Impact of health-system specialty pharmacy services on medication adherence in pediatric patients with cystic fibrosis

Background: Specialty medications represent a growing part of the pharmacological management of chronic disease states such as cystic fibrosis (CF). The management of CF in the pediatric population is complex, as it involves multiple medications and treatment success is largely determined by adherence to the care plan. There is often a delay between prescribing of specialty medications and initiation of therapy in the pediatric CF population. Health-system specialty pharmacy services provide significant benefits when compared to external specialty pharmacies, including direct access to the medical record, collaboration with the healthcare team, continuous patient education and continuity of care. Aims: The objective of this initiative was to assess the impact of Outpatient Pharmacy Services at Yale New Haven Health (OPS), a health system specialty pharmacy, on medication adherence in pediatric patients with CF. Methods: A prospective review of 65 pediatric patients with CF seen by the pharmacist in a health-system CF clinic over 6 months was conducted for medication adherence and compared to a retrospective cohort. Education about the health-system specialty pharmacy services was provided to patients through the following methods: invitation letter, informational pamphlets distributed in clinic and direct education by the clinic pharmacist. A clinic workflow was implemented to streamline the referral process. Primary endpoints include: medication possession ratio (MPR), proportion of days covered (PDC), and percentage of prescriptions sent to and filled by the OPS. Results: A total of 65 pediatric CF prescriptions were written from September 2017 to February 2018, with only 7.7% of the prescriptions sent to OPS prior to implementation of the clinic workflow. The MPR and PDC in this retrospective cohort were 0.85 and 0.75 respectively. From September 2018 to February 2019 the number of prescriptions for all medications written was 304, with 32.9% sent to OPS and a fill rate of 89%. The MPR and PDC for that year were 0.86 and 0.80 respectively. Conclusions: This single-center review that assessed the impact of specialty pharmacy services on pediatric patients with CF in a large health system demonstrated improved and sustained patient medication adherence. The increase in utilization of OPS led to an increase in prescriptions received and filled by the health-system specialty pharmacy.