The approval of elexacaftor-tezacaftor-ivacaftor (ELX/TEZ/IVA) expanded
highly effective cystic fibrosis transmembrane receptor modulator
therapy to approximately 90% of persons age 12 and older with cystic
fibrosis. Clinical pharmacists and pharmacy technicians played a key
role in planning for ELX/TEZ/IVA initiation prior to FDA approval as
well as initiating therapy after approval. This study evaluates the
impact of pharmacy services on time to ELX/TEZ/IVA initiation. A
retrospective chart review evaluated patients qualifying for ELX/TEZ/IVA
at a single health system between October 21, 2019 and April 1, 2020.
Patients filling ELX/TEZ/IVA at an integrated health system specialty
pharmacy (HSSP) versus an outside specialty pharmacy (SP) started on
therapy an average of 10.8 days faster (10.8 days ± 14.0 vs 21.6 days ±
18.8 respectively; p=0.006). More patients filling at a HSSP received
ELX/TEZ/IVA within 14 days of the prescription being written compared to
outside SPs (82.0% vs 41.4% respectively; p=0.001). Pre-ELX/TEZ/IVA
initiation, patients were hospitalized for a CF related complication for
an average of 6.26 days (range 0-183) compared to 1.16 days (range 0-91)
post-ELX/TEZ/IVA initiation. Lastly, an estimated $134,810 was saved in
the 105 patients that were able to fill ELX/TEZ/IVA at a HSSP by
initiating drug an average of 10.8 days quicker than outside SPs. The
results of this study demonstrate the value of an integrated HSSP model.
Further advocacy for inclusion of integrated HSSPs by pharmacy benefit
managers is needed to optimize medication access, control costs, and
improve patient outcomes for patients receiving care within a health
system.
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