Reducing Waste Through Specialized Care

Mar 4, 2014
A study by Accredo shows that intervention by pharmacists with disease-specific expertise can help improve outcomes for patients with CIDP.
  • Mental/Neurological Disorders

Research by Accredo an Express Scripts company – shows that intervention by pharmacists with disease-specific expertise can help improve outcomes for patients with chronic inflammatory demyelinating polyneuropathy (CIDP) being treated with intravenous immune globulin (IVIG).

The study, presented in December at the American Society of Health-System Pharmacists Midyear Clinical Meeting, looked at the impact of dosing-change recommendations by specially trained pharmacists based on evidence-based clinical guidelines and found that it lowered the occurrence of disability among patients and helped lower costs for payers. 

What Is CIDP?

CIDP is a progressive disease caused by a person’s own immune system attacking nerve cells (also known as neurons), which results in the patient experiencing pain, numbness, tingling and weakness in the arms and legs. These symptoms can become so severe that the patient is unable to use his extremities.

IVIG – a complex medication derived from human plasma – has been shown to slow or stop CIDP and reverse the symptoms. However, IVIG has many side effects, some severe. The dose and frequency of administration vary and results can differ by patient. 

The Role of a Specialist

When a CIDP patient on IVIG is referred to Accredo, specially trained pharmacists assess the amount of drug per infusion and frequency of dosing.

Based on the patient’s perceived disability score – how bad the patient perceives the symptoms and resulting disability to be – and optimal dosing as recommended in literature, the pharmacist recommends an increase or decrease in the amount of IVIG over time.

When a patient reported a perceived disability score of 4 or more (on a scale of 0 to 7) and the patient was receiving less than the recommended dose, the pharmacist recommended an increase in the amount of IVIG over time. Conversely, if a patient was being prescribed more than the optimal dose and the patient had a score of 0 (low to no perceived disability), then the pharmacist recommended a decrease in the amount of IVIG over time. 

Better Decisions, Healthier Outcomes

The study found that a majority – 54% – of physicians accepted the pharmacists’ recommendations. In addition, 63% of patients whose prescribers accepted the evidence-based recommendation saw an improved disability score, compared to only 25% of patients  when the prescriber declined recommendations.

As demonstrated by the disability scores, patients experienced fewer and less severe disabilities, felt better, were able to function better and had an overall improvement in their quality of life.

Lower Costs

Better outcomes for patients can mean lower costs for payers. When patients are prescribed medication they do not need or do not benefit from, it creates waste. Many of these medications are expensive, and now, more than ever, clients need tools to rein-in specialty drug costs. By ensuring that patients are receiving exactly the medication they need at the right dose and the right time, Accredo’s specially trained pharmacists can help reduce waste.

When pharmacists in the study recommended higher doses, it resulted in higher medication costs for payers, but also in improved health outcomes that contributed to lower medical and other associated costs. On occasion, it is possible to take patients off a medication completely if their disease is brought into remission and is properly controlled, leading to further savings.

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