Pharmacy resident involvement in prior-authorization drug request adjudication

Britnell, Sara R.; Brown, Jamie N.; Hashem, Mohamed; Hale, John; Bryan, William E.; Hammond, Julie M.; Britt, Rachel B.

doi:10.2146/ajhp170431

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Appendix Tables 1 and 2 summarize recent literature in each of these areas as it pertains to therapeutic interchange. [13][14][15][16][27][28][29][30][31][32][33] In addition to these issues, the economic importance of therapeutic interchange must be considered. 34-37…”

Section: Therapeutic Interchange: Advances and Challengesmentioning

confidence: 99%

“…Other challenges associated with therapeutic interchange include issues related to interchangeability of biosimilars, discharge medication reconciliation, access to care, drug shortages, emergency preparedness, and state regulations. Appendix Tables 1 and 2 summarize recent literature in each of these areas as it pertains to therapeutic interchange 13‐16,27‐33 . In addition to these issues, the economic importance of therapeutic interchange must be considered 34‐37 …”

Section: Therapeutic Interchange: Advances and Challengesmentioning

confidence: 99%

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Guidelines for therapeutic interchange—2022

Welty

Hilaire

Frantzen

et al. 2022

J Am Coll Clin Pharm

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The American College of Clinical Pharmacy (ACCP) Board of Regents charged the 2020 to 2021 Publications Committee to review and revise the 2004 ACCP guideline statement on therapeutic interchange. The committee reviewed previous guidelines and relevant published literature. After development of new guidelines, the committee and Board of Regents voted in support of the updated guideline. The ACCP reaffirms its support of therapeutic interchange. Additional recommendations for appropriate implementation and practice of therapeutic interchange are provided. Therapeutic interchange is an important tool in optimizing patient care, improving access to care, and reducing the cost of medications.

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Section: Therapeutic Interchange: Advances and Challengesmentioning

confidence: 99%

Section: Therapeutic Interchange: Advances and Challengesmentioning

confidence: 99%

Guidelines for therapeutic interchange—2022

Welty

Hilaire

Frantzen

et al. 2022

J Am Coll Clin Pharm

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“…The presence of nonformulary requests, which are orders for approval of medications requiring VA utilization management assessment, for targeted treatments was evaluated by reviewing medical records housed within Joint Legacy Viewer. 11 This study was approved by the Institutional Review Board of the Durham VA Medical Center.…”

Section: Data Sources and Ethical Considerationsmentioning

confidence: 99%

Barriers to Prescribing Targeted Therapies for Patients With NSCLC With Highly Actionable Gene Variants in the Veterans Affairs National Precision Oncology Program

Vashistha

Armstrong

Winski

et al. 2021

JCO Oncology Practice

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PURPOSE: Next-generation sequencing (NGS) gene panels are frequently completed for patients with advanced non–small-cell lung cancer (NSCLC). Patients with highly actionable gene variants have improved outcomes and reduced toxicities with the use of corresponding targeted agents. We sought to identify barriers to targeted agent use within the Veterans Health Affairs' National Precision Oncology Program (NPOP). METHODS: A retrospective evaluation of patients with NSCLC who underwent NGS multigene panels through NPOP between July 2015 and February 2019 was conducted. Patients who were assigned level 1 or 2A evidence for oncogenic gene variants by an artificial intelligence offering (IBM Watson for Genomics [WfG]) and NPOP staff were selected. Antineoplastic drug prescriptions and provider notes were reviewed. Reasons for withholding targeted treatments were categorized. RESULTS: Of 1,749 patients with NSCLC who successfully underwent NGS gene panel testing, 112 (6.4%) patients were assigned level 1 and/or 2A evidence for available targeted treatments by WfG and NPOP staff. All highly actionable gene variants were within ALK, BRAF, EGFR, ERBB2, MET, RET, and ROS1. Of these, 36 (32.1%) patients were not prescribed targeted agents. The three most common reasons were (1) patient did not carry a diagnosis of metastatic disease (33.3%), (2) treating provider did not comment on the NGS results (25.0%), and (3) provider felt that patient could not tolerate therapy (19.4%). No patients were denied access to level 1 or 2A targeted drugs because of rejection of a nonformulary drug request. CONCLUSION: A substantial minority of patients with NSCLC bearing highly actionable gene variants are not prescribed targeted agents. Further provider- and pathologist-directed educational efforts and implementation of health informatics systems to provide real-time decision support for test ordering and interpretation are needed.

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“…Economic benefits of residents in multiple pharmacy practice areas range from decreasing length of hospitalization, reducing medication acquisition costs, generating direct cost savings, and incurring cost avoidance. 4 -10 Unfortunately, existing publications only represent a fraction of the potential pharmacy practice areas in which the value of resident contributions may be observed.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Economic Value of Pharmacy Resident Participation in an Investigational Drug Service

Brown

Gordon

Tillman

et al. 2019

Journal of Pharmacy Practice

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Purpose: Completion of postgraduate residency training gives pharmacists an opportunity to gain advanced practice experience, yet the availability of these positions is often limited. Through participation in an investigational drug service (IDS), residency programs may be able to expand learning experiences while demonstrating a financial benefit to the institution. The purpose of this assessment is to examine the economic value generated by pharmacy resident involvement within an IDS. Methods: This was a single-center retrospective record review. All resident dispensations within the IDS from January 1, 2016, to December 31, 2017, were evaluated for cost avoidance, revenue, and waived revenue. Cost avoidance was defined as the cost of medications the institution would have incurred had the sponsor not provided therapies free of charge. Medical center contract acquisition costs were used to determine cost avoidance. Total economic value accounted for the personnel costs of resident dispensations. Descriptive statistics were utilized for all assessments. Results: A total of 444 resident dispensations occurred during the study period on 15 IDS protocols. The total cost avoidance for resident dispensations was US$144 898. Total revenue for these dispensations was US$1424, and waived revenue fees totaled US$17 625. After accounting for the personnel cost of dispensations by the residents, the total economic value of resident participation in the IDS was US$159 150. Conclusion: Resident participation in the IDS contributed economic value to the institution. The IDS provides a unique learning experience for the pharmacy residents, cost savings for the institution, and supports the advancement of patient care.

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Pharmacy resident involvement in prior-authorization drug request adjudication

Abstract: Pharmacy residents' involvement in adjudicating PADRs at a VA healthcare system resulted in substantial cost savings over the course of the residency year.

Cited by 4 publications

References 8 publications

Guidelines for therapeutic interchange—2022

Guidelines for therapeutic interchange—2022

Barriers to Prescribing Targeted Therapies for Patients With NSCLC With Highly Actionable Gene Variants in the Veterans Affairs National Precision Oncology Program

Assessing the Economic Value of Pharmacy Resident Participation in an Investigational Drug Service

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