Skip to main content
Free access
Research Article
31 March 2024

Cost avoidance from health system specialty pharmacist interventions in patients with multiple sclerosis

Publication: Journal of Managed Care & Specialty Pharmacy
Volume 30, Number 4

Abstract

BACKGROUND:

Specialty pharmacists monitor patients taking multiple sclerosis (MS) disease-modifying therapies (DMTs) to evaluate response to therapy and intervene on adverse effects. These interventions have the potential to avoid health care costs by discontinuing inappropriate therapies and avoiding downstream health care utilization.

OBJECTIVE:

To calculate the costs avoided by specialty pharmacist interventions in MS.

METHODS:

A retrospective observational cohort study including patients at the Vanderbilt MS Clinic who received a specialty pharmacist intervention between February 1, 2022, and July 31, 2022, was performed. A panel of 3 investigators categorized each intervention based on the potential for cost avoidance: (1) no cost avoidance, (2) direct cost avoidance, and (3) indirect cost avoidance. A single intervention may have one or both cost avoidance types. Direct costs avoided included the cost of the potential service or medication avoided due to the intervention. Medication costs were calculated using the range of the average wholesale price and average wholesale price − 20%. For indirect costs avoided, the range of costs of a consequence (self-care, ambulatory visit, emergency department visit, hospitalization, or death) occurring had the intervention not been performed were multiplied by the range of probabilities for the consequence occurring (from zero [0] to very likely [0.5]). Self-care indirect cost savings equated to $0. Descriptive statistics summarized types of pharmacist interventions, the patients impacted, and costs avoided. In patients with an intervention that resulted in cost avoidance, chart review was performed to collect patient demographics, disease history, and MS-related health care usage during the 12 months prior to the pharmacist intervention.

RESULTS:

485 pharmacist interventions in 354 individual patients were included. Fifty interventions in 38 individual patients (76% female, median age 51 years, 68% White) resulted in cost avoidance. The total estimated costs avoided in 6 months ranged from $123,733 to $156,265. In total, $138,410 were direct costs and $1,890 were indirect costs. Reasons for direct costs avoided (n = 13) were often safety monitoring (69%) or common side effects management (23%). Indirect costs avoidance (n = 37) resulted primarily from interventions on common side effects management (57%) and safety monitoring (22%). Self-care was the most common type of indirect cost avoided (n = 27). Interventions resulting in costs avoided were commonly seen in patients with relapsing-remitting MS (82%). The median time from MS diagnosis was 15 years and 42% of patients had previously trialed 1 other MS DMT.

CONCLUSIONS:

There is a potential for significant health care savings after specialty pharmacist interventions in MS, primarily from preventing the dispensing of inappropriate therapies.

Plain language summary

Specialty pharmacists who work in multiple sclerosis clinics help patients with their complex medicines. This can save the health care system money down the line. This study reported the money saved by pharmacist interventions. Pharmacists saved up to $156,265 in 6 months. They helped patients with side effects. They also stopped medicines that were not appropriate.

Implications for managed care pharmacy

We found that health system specialty pharmacist interventions in multiple sclerosis can lead to substantial direct and indirect cost avoidance—up to $156,265 within a 6-month time frame. Most costs were avoided directly by preventing the dispensing of inappropriate therapies and indirectly by preventing additional health care utilization. Specialty pharmacies and payors should consider these downstream savings when justifying additional pharmacist resources and contracts.
Multiple sclerosis (MS) is a chronic autoimmune neurological disease affecting more than 1 million patients in the United States.1 The progressive nature of MS leads to significant disability over time. Over the past 30 years, the US Food and Drug Administration has approved 20 disease-modifying therapies (DMTs) for MS, which are intended to slow the disease course, prevent relapses, and better control symptoms.2 However, these medications come at a high cost, may have significant adverse effects, and require monitoring for safety and effectiveness. Additionally, previous studies have shown that patients with MS frequently change or discontinue treatment because of side effects, insurance formulary requirements, or clinical decline.3 Therefore, DMT monitoring and management is essential to realize the benefits of these therapies and slow disease progression.
Patients living with MS can accumulate considerable costs, including cost of medications, hospitalizations, and loss of productivity and quality of life. Patients living with MS are also more likely to be hospitalized, visit the emergency department, and need physical, occupational, and speech therapies. Their all-cause health care costs were 4.7 times higher than those of a healthy comparison group, and almost a quarter of the cost was spent on DMTs.4 In 2022, patients with MS were estimated to incur more than $65,000 in direct medical costs and $35,154 in DMT medication costs per year.5 Additionally, indirect costs, such as loss of productivity, premature death, and expenses not covered by insurance, were estimated to be $22,875 per year per patient.5 Interventions to reduce direct and indirect costs are needed to reduce the financial burden to this population.
Owing to their cost and associated complexity, DMTs are typically dispensed through an accredited specialty pharmacy. The integrated health system specialty pharmacy (HSSP) model, where specialty pharmacists are embedded within the MS clinic, has previously demonstrated benefits such as improved adherence, increased persistence on therapy, decreased turnaround time, and increased patient satisfaction.3,6-10 However, the impact of the HSSP pharmacist interventions on preventing health care utilization and associated costs in MS has not been previously studied. Cost-avoidance studies on pharmacist interventions in other specialties using HSSP pharmacists have shown a decrease in number of office visits over time and reduced total cost of care.11,12 Yung et al found that with 212 interventions in pediatric ambulatory care clinics, pharmacists avoided $307,210 in costs over 4 months.13 Lankford et al estimated that pharmacists in the hematology and oncology area of specialty pharmacy avoided more than $1.5 million in costs based on 547 interventions over 5 months.14
The purpose of this study is to evaluate potential cost avoided due to specialty pharmacist interventions performed for patients in the MS clinic.

