Development of a palivizumab specialty pharmacy management program

Background: Palivizumab is indicated for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in high risk pediatric patients. Due to the high cost, handling requirements, administration route, and importance of adherence, palivizumab is best managed by specialty pharmacies able to provide robust clinical services. In collaboration with the health system and surrounding pediatric clinics, a specialty pharmacy management program was established to serve patients receiving palivizumab. Aims: To develop a relationship with local pediatric clinics to provide specialty pharmacy services for patients receiving palivizumab. Methods: The patient medication liaison (PML) completed a query of the internal electronic medical record based on diagnosis code to target high risk infants and newborns meeting approval criteria for palivizumab. Providers were notified and palivizumab was prescribed if warranted. During RSV season, internal referrals were also received from the transition of care team directly from the neonatal intensive care unit. An intake form was created for outside clinic/institutions referring pediatrics meeting criteria. The form included: patient, insurance, prescriber, clinical, and prescription information. The PML initiated contact with the parent/guardian and proceeded with benefits investigation. The PML coordinated refills, clinic visits, and nurse visits. The clinical pharmacist provided education on dosing, administration, side-effects, warnings/precautions, importance of adherence, goals of therapy, and RSV prevention strategies. The outcomes of the project include: number of approved prior authorizations, number of prescription fills for Mizzou Specialty Pharmacy, and the number of patients enrolled in patient assistance. Results: From October 2016 through April 2019, the specialty pharmacy worked with two local pediatric clinics. Two hundred and thirty-nine patients were referred to the pharmacy for benefits investigation; 172 prior authorizations (PAs) were approved: 34 triaged to an outside specialty pharmacy, 129 managed by Mizzou Specialty Pharmacy, 18 chose not to pursue. Finally, 48 PAs were denied and 19 patients were approved for patient assistance. Conclusions: Mizzou Specialty Pharmacy successfully developed relationships with local pediatric clinics to serve their patients receiving palivizumab.