Pharmacists Can Improve Specialty Medication Management in Dermatology Space

Dermatological conditions such as atopic dermatitis (AD), psoriasis, and hidradenitis suppurativa (HS) can be difficult to manage, specifically presenting challenges in specialty medication access and adherence. These chronic inflammatory skin conditions often require specialty medications to improve symptoms and prevent flares. However, high cost and limited distribution of medications can lead to delayed treatment, which could negatively affect the patient’s quality of life.^1,2

Image credit: SNAB | stock.adobe.com

To address challenges with specialty medication access and adherence, health systems are increasingly integrating specialty pharmacies and adding pharmacists within clinics. Embedding a pharmacist in dermatology clinics could improve dermatological outcomes and the patient’s quality of life.¹

According to data published in the Journal of the American Pharmacists Association, findings from previous studies have shown that integrating pharmacists into clinics improves continuity of care, patient satisfaction, and medication adherence while decreasing time to medication approval and initiation.¹ To further assess the impact of embedding pharmacists in dermatology clinics, researchers created a study based on data collected by retrospective chart review for patients who were seen in the University of Louisville (UofL) Health Dermatology Clinic in Kentucky and filled a specialty dermatology medication with the UofL Hospital Specialty Pharmacy from October 15, 2019, to October 14, 2021.¹

The UofL Health Dermatology Clinic included a postgraduate year 2 ambulatory care pharmacy resident in its practice from October 2020 to April 2021. The pharmacist spent 4 hours a week in the clinic, establishing a workflow that assisted with medication selection, initiation, access, education, and monitoring.¹

In the study, researchers evaluated the financial and clinical effects of adding a pharmacist to the UofL Health Dermatology Clinic, aiming to secure funding for a full-time pharmacist position within the clinic. Researchers examined financial outcomes such as prescription volume at the UofL Hospital Specialty Pharmacy and return on investment. Clinical outcomes measured included time to medication initiation, medication adherence, adverse events, quality-of-life changes, pharmacist interventions, and patient satisfaction.¹

A total of 27 individuals were included in the postintervention group, and 21 individuals were included in the preintervention group. However, 2 patients from the postintervention group switched dermatology specialty medications during the study period.¹

The study authors noted that most individuals in both groups had Medicaid or Medicare insurance and had similar baseline demographic information. The most common dermatology diagnosis among both groups was psoriasis, followed by AD and HS. Most individuals were treated with adalimumab (Humira; AbbVie) and dupilumab (Dupixent; Regeneron, Sanofi).¹

The results demonstrated a 28.87% increase in prescription volume (P = .023) when the pharmacist was integrated into the clinic, with 183 prescriptions sent to the UofL Hospital Specialty Pharmacy during postintervention compared with the 142 sent during preintervention. The average time to initiation of medications was 13.6 days for the postintervention group and 21.3 days for the preintervention group (P = .41). Additionally, adherence to medication was 93.14% for the postintervention group and 99.2% for the preintervention group (P = .22), according to the study authors.¹

Further results demonstrated that pharmacist interventions, including recommendations for laboratory monitoring and dose adjustments, were provided to 25.9% of the postintervention group and 19% of the preintervention group. Patient satisfaction was high in both groups, with the postintervention group averaging 97.6% and the preintervention group averaging 93.6%. “This statistically significant increase in prescriptions and, in turn, positive increase in revenue resulted in a positive return on investment, which could be used to gain an additional full-time equivalent to add a pharmacist to the specialty pharmacy staff and dermatology clinic using the hybrid model,” the study authors wrote.¹

The findings suggest that embedding a pharmacist in the dermatology clinic improved the relationship between the providers and specialty pharmacy, causing a positive impact on clinical and financial outcomes. The results emphasize the pharmacist’s crucial role in dermatology services, leading to positive impacts on the patient’s quality of life.¹

REFERENCES

1. Penick T, Hawkins T, O’Reilly E, Maniyar H, Maier C, McPheeters C. Impact of embedding a pharmacist in a dermatology clinic on outcomes in a specialty pharmacy. J Am Pharm Assoc (2003). 2023;63(2):661-666. doi:10.1016/j.japh.2022.09.009

2. Rischke S, Schäfer SMG, König A, et al. Metabolomic and lipidomic fingerprints in inflammatory skin diseases - systemic illumination of atopic dermatitis, hidradenitis suppurativa and plaque psoriasis. Clin Immunol. 2024;265:110305. doi:10.1016/j.clim.2024.110305