Methods

SETTING

The Vanderbilt University Medical Center’s Multiple Sclerosis Center of Excellence provides comprehensive care to patients with MS using a multidisciplinary model. Three specialty pharmacists and 2 pharmacy technicians from the Vanderbilt Specialty Pharmacy (VSP) are integrated as part of the multidisciplinary team to manage specialty medication access, education, and treatment monitoring.6 Prior to therapy initiation, pharmacists ensure baseline laboratory monitoring has been completed and provide medication education, in addition to support with prior authorizations and financial assistance. Once therapy is started, patients are contacted proactively for their medication refill, which includes a standard questionnaire to identify response to therapy and therapy concerns. These questionnaires, completed by a certified pharmacy technician, are escalated to a pharmacist if concerns are identified. Pharmacists review the concern and complete an intervention assessment if warranted. Pharmacists also complete an annual therapy reassessment in which they evaluate adherence, therapy appropriateness, efficacy, and side effects; reconcile other medications; confirm appropriate laboratory monitoring; and record disease-specific outcomes metrics. Pharmacist interventions may also occur when patients directly contact the specialty pharmacists or during routine safety laboratory monitoring. Laboratory monitoring cadence for each medication is predetermined by clinic guideline. The specialty pharmacy patient management system alerts pharmacists when a new DMT prescription is needed when the last refill is dispensed. Pharmacists then order laboratory tests if needed, evaluate laboratory test results, and issue a new DMT prescription under a collaborative pharmacy practice assessment with refills to last until laboratory tests are due again. Pharmacists complete an intervention assessment if they order laboratory tests or if an action needs to be taken based on the results. When an intervention is performed, pharmacists complete a pharmacist intervention assessment within the specialty patient management software and manually assign a category to classify the type of intervention they made. They may also document in the electronic health record and contact the prescriber, if warranted.

STUDY DESIGN

This was a retrospective observational cohort study conducted at the VSP and Vanderbilt University Medical Center’s Multiple Sclerosis Center of Excellence and approved by the center’s institutional review board. Patients were included if they received a specialty pharmacist clinical intervention related to their MS treatment between February 1, 2022, and July 31, 2022. Pharmacist interventions were extracted from the specialty pharmacy patient management software (Cervey Specialty). Pharmacist interventions were included if they were clinically focused, rather than administrative, determined by including the following categories of interventions initially categorized by the specialty pharmacist: safety monitoring, disease-related concern, efficacy monitoring, common side effect, health care utilization, medication interaction, lost productivity, adverse event, or medication change. Additionally, interventions for medication dose change or discontinuation were included if the pharmacist noted that the change was made on their recommendation. The intervention categories assigned by the specialty pharmacist at the time of the intervention were verified by the study investigators and recategorized if needed. After review, duplicative interventions or those that were not considered clinical were excluded.

