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Navigating Treatment of Dermatologic Inflammatory Conditions with Specialty Drug Therapies, with Vanderbilt Specialty Pharmacy, Vanderbilt H · Pharmacy Podcast Network

• 0:07
  Speaker 1: Thanks for listening to the Pharmacy Podcast Network.
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  Speaker 2: You're listening to the NASP Specialty Pharmacy Podcast, a collaboration
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  Speaker 2: between the National Association of Specialty Pharmacy and the Pharmacy
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  Speaker 2: Podcast Network. Each episode dives deep into trends, challenges, innovations,
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  Speaker 2: and patient centric practices shaping the future of this dynamic
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  Speaker 2: and rapidly evolving industry. Whether you're a pharmacist or healthcare provider,
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  Speaker 2: patient advocate, or industry leader, you'll hear expert insights, real
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  Speaker 2: world evidence, and thought provoking discussion that highlights all that
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  Speaker 2: makes specialty pharmacy special.
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  Speaker 3: In support of NASP's mission to empower specialty pharmacy stakeholders
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  Speaker 3: to advance the standard of patient care, NASP supports a
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  Speaker 3: free market healthcare system in which all specialty pharmacies compete
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  Speaker 3: on the same fare and level playing field, because that
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  Speaker 3: is in the best interest of the patients we collectively serve.
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  Speaker 3: NASP is committed to working with all stakeholders and policymakers
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  Speaker 3: to ensure that all patients have access to the life
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  Speaker 3: saving medications they need and the high touch patient care
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  Speaker 3: and support services they deserve from the pharmacy of their choosing.
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  Speaker 1: Hello. My name is Shehila Arquette, and I am the
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  Speaker 1: President and CEO of the National Association of Specialty Pharmacy.
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  Speaker 1: I am delighted to welcome my very special guest, Matthew G.
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  Speaker 1: Bowles to this episode of the NASP podcast. Matthew Bowles
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  Speaker 1: farm d NBACSP is a pharmacy clinical team lead with
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  Speaker 1: Vanderbilt Specialty Pharmacy Vanderbilt Health. He is the primary clinical
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  Speaker 1: pharmacist in dermatology and the clinical lead over dermatology, asthma, allergy,
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  Speaker 1: and ender chronology clinics. Doctor Bolt holds a farm DY
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  Speaker 1: and NBA from the University of Kentucky. Matt thanks so
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  Speaker 1: much for joining me today.
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  Speaker 4: Thank you for having me, Sheila, So tell us a.
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  Speaker 1: Little bit about your role within Vanderbilt Specialty Pharmacy in
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  Speaker 1: your practice site.
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  Speaker 5: I have actually been at VSP now for over ten years,
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  Speaker 5: which is crazy.
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  Speaker 4: It's flown by.
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  Speaker 5: I started out as a floater pharmacist and then soon
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  Speaker 5: moved into the dermatology role. I'm also a clinical team
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  Speaker 5: lead as you had mentioned, and then as the dermatology pharmacist.
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  Speaker 5: I work directly with the providers. I'm on all specially
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  Speaker 5: medications that they prescribe, and as clinical team lead, I
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  Speaker 5: am the mediate supervisor of the dermatology ASM an allergy
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  Speaker 5: and inter chronology clinical pharmacist. Regarding the practice site, the
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  Speaker 5: Vanderbilt Dermatology Clinic is a very large practice. We have
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  Speaker 5: over twenty attendings, three midle level providers, and fifteen residents.
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  Speaker 5: We also have two main sites and two satellite sites
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  Speaker 5: that some of the providers go to one day a week.
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  Speaker 1: Is your practice centered just in Nashville? With that, many
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  Speaker 1: providers like, how far is your reach?
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  Speaker 5: So we have one major site in Nashville, another site
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  Speaker 5: down Franklin, which is not too far from Nashville, and
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  Speaker 5: then we have a satellite site that's also in Nashville,
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  Speaker 5: just in a different area of the city, as well
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  Speaker 5: as another site that's about an hour from Nashville. Within dermatology,
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  Speaker 5: we have two specialty pharmacists. That is a recent change
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  Speaker 5: just because of the growth. So there are there's myself
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  Speaker 5: and another pharmacist, and we do have two technicians that
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  Speaker 5: are also with us in dermatology that are integrated into
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  Speaker 5: the outpatient dermatology clinic.
