）的整合对保险批准时间的影响。此外，我们还描述了一个由药师主导的监测项目。
这是一项单中心回顾性研究，研究对象为2016年6月至2018年6月在神经科诊所开具匹莫范色林处方的成年人。排除在外部接受匹莫范色林治疗或通过临床试验接受治疗的患者。评估了专科药师整合前（2016年6月至2016年12月）和整合后（2017年1月至2018年6月）两个时期。采用比例优势逻辑回归分析整合后批准时间与患者特征（年龄、性别、保险类型）之间的关联。干预措施分为临床护理、护理协调、不良事件管理或依从性管理。
我们纳入了94例患者（整合前32例，整合后62例），其中80%为男性（n = 75），96%为白人（n = 90），平均年龄73岁。整合前批准的中位时间为22天，整合后为3天。整合后观察到更高的批准率（81%对95%）和开始用药率（78%对94%）。比例优势逻辑回归分析表明，与医疗保险/医疗补助患者相比，商业保险患者的批准时间可能更长（优势比7.1；95%置信区间：1.9，26.7；P = 0.004）。大多数干预措施为临床护理（51%，n = 47）或护理协调（42%，n = 39）。
整合后批准的中位时间缩短。专科药师进行了有价值的监测和干预。