COST CALCULATION

Costs avoided were classified as direct or indirect (including self-care). Direct cost savings could be connected to a tangible product—ie, medication or laboratory test.15 The financial impact of preventing a medication from being dispensed was calculated using a range of the average wholesale price (AWP) and AWP minus 20%, because using AWP alone can overestimate the true cost avoided. We calculated savings based on preventing a 1-month supply, as the total number of inappropriate refills prevented is uncertain. The value of preventing unnecessary safety laboratory monitoring was calculated using Vanderbilt University Medical Center’s charge master, which lists the cost of laboratory tests and procedures at the institution for cash-paying patients. An example of preventing unnecessary laboratory monitoring is the pharmacist identifying that a patient had already obtained laboratory tests at another clinic and—instead of subjecting the patient to the additional blood draw—using those already available results. Interventions where the downstream effects were subjective, but anticipated to result in cost avoidance, were classified as indirect cost savings and accounted for what could have happened had the pharmacist not intervened, based on guidance by Patanwala et al and Yung et al.13,15
Patanwala et al provided guidance on completing cost-analysis studies in pharmacy.15 The proposed method calculates indirect costs avoided by pharmacist interventions using a sensitivity analysis that takes into account the cost of pharmacist time, probability of trajectory change, consequences had the intervention not occurred, and cost and probability ranges of the consequence. The current study used a modified version of this calculation, accounting for ranges of consequences had the intervention not occurred, costs associated with these consequences, and the probabilities of the consequences. A panel of 3 investigators reviewed each intervention for the possibility of direct or indirect cost avoidance. Interventions determined to result in indirect cost avoidance were assigned a potential range of consequences (ie, level of additional health care utilization, such as self-care, ambulatory visit, emergency department visit, hospitalization, or death), a probability for the consequence (0 = not possible, 0.01 = rare, 0.05 = unlikely, 0.1 = possible, 0.25 = likely, and 0.5 = very likely), and an associated cost by the panel. In addition to the estimated most likely cost avoidance consequence, a range of costs avoided was constructed by assigning lower and upper limits of the cost and probability of the consequence. Indirect costs avoided were calculated as the probability of the consequence multiplied by the cost of the consequence. Cost data were referenced from the Healthcare Cost & Utilization Project, the Agency for Healthcare Research and Quality, and relevant literature and the study institution’s charge master.16 The self-care category of indirect costs was assigned to interventions where some health care utilization was avoided, but not to the level of an ambulatory visit (pharmacist interventions were anticipated to improve quality of life, but if not performed, the patients would be unlikely to seek health care services) and assigned a cost savings of $0. In contrast, if an intervention was unlikely to prevent any additional health care utilization, it was categorized as having no cost-saving potential and excluded from further analysis. Each intervention could be designated as having avoided direct and/or indirect costs. Table 1 shows an example intervention with direct and indirect costs calculated.
TABLE 1 Example Calculation of Direct and Indirect Cost Avoided Due to a Specialty Pharmacist Intervention
SummaryType of costs avoidedLikelihoodProbability of consequenceCost of consequenceCosts avoided
EstimateLowerUpperEstimateLowerUpperEstimateLowerUpper
Pharmacist recommended not starting treatment due to safety monitoring laboratory resultsDirect: Drug dispense avoided    $9,200 (AWP − 10%)$8,178 (AWP − 20%)$10,222 (AWP)$9,200$8,178$10,222
Indirect:Ambulatory visitRare to unlikely0.01 (rare)0.01 (rare)0.05 (unlikely)$289 (average ambulatory visit cost)$159 (lowest ambulatory visit cost)$419 (highest ambulatory visit cost)$2.89$1.59$20.95
Pharmacist interventions associated with direct or indirect cost avoidance were subject to a retrospective chart review to collect patient and disease characteristics. Data collected included patient age, sex, race, pharmacy insurance, type of MS, years since MS diagnosis, number of prior failed MS treatments, 25-foot walk time, depression diagnosis, relapse history, emergency department visits, urgent care visits, and hospitalizations in the previous 12 months. The data were managed using Research Electronic Data Capture hosted at Vanderbilt University.17,18

STUDY OUTCOMES

The primary outcome was direct and indirect costs avoided due to specialty pharmacist interventions within the MS Clinic. Secondary outcomes included the number and types of interventions performed that resulted in cost avoidance and the medications and types of interventions associated with higher costs avoided.

STATISTICAL ANALYSIS

Continuous variables were described using the median and IQR. Categorical variables were reported as frequency and percentage. Costs avoided are reported as the most likely estimate, with the lower and upper bounds in parentheses.

