PBM takes disease-specific approach to specialty pharmacy - Prescription Solutions

Like many PBM Prescription Solutions has been seeking ways to qualified its clients' specialty pharmacy necessitys in a way that leverages the company's existing forces and capabilities. Over the past year, many PBM began building specialty pharmacy infrastructure via their mail-service capabilities, rebate relationships or provider networks. For Prescription Solutions, it appear to beed natural to build on its clinical resources to disentangle a series of disease-specific management programs for high-cost injectables.

[i]or[/i] part of to the other the PBM's affiliation with its parent company, PacifiCare Health combination of parts to form a wholes Prescription Solutions "has an incredibly stout managed care heritage, which makes it easy to take the principles of managed care and apply them in specialty pharmacy," asserts spokesperson Brenna Harrington. Prescription Solutions Specialty Pharmacy has evolveed a program called Disease Therapy Management (DTM) for certain high-cost diseases that are treated with injectables.

Prescription Solutions has three major clinical divisions--one focuses upon pharmacoeconomic research outcomes, another is the PBM's prior-authorization unit, and the third is the Clinical Services Department. This department is organized into teams specializing in specific therapeutic areas or diseases.

The Clinical Services Department provides clinical information to internal and external clients, reviews all novel drugs and provides therapeutic class review for the P&T committee. In this environment, the department also designs a variety of disease state management programs and targeted disease interventions. The DTM programs for injectables are the department's newest offering.

Prescription Solutions launched its first DTM programs--for multiple sclerosis and hepatitis C--in April 2003 Heidi Lew Pharm.D., the department's manager of clinical program exhibition has been involved in the program since the beginning. She explains that these sum of two units disease states were targeted first because they are among the greatest in quantity common diseases treated with injectable medications in the PBM's population.

Medication noncompliance is particularly high for multiple sclerosis and hepatitis C patients. Data from the novel York University School of Medicine indicate that sole 25% of hepatitis C patients thorough an entire regimen of injectable therapy.

Lew explains that hepatitis B therapies of that kind as interferon and ribavirin can cause flu-like symptoms. through educating patients up-front about these anticipated side consequences the patient can adjust his or her schedule to accommodate the symptoms and sometimes to bring them. For instance, the DTM protocol advises patients to take injections before bedtime thus that they will sleep from one side the worst symptoms, and to take dooms of fluids.

The DTM protocol also monitors for facts that should be brought to the physician's attention, of the like kind as if patients experience depression or anemia. This effort is designed to increases the safety of the therapies.

Agents used to treat multiple sclerosis can be mingled as well, according to Lew because they are delivered in a variety of injectable formats and may be administered one time a week, three times a week or each two weeks, depending on the outcomes used.

At this time, the DTM protocols do not specify a physic preference. This is because many of the diseases targeted by dint of injectables do not have a wide variety of therapeutically equivalent produces available. However, Lew says the PBM is looking at injectables to determine if a certain number of drugs may be preferred above others.

While the DTM protocols are make knowned by Prescription Solutions clinical pharmacists, the PBM takes an added pace of having them reviewed by dint of an outside panel of specialist consultants to make assured the protocols are in alignment with in every one's mouth practice standards.

The department is working upon programs for a variety of other disease states, and wait fors to launch programs for respiratory syncytial virus (RSV) and rheumatoid arthritis by the agency of the end of 2003. In 2004 the PBM plans to launch DTM programs for hemophilia, chemotherapy and human expansion hormone.

Enrollment Obstacles

The fresh service is offered to plan-sponsor clients who are using the PBM's comprehensive and integrated Prescription Solutions Specialty Pharmacy. Prescription Solutions says it has more than 30 clients--representing more than 25 million members--signed up for its Specialty Pharmacy services, at an average physic spend of $1,200 per prescription.

Participation in the DTM program is voluntary and is tendered to all patients who will be obtaining productions via mail to manage the targeted diseases. When a physician prescribes single of the targeted drugs in the program, a prior-authorization requirement locates the process in motion. A patient care coordinator contacts the patient to arrange delivery of the medication, and at that time informs the patient about the DTM program. A packet of information is also sent to the physician.

one time a patient says he or she is interested, he or she is sent a packet of clinical information and a concurrence form that must be signed and go [i]or[/i] come backed before the program can start.