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December 14, 2022

Addressing Specialty Pharmacy Adherence Challenges Head On

Sarah Kester, PharmD
Pharmaceutical Program Manager, Omnicell Specialty Pharmacy Services

Medication non-adherence is a crippling problem in healthcare today, causing unnecessary hospitalizations and escalating costs. This problem is especially prevalent for patients receiving long-term therapy for chronic conditions. In fact, estimates show that adherence to chronic medications is only about 50%. 1

Several factors contribute to non-adherence, including forgetfulness, confusion, and cost of the medication. For example, of the staggering 81 million prescriptions abandoned in 2021, medications that cost more than $125 had the highest abandonment rate. 2  

Specialty pharmacy is a hotbed for adherence issues. Not only are many specialty medications used to treat chronic illness, but these drugs are complex, high-touch, and expensive. Ensuring successful patient outcomes requires a specialty pharmacy program that is well equipped to facilitate access to specialty medications, control costs, and actively monitor and consult with patients to promote therapy adherence.

This was the focus of a session titled Advancing Adherence and Clinical Outcomes in Specialty Pharmacy presented by Omnicell and Bausch Health at ASHP Midyear 2022 in Las Vegas. I was honored to serve as a speaker for this panel-style discussion that outlined how Bausch Health and Omnicell Specialty Pharmacy Services partnered to improve adherence to XIFAXAN, a specialty medication used to treat patients with overt hepatic encephalopathy (OHE) and irritable bowel syndrome with diarrhea (IBS-D).

Streamline PA approval and get meds to patients quickly 

Omnicell Specialty Pharmacy Services helped Bausch Health improve XIFAXAN adherence in many ways, starting with the prior authorization (PA) process. Typically, when a referral for XIFAXAN is sent to a big-box pharmacy or Pharmacy Benefit Manager (PBM), it is initially rejected because a PA is needed. In these cases, the pharmacy will send the rejection back until the provider obtains approval. Meanwhile, the patient languishes for days, sometimes weeks, without their medication.

By contrast, Omnicell Specialty Pharmacy Services provides dedicated experts that work with health system-owned specialty pharmacies to expedite the PA approval process. These experts don’t send referrals back to providers. Instead, they are skilled to work directly with PBMs to get PAs approved quickly. To date, Omnicell has a 92% PA approval rate for all indications of XIFAXAN and the average turnaround time for medication delivery to patients is less than two days. 

Ongoing outreach and consultation drives adherence

Once PA is approved, the Omnicell clinical team contacts the patient to provide in-depth counseling about the medication, dosage and frequency, disease state, side effects, drug interactions, and desired outcomes for treatment. 

Many patients we counsel are just returning home from a hospital visit for acute OHE, a disease where cognitive deficit is a hallmark symptom. Our clinical support team aims to provide patients with a clear understanding of why they need to be on XIFAXAN, how the medication works, and the benefits of long-term adherence. Our goal is to prevent a patient from relapsing because they inappropriately discontinue the medication once they start feeling better.

After XIFAXAN is delivered to patient, our clinical support team conducts follow-up calls with patients every month for the next 35 months. The purpose of these consultations is to monitor for clinical efficacy, side effects, and hospitalizations, and to promote continued adherence. These outreach efforts have had a marked impact on days on therapy (DOT), nearly doubling the national XIFAXAN DOT average of 5.4 months to 9 months. 

Metrics like these are great, but I personally find the impact our adherence efforts have on patient quality of life to be most rewarding. For example, one patient we counseled responded so well to continued adherence to XIFAXAN that he was able to regain driving privileges that had been previously revoked due to his struggle with OHE. This outcome was especially meaningful for the patient and a powerful reminder of how the daily actions of our clinical support team help improve lives.

PA authorization and adherence monitoring are just two of the many turnkey solutions provided by Omnicell Specialty Pharmacy Services. Learn more about how our full suite of services can help optimize your specialty pharmacy access, adherence, and performance. 

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The views and opinions expressed in this blog are those of the authors. They do not necessarily reflect the official policy or position of any other agency, organization, employer, or company. Assumptions made in the analysis do not reflect the position of any entity other than the author(s). These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.

  1. Medication Adherence: The Elephant in the Room, U.S. Pharmacist, January 2019
  2. IQVIA Institute for Human Data Science 2022