Sabrina McMillen, a specialist pharmacist in Express Scripts’ oncology Therapeutic Resource Center, specializes in patients who take medications for cancer and blood disorders.
Recently, when reviewing the therapy of one patient with kidney disease on medication to control anemia – a blood disorder – Sabrina made a decision that markedly reduced the patient’s risk for heart attack and stroke.
Knowing What to Watch For
To manage severe anemia, patients may be prescribed erythropoietin stimulating agents that help raise hemoglobin levels. The Food and Drug Administration (FDA) warns, however, that overtreatment can be deadly in patients with kidney disease.
“Having a hemoglobin level higher than that indicated by the FDA puts the patient at increased risk of a heart attack or stroke,” Sabrina says. “While helping a patient manage anemia that results from chronic kidney disease is important, patient safety is critical.”
In this case, recent blood tests showed the patient’s hemoglobin level was significantly higher than recommended by the FDA for patients with kidney disease.
“As a specialist, I know that it is vital to check lab results before dispensing anemia medications for kidney disease patients,” Sabrina says.
Working With Physicians to Help Patients
Sabrina called the physician’s office and discussed the patient’s risk for heart attack and stroke. Grateful for the heads-up, the physician put the patient’s therapy on hold until hemoglobin levels declined.
“It’s one of the things I love about my job,” Sabrina says. “I can work closely with physicians and others and use my clinical knowledge to enable decisions that lead to better health outcomes for the patient.”
Increasing Safety, Reducing Waste
Patient safety is a key aspect of our specialist pharmacist programs. But it is important not to forget another significant issue: reducing waste.
In this instance, appropriately holding therapy for this expensive medication (more than $1,000 per dose) not only reduced a serious risk but also had immediate savings for the patient and the plan sponsor. It also has indirect savings because strokes and heart attacks are very costly – from both a health and a financial standpoint.
The Value of Specialist Pharmacists
Pharmacists such as Sabrina who specialize in a single clinical area possess a deep and nuanced understanding of a particular disease and therefore can deliver helpful counsel to help patients stay on the right treatment and avoid unnecessary, harmful side effects.
This level of clinical specialization, along with the application of the behavioral sciences and actionable data, form an approach we at Express Scripts call Health Decision Science℠. And through this approach, we enable the better decisions that ultimately lead to healthier outcomes.
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