OPTIME CARE CORNER: Patient-First Approach Provides Optimal Clinical Outcomes

Almost 10% of the U.S. population is impacted by one of 7,000+ rare diseases, the majority of which are life threatening and 80% genetic in origin. Rare disease patients and their families face significant challenges: difficulty getting a diagnosis, lack of medical expertise on their disease, few opportunities for optimal care and the high costs of disease-specific medications, including gene/cell therapies (GCT).

To address these issues, Specialty Pharmacy (SP) solution providers go above and beyond the typical retail pharmacists to optimize treatment and reduce costs. The best SP solutions go even one step further by taking a patient-first approach to optimize medication management and enhance outcomes.

AscellaHealth’s strategic partner, Optime Care, offers SP pharmacists and trained care coordination teams who put patients first, deploying solutions that offer outcomes tracking, compliance reporting and .persistency, as well as real-world evidence to maximize the benefits of drug therapy and improve quality of life.

In this issue of Developments in Specialty Pharmacy, we begin the first installment of Optime Care Corner in which we explore the issues, trends and news impacting rare disease patients and other stakeholders in the world of specialty treatments.

Everyday Challenges for Rare Disease Patients

While there has been significant progress made in SP therapy breakthroughs, these are only part of the equation. More than 95% of rare disease patients lack an FDA approved treatment for their condition. Other key access barriers to care include:

Medical Specialists -- Too often, many physicians are unfamiliar with diseases or prescribe advanced therapies. As a result, people have difficulty finding a physician who can offer appropriate care and treatment, especially in rural communities or among marginalized populations where health equity is highly problematic. What’s more, prescribers are cut off from the patient journey once they’ve prescribed therapy or enrolled the patient into the manufacturer-sponsored patient services, resulting in treatment delays of up to eight weeks. This can lead to deteriorating health, delays to diagnosis and worsening symptoms among these vulnerable patients.

Medication – Approximately 82% of individuals prescribed specialty therapies reported spending an hour on the phone coordinating care to begin their therapy, and over one-third spent at least three hours. Medication access and adherence challenges can be so significant for specialty patients, up to 27% of prescriptions and therapies are abandoned—or never started at all.

Cost -- The cost for one Specialty medication used on a chronic basis is three times the average annual income for Medicare patients, placing prescription medications out of reach for many older adults or forcing them to choose between the medicines they need or buying groceries or paying rent. While the direct medical costs associated with the cost of medications and managing the disease are profound, there are also indirect costs associated with productivity losses due to the disease and non-medical costs associated with necessary modification of home or vehicles.

Effective Management – SP therapies require customized management and services beyond what traditional pharmacies can provide to rare disease patients. New specialty drugs may not align with current medication requirements, dosing regimens, prior authorization processes, logistical hurdles and high out-of-pocket costs.

Social Determinants of Health (SDOH) -- Many people with rare diseases or their caregivers don’t have access to paid family and medical leave, and without it they face the difficult decision of risking financial hardship or not getting the care they or their loved ones need.

Optime Care’s SP Pharmacists

Optime Care’s specialty-focused pharmacists are optimally positioned to treat and assist a patient as a “whole” person instead of simply focusing on an illness or diagnosis. As a result, rare disease patients stand a better chance of thriving, working and pursuing everyday activities -- despite the disruption and uncertainty brought on by the pandemic and other unforeseen emergencies. 

Optime Care pharmacists often interact more regularly and frequently with rare disease patients than prescribing medical professionals, developing relationships with patients and helping them to avoid dangerous drug interactions or adverse health effects in order to optimize therapy. They are able to improve medication safety because they have the time and clinical expertise to make a difference in the way patients manage chronic conditions for which they may be taking multiple medications.

Every decision these professionals make is patient-first, meaning the care team focuses on what is best for the patient. They help mitigate the high costs of specialty drugs with connectivity and unique financial solutions, such as custom co-pay assistance programs, to expand health equity and ensure that therapies are more attainable for those in need. When supported by an advanced technology platform that provides an automated algorithm to identify ideal programs for patients, Optime Care’s specialty pharmacists help to eliminate barriers to accessing high-cost therapies and ensure that members receive the specialty medications they need, when they need them most, regardless of financial status.