Integrated Outpatient Specialty Neurology Pharmacists Influence Care in Non-MS Clinical Settings

Johnson,Kayla;

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May 28, 2025

Pharmacy Practice in Focus: Health Systems

May 2025

Volume14

Issue 3

Integrated Outpatient Specialty Neurology Pharmacists Influence Care in Non-MS Clinical Settings

Author(s):

Kayla Johnson, PharmD, BCPS, BCPP

Key Takeaways

IHSSPs provide essential clinical support for non-MS neurologic conditions, reducing frequent provider visits through transparent EHR documentation.
Vanderbilt Health System's study showed pharmacists performed 2244 interventions, with a 98% acceptance rate for recommendations.
Pharmacist interventions led to $188,570 in cost avoidance, primarily through medication therapy changes and dose adjustments.
Future research should explore the impact of non-MS neurology pharmacists on clinical and humanistic patient outcomes.

Integrated health system specialty pharmacies can improve patient care for non–multiple sclerosis neurologic conditions.

Patients with non–multiple sclerosis (MS) neurologic conditions, such as epilepsy, autonomic dysfunction, and movement disorders, have complex medical needs and often require specialty medications for the management of their condition. Once access to specialty medications has been obtained, additional clinical support is often needed to ensure treatment is safe and effective.

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Integrated health system specialty pharmacies (IHSSPs) with outpatient pharmacists can provide needed clinical support and transparent documentation in the electronic health record (EHR), reducing the need for frequent provider visits. The extent of clinical monitoring performed by external (non-HSSP) pharmacies is unknown, as monitoring results, if performed, are not reported back to the prescribing clinic and are not easily viewable by the providers. Pharmacists have demonstrated a beneficial impact on patient outcomes in many neurologic conditions.^1-5

Recently, in the MS population, data have been published on adherence to and persistence with disease-modifying treatment in treatment-naive and -experienced patients relating to improving the efficiency and timeliness of patient care.^1-3 However, data describing the role and outcomes associated with pharmacist services are not widely available in other neurologic disease states. Additionally, cost avoidance from integrated pharmacists’ interventions has not been explored in non-MS neurology clinics and could help demonstrate the financial value of embedded pharmacists, as is the case in the MS population.⁴

At Vanderbilt Health System in Nashville, Tennessee, we performed a retrospective chart review, which included 741 patients, to examine the role of an integrated outpatient specialty neurology pharmacist in the non-MS setting by evaluating interventions performed. The results of our study were presented at the 2025 American Academy of Neurology Annual Meeting in San Diego, California.

Patient Inclusion and Demographics

Our study included adult and pediatric patients with epilepsy and movement disorders, autonomic dysfunction, neuromuscular disorders, or transthyretin amyloidosis at an academic medical center with an IHSSP; additionally, patients admitted to the inpatient facility were included if transitions of care coordination was required.⁶ Patients were included if an intervention was documented in the EHR or specialty pharmacy patient management database from January 2023 through March 2023. The study included 741 patients with a median age of 60 years (IQR, 22-72); 83% of patients were White, 55% were male, and 69% used the IHSSP for medication fulfillment.

Pharmacist Impact

Pharmacists performed 2244 interventions, generating 385 recommendations to patients or providers with a 98% acceptance rate. Recommendations commonly resulted in therapy changes (n = 129; 33.5%), financial assistance referrals (n = 64; 16.6%), appointment recommendations (n = 35; 9.1%), and safety monitoring such as laboratory testing or electrocardiograms (n = 22; 5.7%). Of the 56 interventions related to follow-up on a medication titration or dose change, 32 interventions led to further recommendations. On a scale from 1 to 4, the most common impact score was 2 (76%, quality of life affected), and a median of 10 minutes (IQR, 5-15) was required per intervention. The only factor associated with shorter intervention time was clinic specialty in comparison with movement disorders (amyloidosis [P = .047; OR 0.70 (95% CI 0.49-1.00)], epilepsy [P = .043; OR 0.73 (95% CI 0.54-0.99)], and inpatient [P = .015; OR 0.67 (95% CI 0.49-0.93)]).

Medication therapy change recommendations led to $188,570 in cost avoidance using the average wholesale price minus 20%. The most common therapy changes involved prescription cannabidiol, deutetrabenazine, and droxidopa. Dose changes resulted in most of the cost avoidance, totaling $154,446, whereas discontinuation cost avoidance totaled $34,124 over 3 months.

About the Author

Kayla Johnson, PharmD, BCPS, BCPP, is a clinical pharmacist specialist at Vanderbilt Specialty Pharmacy in the Vanderbilt Health System in Nashville, Tennessee.

Conclusions

In our analysis of a 3-month time span, we showed that IHSSP pharmacists perform a high number of interventions, often leading to medication therapy changes, medication monitoring, and cost avoidance for pharmacy benefit managers. Future studies should examine the impact of non-MS neurology pharmacists on clinical and humanistic patient outcomes.