Accredo’s Clinical Tools in Managed Care

Apr 2, 2014
Creating a healthcare team of insurers and physicians ensures that patients receives optimal care without unnecessary cost.

As the cost of specialty medication rises, plan sponsors need to find effective solutions to control trend and rein in costs.

One way to do it is through better communication between insurers and physicians – in essence creating a healthcare team that ensures patients receive optimal care without unnecessary costs.

A recent article in Managed Care Magazine highlights tools provided by Accredo, Express Scripts’ specialty pharmacy. These solutions include ExpressPATH®, our therapy management programs, and the specially trained pharmacists and nurses in the disease-specific Therapeutic Resource Centers®.

In the article, Mary Dorholt, vice president and clinical practice leader for specialty, discussed the changing nature of physician communications:

“We’re interacting with physicians frequently, sometimes daily. Those interactions involve situations where we apply standardized assessments that are often unique by drug and by patient to ensure proper drug utilization and medication management.”

“These communications are highly patient-specific, given the unique characteristics of each patient and their therapy and the comparatively small number of patients for rare diseases.”

One example of this is Accredo’s Managing Erythropoiesis-Stimulating Agents (ESAs) program to prevent anemia in cancer patients.

The program monitors prescription patterns of ESAs to ensure they comply with the FDA dosage requirements. If the patient’s hemoglobin levels are out of range, Accredo pharmacists reach out to the physician and recommend a dose change. This has meant healthier outcomes for patients and savings for plan sponsors.

“We’ve been able to show annual savings of about $2 million – about 40% of our business for ESAs,” said Dorholt.

A recent therapy management pilot for patients of chronic inflammatory demyelinating polyneuropathy (CIDP) also highlighted the value of intervention by specially trained Accredo clinicians. CIDP is a neurological disorder, and dosage is based on various patient-specific factors including disease severity. Dorholt explained how the specially trained clinicians in Accredo’s Therapeutic Resource Centers – and the patient-specific assessments they perform  can help improve outcomes for CIDP patients.

“We recognized that dosing can be all over the place, so we decided to look at it at the patient level and assess the patient’s functionality. Because this is a neurologic disorder, there are some simple things you can ask patients about their ability to do things such as buttoning their shirt,” Dorholt said.

“We found that in many cases patients were underdosed, and we developed a new approach to go back to doctors with this information. In this study we found that physicians responded to our recommendations 54% of the time. Then we performed follow-up at 24 weeks to see if there was improvement in their functionality.

“Where physicians followed our recommendations, 63% of patients were doing better. And where they did not, only 25% were doing better.”

To read the entire article visit the Managed Care website.

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Lab Staff
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