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  Speaker 1: Oh my gosh, that's awesome. I just think back when
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  Speaker 1: I was in pharmacy school, right, that was all like
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  Speaker 1: hopefully maybe someday those types of things, those opportunities would
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  Speaker 1: be available.
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  Speaker 4: So that's awesome.
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  Speaker 5: Yeah, it's been very interesting since I was I've been
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  Speaker 5: here since day one with dermatology and how much it
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  Speaker 5: has grown.
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  Speaker 4: Awesome.
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  Speaker 1: So let's talk a little bit about your project titled
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  Speaker 1: getting to Specialty Treatment in Dermatologic Inflammatory Conditions Treatment Requirements
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  Speaker 1: in the Patient Journey. This was recently published in the
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  Speaker 1: Journal of Managed Care and Specialty Pharmacy. So what made
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  Speaker 1: you decide to conduct this study.
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  Speaker 5: As a dermatology I, you know, I saw a major
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  Speaker 5: uptick and especially medications being approved by the FDA for
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  Speaker 5: atopic dermatitis and psoriasis and other dermatological indications.
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  Speaker 4: Over the past several years.
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  Speaker 5: We started seeing a large number of patient referrals that
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  Speaker 5: were coming to us where the patient did not start
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  Speaker 5: due to st therapy requirements. And oftentimes we would see
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  Speaker 5: the patient coming back soon after or being referred back
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  Speaker 5: to us after they had failed the step therapy. And
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  Speaker 5: I'll kind of add there kind of like our process.
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  Speaker 5: So the provider decides to start a patient with especially
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  Speaker 5: medication and then they send the referral to us just
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  Speaker 5: a message saying, hey, I want to get this patient
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  Speaker 5: started on this medication for this diagnosis. And then our
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  Speaker 5: technician does the benefits investigation and the prioritization with the insurance,
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  Speaker 5: and then the pharmacist, if needed, does the appeal if
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  Speaker 5: it was denied, and then we also help with the
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  Speaker 5: financial assistance portion of it, if it's a copay card
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  Speaker 5: or if they're needing you know, something internally that Vanderbilt
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  Speaker 5: offers or programs outside with the patient assistance program through
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  Speaker 5: the manufacturer, other type of financial assistance that available. And
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  Speaker 5: then we also counsel the patient. And then also every
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  Speaker 5: single patient, regardless of the pharmacy they use, we are
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  Speaker 5: the direct contact regarding their specially medication. So if they
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  Speaker 5: have been on it for six months and they're using
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  Speaker 5: another you know, using a pharmacy and having issues, they
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  Speaker 5: have our direct number to reach out so that we
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  Speaker 5: can help, you know, troubleshoot what the issue is.
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  Speaker 1: Oh, that's amazing. You're like an extension rate of that
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  Speaker 1: provider's office providing that that clinical druggya.
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  Speaker 5: We we're pretty much fully embedded with you know, with
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  Speaker 5: the providers. So a lot of times, I feel like
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  Speaker 5: I'm more on the provider side of things than the
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  Speaker 5: pharmacy side of things, just because we are so involved
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  Speaker 5: in you know, the special medication process.
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  Speaker 4: That's awesome, and you know.
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  Speaker 5: Looking at going back to the project, that is kind
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  Speaker 5: of why we were able to see, you know, kind
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  Speaker 5: of this breakdown that was occurring with you know, the
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  Speaker 5: referral process of you know, the patient being referred and
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  Speaker 5: then not getting started on medication. So when we started
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  Speaker 5: looking at this project, the objective was to evaluate medication
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  Speaker 5: outcomes and the times requirements to access therapy and patients
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  Speaker 5: required to use a step therapy or a formulary alternative
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  Speaker 5: after being prescribed, especially in medication. We did just look
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  Speaker 5: at psoriasis and atopic dermatitis with our patients.
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  Speaker 1: So what did your study find.
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  Speaker 5: Well, so the first thing when we started looking at things,
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  Speaker 5: we wanted to look at formular alternatives and step therapies.
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  Speaker 5: Formularly alternatives they are other special medications, they're preferred by
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  Speaker 5: the insurance. These are typically in the same class. But
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  Speaker 5: we did find that this approval time was much less
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  Speaker 5: than step therapy. So in the study and we mostly
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  Speaker 5: looked at step therapies which are typically medications that are
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  Speaker 5: required prior to getting approved for special medication. They are
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  Speaker 5: typically much cheaper, but oftentimes have more side effects and
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  Speaker 5: require much more monitoring for the provider and the patient.
