Advocacy and Precision in Hemophilia Pharmacy Care: Insights and Best Practices


Experts discuss the critical role of specialty pharmacists in advocating for patients during challenging moments in their hemophilia treatment journey and explore precision dosing considerations and the importance of adherence to dosing guidelines.

Jonathan Ogurchak, PharmD, CSP: Now Dr Chowdhry, on that topic of advocacy, what are some things that you've seen that have been successful for specialty pharmacies to engage with patients and their families whenever they're dealing with an especially difficult period in their treatment course?

Atta Chowdhry, RPh: I usually joke around to say that as specialty pharmacists, 90% of the time, like all the specialty pharmacists, they do a fantastic job of taking care of the patient. What sets apart being a hemophilia pharmacist is that 10% of the time when the urgency is required to get that medication delivered and earn that patient's trust that they are having a bleed. For them, it's a life-threatening situation. Any delay on getting that medication to them, it's a significant damage to their physical and emotional well-being. At that point, I think that's where that time, that 10% of the time you have to come across and earn the patient's trust and advocate for that patient with the payer, with the provider. Even like if you have a close relationship with the hemophilia treatment center, a lot of times the patients don't share certain information with the treatment center because they see them once every 3 months or six months as compared to their specialty pharmacist every month. And it depends on the relationship that I just a lot of times joke around with them that, “Hey, I'm going to tattle-tail on you, giving you heads up, I'm calling the treatment center because you need to call them up because of XYZ.” I have never found a patient who got upset with me. They were like okay. Because for a lot of the patients they live 30 miles away 40 miles away —for those patients to make that trip to the treatment center [when] a lot of the stuff can be resolved over the phone. Because going to the treatment center is kind of difficult. Another thing which a lot of the hemophilia pharmacist can do is … when you're sending a product through a third-party courier like FedEx and UPS, waving the signature requirement. We don't get it because when somebody is having a bleed they're not getting through their door as quickly as some other folks. For them, then going to the FedEx center trying to get that package released or sometimes if it's a weekend and the product have a temperature sensitive product in it, that can cause a serious issue for that. There is a lot of little things which you pick up on those pearls on how to serve the community better and how you can take care of those patients properly.

Jonathan Ogurchak, PharmD, CSP: I'm going [to] stay with you for a second here because you talked about that whole tattletale notion of things and 1 area that tends to come up for patients is—especially you know as you're getting older—is related to weight. Is it the weight that you want to be or is it the weight that you are and with drugs like emicizumab you have to worry about that from a dosing perspective. There have been some studies out there looking at things like that. Could you talk a little bit more about how that may come into play?

Atta Chowdhry, RPh: I think that is 1 of the things with hemophilia claims [which] is key for being a specialty pharmacy. If you are not a part of Pharmacy Benefits Manager (PBM), maybe sometimes you are a part of the PBM, is that a lot of the claims get audited. And the thing is that as a pharmacist, if you are not very careful and a good steward of their payer’s money at that point, because these drugs are not cheap, even emicizumab or a factor product, you have to make sure that you use the combination of the vial who comes as close as possible to the dosing. Because either way you can cause harm by having supra therapeutic dose or subtherapeutic dose. You have to come to the level where the dose is in that optimal range and a lot of payers will allow you 5% plus/minus deviation. Some of the payers will give you 3%, some of them are wanting to do 1%. You have to be very careful because you know that once that product is dispensed and once you have the delivery confirmation, you are getting a fax from a payer who is requiring all the documentation so they can review the claim.

Jonathan Ogurchak, PharmD, CSP: Absolutely. I always love that you click the adjudicate button and the faxes on your fax will shoot before even think twice.

This transcript was AI-generated and reviewed by a Pharmacy Times editor.

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