Pharmacy Quality Alliance, Alexandria, VA.
Merck & Co, Inc, Kenilworth, NJ.
J Manag Care Spec Pharm. 2022 Nov;28(11):1244-1251. doi: 10.18553/jmcp.2022.28.11.1244.
Patients receiving specialty medications have conditions that are often complex, high cost, and high need. Prompt treatment initiation is essential for the appropriate management of many conditions treated by specialty products. Improving the turnaround time (TAT) of specialty pharmacy prescriptions helps ensure patients receive the medication they need in the necessary time frame to optimize health outcomes. Despite a clinical justification for improved TAT, there is a gap in the literature describing what factors impact these times. To determine factors that may influence specialty pharmacy TATs and to identify good practices that specialty pharmacies use to improve TAT. This qualitative study used 4 focus groups with specialty pharmacy subject matter experts. Each focus group represented different specialty pharmacy types, including health system, payer-associated, retail chain, and independent specialty pharmacies. Attitudes, beliefs, and experiences regarding specialty pharmacy TAT were captured. Open-ended questions and prompts eliciting impediments, facilitators, and good practices associated with specialty pharmacy TAT were asked of participants. Data were analyzed thematically. Fifteen individuals participated across 4 focus groups: payer-associated (n = 4), independent (n = 3), health system (n = 5), and retail chain (n = 3) specialty pharmacies. Average TATs varied across specialty pharmacy type and by prescription type (clean vs intervention). Several interconnected themes were identified, including barriers with health benefits formulary management, prior authorization delays, differences in requirements between managed care organizations, and miscommunication with physicians, among others. Five subthemes were identified during the discussion of factors influencing TAT, including patient characteristics, pharmacy characteristics, provider characteristics, clinical situations, and health benefit design and formulary considerations. Pharmacy workflow improvements through technology integration are thought to improve TAT. In addition, participants noted facilitators including specialization among pharmacists and technicians in certain diseases, particularly hepatitis C and cancer. Some good practices included using patient financial advocates, technology integration, and a structured patient onboarding process, which were found to minimize delays caused by prior authorization, communication, and formularies. A multitude of factors impacting specialty pharmacy prescription TAT were identified. Multidisciplinary coordination between pharmacies, physicians, and managed care organizations is essential to ensure patients receive medications in the necessary time frame to optimize health outcomes. This study was conducted with support from Pfizer.
患者接受专科药物治疗的病症通常较为复杂、费用高昂且医疗需求较高。对于许多专科产品治疗的病症，及时开始治疗至关重要。提高专科药房处方的周转时间（TAT）有助于确保患者在必要的时间内获得所需的药物，从而优化健康结果。尽管有临床依据证明 TAT 有所改善，但文献中仍存在差距，无法描述哪些因素会影响这些时间。为了确定可能影响专科药房 TAT 的因素，并确定专科药房用来改善 TAT 的良好做法，本研究采用了 4 组专科药房专题专家焦点小组。每个焦点小组代表不同类型的专科药房，包括医疗系统、支付方关联、零售连锁和独立专科药房。重点小组讨论了专科药房 TAT 的态度、信念和经验。向与会者提出了有关专科药房 TAT 的障碍、促进因素和良好做法的开放式问题和提示。对数据进行了主题分析。共有 15 人参加了 4 个焦点小组：支付方关联（n=4）、独立（n=3）、医疗系统（n=5）和零售连锁（n=3）专科药房。不同类型的专科药房和不同类型的处方（常规 vs 干预）的平均 TAT 有所不同。确定了几个相互关联的主题，包括医疗福利目录管理方面的障碍、预先授权延迟、管理式医疗组织之间的要求差异以及与医生之间的沟通不畅等。在讨论影响 TAT 的因素时，确定了 5 个子主题，包括患者特征、药房特征、提供者特征、临床情况以及健康福利设计和目录考虑因素。通过技术集成改善药房工作流程被认为可以提高 TAT。此外，与会者还提到了一些促进因素，包括药剂师和技术人员在某些疾病方面的专业化，特别是丙型肝炎和癌症。一些良好做法包括使用患者财务顾问、技术集成和结构化的患者入职流程，这些做法被发现可以最大限度地减少预先授权、沟通和目录造成的延误。确定了影响专科药房处方 TAT 的多种因素。药房、医生和管理式医疗组织之间的多学科协调对于确保患者在必要的时间内获得药物以优化健康结果至关重要。这项研究是在辉瑞公司的支持下进行的。