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  Speaker 5: So we conducted a single center retrospective review of data
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  Speaker 5: collected from our electronic health record as well as the
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  Speaker 5: specially pharmacy management system. We included any patients that were
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  Speaker 5: referred by the dermatology provider for psoriasis or atopic dermatitis
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  Speaker 5: that was discontinued because the PBM or payer was requiring
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  Speaker 5: the patient to try a step therapy or formulary alternative
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  Speaker 5: between January twenty twenty one and June twenty twenty two.
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  Speaker 5: We did look at the primary outcome, which is the
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  Speaker 5: number of days for the referral for the special medication
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  Speaker 5: and then when they came back after failing the step therapy,
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  Speaker 5: and then the secondary income was the number of patients
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  Speaker 5: that failed step therapy or formulaly alternative and were referred
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  Speaker 5: back to the specialty pharmacy as well as the number
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  Speaker 5: of patients that did not start special medication and the
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  Speaker 5: reasoning behind that. So you know, our study every patient.
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  Speaker 5: What we did think was very interesting every single patient
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  Speaker 5: had already trialed and failed to topical horticosteroids, so they
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  Speaker 5: had already done a step therapy when we were, you know,
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  Speaker 5: submitting for approval for the specially medication. But most insurances
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  Speaker 5: require at least one more step therapy outside of the
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  Speaker 5: topical quarticosteroid. Most of the times it would be a
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  Speaker 5: topical causeinger, an inhibitor or methotreks eight.
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  Speaker 1: Oh wow.
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  Speaker 5: And so that our findings on which was a huge
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  Speaker 5: you know, sixty percent or thirty seven patients failed to
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  Speaker 5: step therapy with a medium time frame of just seventy
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  Speaker 5: five days. And we had twenty five patients that were
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  Speaker 5: included in the study that were not started on specially medication,
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  Speaker 5: but only five of those patients benefited from the step
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  Speaker 5: therapy and continued the step therapy. We did have fifteen
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  Speaker 5: patients that were lost to follow up. It is very
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  Speaker 5: difficult to get into our site just because of the
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  Speaker 5: it's a very busy clinic and just you know, we
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  Speaker 5: have so many providers, but we probably could have at
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  Speaker 5: least another ten for the demand. So we do have
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  Speaker 5: patients lost the follow up for that reason. And then
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  Speaker 5: we did have two patients that had storiatic arthritis, and
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  Speaker 5: typically that's handled by rheumatology, So they were able to
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  Speaker 5: bypass step therapy requirement by going to rheumatology and they
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  Speaker 5: were started on the specialty medication.
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  Speaker 1: Okay, so what are the potential impacts of your study
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  Speaker 1: on specialty and managed care pharmacy.
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  Speaker 5: With especially pharmacy, you know, I think conducting you know,
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  Speaker 5: a thorough medical history of the patients and what they
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  Speaker 5: have tried in the past. A lot of times when
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  Speaker 5: patients come to our practice, they've already seen a local provider,
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  Speaker 5: you know, even a PCP that has already prescribed them topicals,
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  Speaker 5: or they may have seen a local dermatologist, but then
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  Speaker 5: they you know, were then sent to Vanderbilt and referred
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  Speaker 5: to one of our providers. So I think especially pharmacy
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  Speaker 5: and the dermatology providers, just having a thorough medical history
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  Speaker 5: is one thing that I think is very important.
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  Speaker 4: You know, with managed care, I think the managed.
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  Speaker 5: Care stakeholders should consider the impact of you know, cost
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  Speaker 5: containment strategies on patients' ability to start the needed treatment.
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  Speaker 5: Also with dermatology provider, you know, having them understand that
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  Speaker 5: most insurances do require specific step therapies and just having
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  Speaker 5: those step therapies done on the front end would help
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  Speaker 5: decrease that time frame to get the specially medication eventually approved.
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  Speaker 5: But on the flip side of that, you know, providers
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  Speaker 5: can have you know, they can really push with the
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  Speaker 5: findings we found with sixty percent of the patients coming
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  Speaker 5: back and failing the step therapy, it just goes to
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  Speaker 5: show that it's just a delay tactic. And you know, providers,
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  Speaker 5: do you know these patients have modern to severe soiasis,
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  Speaker 5: a topic dermatitis, and typically are going to end up
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  Speaker 5: on a specialty medication.
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  Speaker 1: Right, are they able to share that data back with
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  Speaker 1: like the payers or the PBMs to say, hey, look
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  Speaker 1: it right, sixty percent of the people still have to
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  Speaker 1: go on or is that not effective in having them
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  Speaker 1: look at their policies.
