Role of Specialty Pharmacies in Hemophilia Care: A Collaborative Approach


Lisa Schrade, PharmD, and Robert Sidonio Jr, MD, MSc, explore the integral partnership between specialty pharmacists and hematologists in managing patients with hemophilia.

Jonathan Ogurchak, PharmD, CSP: Now, we’ve kind of alluded to it as we’ve gone here, but the specialty pharmacist plays a big role in helping to work alongside hematology to not only get the patients started on therapy but [determine] how you can best access them. I wanted to frame some ideas here in the form of a case. Let’s say that we have a 6-year-old boy who’s recently been diagnosed with hemophilia A, and they’re going to be working alongside the hematologist just to decide what types of options might be available for prophylaxis. Dr Schrade, what would a specialty pharmacist be doing hand in hand with hematology to try to help make the best decision for that patient?

Lisa Schrade, PharmD: I think as the specialty pharmacy part of it, we’re supporting the provider’s discussion with the patient. Our involvement usually comes in when it’s processing the insurance coverage of the medication. Just because it’s the choice that initially occurs between the provider and the patient doesn’t necessarily mean that’s going to be the one that the insurance will allow. It’s up to us as the pharmacist to make sure that we have all the information about the other therapy lines that are in line. Or what other avenues we can pursue to try to get the covered product that is originally intended for the patient. Even if the product is covered, there could be a substantial out-of-pocket expense for the patient, so [make] sure that they’re informed about other assistance programs, whether it be through manufacturer copay programs, foundational assistance, or other kind of grants that are available for [patients with] hemophilia. We take that all into consideration, take it back to the table for the provider, and just support the initial decision. Then again, since we touch these patients’ lives every month, whereas the doctor might see them maybe every 3 months, every 6 months, maybe every year. Just reporting back to them what we’re seeing as far as adherence, any reported adverse effects, issues, concerns that the families are having.

Jonathan Ogurchak, PharmD, CSP: What are some of the things that you see as far as that relationship is concerned between specialty pharmacy patients and your practice when you’re trying to bring patients to therapy?

Robert Sidonio Jr, MD, MSc: We have this sort of team mentality, and sometimes patients will communicate something to any one of the team members, right? You go in there, say everything’s great, or the nurse might go in there and say, “They really seem upset,” and you go in there and they seem totally fine. We always joke about that. I was like, “Well, they were nice to me.” But they may not always bring up those topics. A lot of specialty pharmacies have a number of different people who work with them. They have social workers. And the nurses who go to their houses initially, because you’re talking about a young child, they just started this, maybe the family doesn’t know how to infuse; they get to see the whole situation. They’re in the house. They get to see what’s going on, whether there are issues unrelated to the bleeding disorder. Obviously, it’s difficult; it’s not like you just write the script and it happens. They need a copy of your notes, you’ve got to do a prior authorization, [and] you might have to write a letter explaining this, particularly if it’s a new patient. The insurance is going to be like, “What’s going on?” This is a new patient who’s got this, so they don’t have a record of any of this. It can take some time to get this. There are a number of services that the specialty pharmacy can offer. As we talked about before, there’s the shared decision-making. We outline all the different products, what the pros and cons are. We often will tell them what’s on our formulary because sometimes that matters to families. They just say, “Well, I’ll just do whatever you guys have in the hospital,” because for the most part, if they’re in for surgery, they’re typically going to use that factor product unless it’s an unusual situation. They ask us for our personal opinion about it, and they ask others as well. We just help guide them on that and then, hopefully, all the other issues that have to be dealt with. All the insurance stuff is difficult. You could prescribe something—Advate—for 15 years to a patient, and then all of a sudden, the insurance company says it’s not going to be covered. And you’re just like, what is happening? This is where you really have to have everybody help convey why it’s important that they chose this product vs others and hope there are not too many barriers to getting the products that the patients want.

Transcript is AI generated and reviewed by an AJMC editor.

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