Specialty Pharmacy Programs Facilitate Proper Use of Immunosuppressive Therapies in Kidney Transplant Patients

A recent study found that transplant pharmacology experts working in specialty pharmacy programs positively influence patient adherence to immunosuppressive agents.

The use of a mandatory specialty pharmacy program to manage immunosuppressive medications in post-renal transplantation patients was found to be associated with lower transplant-related and overall medical costs than when these therapies were dispensed by a retail pharmacy.

According to recent research published in the January/February 2013 issue of the Journal of Managed Care Pharmacy (JMCP), specialty services such as disease therapy management, patient education, and counseling services by “transplant pharmacology experts” positively influenced medication adherence in organ transplant recipients.

Even though remaining adherent to immunosuppressant therapies is crucial to the success of a transplantation procedure and can protect a patient from having to experience allograft organ rejection, late graft organ rejection, or additional dialysis treatment, nonadherence to immunosuppressive medications has been reported in 20% to 70% of the transplant population. In addition, the JMCP reports that immunotherapies can cost nearly $30,000 for up to 1 year after transplantation and $15,000 every year thereafter. “In order to improve quality of care and possibly reduce overall medical costs, health plans are looking increasingly to specialty pharmacy programs and/or specialty pharmacies to address the challenges of managing transplant patients taking oral immunosuppressive therapy,” the authors of the report noted.

Through a 1-year retrospective claims analysis using data from UnitedHealthcare, investigators examined 519 transplant patients enrolled in a specialty pharmacy program and compared their costs with 519 transplant patients in a nonspecialty pharmacy setting. Each patient was assigned an index drug and a “first-fill” date. After the first 2 prescriptions were filled for each patient at a pharmacy of their choice, the researchers took over and assigned half of the participants to the specialty pharmacy cohort and the other half to the retail group.

During the year after transplantation, the mean total health care cost in the specialty group was 15% lower than the mean total health care cost in the retail group ($24,315 vs $27,891), whereas the mean transplant-related medical cost in the specialty group was 42% lower than the mean transplant-related medical cost in the retail set ($5960 vs $8486). Typically, better medication adherence translates into higher pharmacy costs—but in this study, prescription increases in the specialty pharmacy group were actually coupled with a decrease in pharmacy costs. This finding was reconciled by UnitedHealthcare’s explanation of their business deal with the specialty pharmacy, wherein they “successfully negotiated program components of discounted transplant medication rates and services through the contracted specialty pharmacy to mitigate the effect of increased adherence contributing to higher immunosuppressive therapy medication costs.”

The authors concluded that with the help of tailored specialty pharmacy programs, patients will be able to improve their medication adherence, achieve positive health outcomes, and reduce the overall cost of their care—all at the same time. “Specialty clinical pharmacists appear to better coordinate care and reduce unnecessary medical costs in patients with renal transplantation, improving effectiveness and outcomes,” the authors asserted.