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  Speaker 5: I think they could definitely share the data in the findings,
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  Speaker 5: but a lot of times, you know, the PBMs and
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  Speaker 5: payers they are just kind of they have their guidelines
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  Speaker 5: and their requirements and it's really hard to get them
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  Speaker 5: to change that at all. Even with you know, when appealing,
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  Speaker 5: you know they're saying, you know, these are our findings
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  Speaker 5: and the patient's going to require this because they're so
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  Speaker 5: they have moderate to severe. It's still a lot of
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  Speaker 5: times I don't know with the findings if they would
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  Speaker 5: be able to get the.
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  Speaker 4: Payers to really go the other direction.
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  Speaker 1: Right, Okay, just wondering, So what are the next steps
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  Speaker 1: with the results of your project.
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  Speaker 5: One is sharing the findings with my dermatology providers that
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  Speaker 5: I work with on a daily basis and then and
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  Speaker 5: the other is, you know, at the NASP conference when
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  Speaker 5: I present in my findings and poster, I had several
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  Speaker 5: people actually ask did the patients actually benefit from the
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  Speaker 5: specially medication that they started and were they still taking it?
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  Speaker 5: So at the PQA annual meeting which is next month
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  Speaker 5: in Tampa, I will be presenting where patients were twelve
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  Speaker 5: months after starting the specially medication.
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  Speaker 1: Awesome, and those are all your patients, right, so that
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  Speaker 1: there's no any kind of control with like maybe practitioners
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  Speaker 1: who aren't embedded with with the with the clinical practice.
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  Speaker 4: That is correct, they're all our patients.
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  Speaker 1: Okay, all er, I'm sure that is you know, has
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  Speaker 1: a has a tremendous positive impact on at least I
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  Speaker 1: would I would think adherence or if the patient isn't responding, right,
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  Speaker 1: then switching them to a product that perhaps.
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  Speaker 4: They would respond to exactly awesome.
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  Speaker 1: Well, any any final thoughts, mat any closing thoughts.
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  Speaker 5: Really the you know, after doing this study, the findings
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  Speaker 5: were very interesting, I thought, just because it goes to
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  Speaker 5: show you insurances and providers definitely have two totally different
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  Speaker 5: ideas on you know, what patients should be on, and
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  Speaker 5: a lot of times, you know, the insurance is dictating
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  Speaker 5: what the provider is having to prescribe initially, and the
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  Speaker 5: findings specifically, you know, show that typically the patients do
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  Speaker 5: end up on what the provider initially wanted them to start.
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  Speaker 1: Right, That's quite that's quite telling. Right. So was that
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  Speaker 1: you know those whatever months, weeks, whatever it was that
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  Speaker 1: the patient was on that that prerequisite drug, you know,
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  Speaker 1: is that just a waste, right, both in terms of
• 15:50
  Speaker 1: you know, the patient's time and you know, time that
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  Speaker 1: they're not controlled or diseases in control, but then also
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  Speaker 1: the money spent on that prerequisite drug.
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  Speaker 5: Yeah, you know a lot of time they have another
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  Speaker 5: opposite edit to see how they're doing on their step therapy,
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  Speaker 5: and you know, if they are doing something like metatrech
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  Speaker 5: state they're having to pay for the labs and things
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  Speaker 5: like that, so it definitely there are costs associated with
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  Speaker 5: that as well.
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  Speaker 1: Right, so this seems like a definite I think it's
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  Speaker 1: a great, great project. The data is excellent right to
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  Speaker 1: kind of facilitate that conversation of gez, how do we
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  Speaker 1: work better together? Right? Keeping the patient at the center
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  Speaker 1: of this. Well, Thanks so much Matt for chatting with
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  Speaker 1: me and sharing this valuable information.
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  Speaker 4: Really appreciate you having me today.
• 16:38
  Speaker 1: And I look forward to seeing to seeing you at PQA.
• 16:41
  Speaker 1: And as a reminder, NSP corporate members are invited to
• 16:44
  Speaker 1: be my guest on one complimentary podcast per year. For
• 16:47
  Speaker 1: more information about this or other NASP membership benefits and events,
• 16:51
  Speaker 1: please feel free to reach out to membership at NA
• 16:54
  Speaker 1: SP n E T dot org or visit our website
• 16:58
  Speaker 1: www dot na s P n e T dot org.
• 17:02
  Speaker 1: Until next time, have a great day,