Results

INTERVENTIONS

Initially, a total of 485 interventions in 354 patients were identified. After review, 31 interventions were excluded due to being duplicates, not clinical, or completed outside the inclusion date range. A total of 454 interventions were evaluated, of which 39 interventions in 38 individual patients resulted in costs avoided. Because some interventions had both direct and indirect costs avoided, there were 50 cost-avoidance opportunities (n = 13 direct and n = 37 indirect) within the 39 interventions (Figure 1). Table 2 shows the characteristics of the patients (n = 38) with costs avoided due to pharmacist intervention. Patients were primarily female (76%), with a median age of 51 years (IQR = 41-54), and had commercial insurance (70%); 32% were not filling their DMT at the VSP.
FIGURE 1 Pharmacist Interventions Attrition
TABLE 2 Characteristics of Patients With Cost-Avoiding Interventions
Patient characteristicValue
Sex
  Female29 (76)
  Male9 (24)
Age in years, median (IQR)51 (41-54)
Race
  White26 (68)
  Black or African American5 (13)
  American Indian or Alaska Native3 (8)
  Unknown4 (11)
Insurance
  Commercial26 (68)
  Medicaid2 (5)
  Tricare2 (5)
  Medicare8 (21)
Vanderbilt Specialty Pharmacy utilization26 (68)
Type of MS
  Clinically isolated syndrome1 (3)
  Relapsing-remitting MS31 (82)
  Secondary progressive MS2 (5)
  Primary progressive MS3 (8)
  Unknown1 (3)
Years since MS diagnosis
  Median (IQR)15 (6-20)
Number of failed MS treatments
  07 (18)
  116 (42)
  29 (24)
  3 and above6 (16)
Time on therapy at the time of intervention, months
  ≤113 (26)
  >1 and ≤612 (24)
  >625 (50)
Median 25-foot walk test, seconds (n = 35)6 (5-9)
Depression codiagnosis25 (66)
Relapse in the past 12 months0 (0)
Number of MS clinic visits in the past 12 months
  01 (3)
  114 (37)
  215 (40)
  36 (16)
  42 (5)
Number of MS-related urgent care visits in the past 12 months
  036 (95)
  11 (3)
  21 (3)
MS-related emergency department visits in the past 12 months3 (8)
MS-related hospitalizations in the past 12 months3 (8)
These are the demographics and disease state characteristics of the 38 individual patients whose interventions resulted in cost avoidance.
Values are presented as n (%) unless otherwise noted.
MS = multiple sclerosis.
The total estimated costs avoided for all 50 interventions were $140,300 ($123,733-$156,265). Costs avoided ranged from $0 to $59,239 for a single pharmacist intervention (Table 3). The DMTs linked to the most avoided costs were cladribine (n = 8, $79,042 [$70,256-$87,849]) and ofatumumab (n = 5, $16,516 [$14,657-$18,367]).
TABLE 3 Cost-Avoiding Interventions: Value, Type, and Drugs
Cost brackets$0-$100$100-$1,000$1,000-$10,000$10,000-$59,239Overall
(N = 38)(N = 3)(N = 6)(N = 3)(N = 50)
Type of costs avoided
  Direct3 (8)1 (33)6 (100)3 (100)13 (26)
  Indirect35 (92)2 (67)37 (74)
Drug
  Cladribine6 (16)2 (67)8 (16)
  Dalfampridine2 (5)1 (17)3 (6)
    Dimethyl fumarate10 (26)2 (33)12 (24)
  Diroximel fumarate3 (8)1 (17)4 (8)
  Fingolimod1 (3)2 (67)3 (6)
  Glatiramer2 (5)2 (4)
  Interferon β-1a1 (3)1 (2)
  Monomethyl fumarate2 (5)1 (17)3 (6)
  Ofatumumab4 (11)1 (33)5 (10)
  Teriflunomide7 (18)1 (33)1 (17)9 (18)
Each column shows the cost-avoidance range per intervention and the number of interventions that fall in that range. Underneath is the split between direct and indirect costs avoided—all interventions worth more than $1,000 were due to direct cost savings. The majority of costs avoided under $100 were indirect. The cost brackets are also broken down by drug, showing that dimethyl fumarate was the reason for the highest number of cost-saving interventions, whereas cladribine and ofatumumab were linked to the highest costs avoided.
Values are presented as n (%).

DIRECT COSTS AVOIDED

The estimated total direct costs avoided (n = 13) were $138,409 ($123,059-$153,761). The most common reasons for pharmacist intervention resulting in direct cost avoidance were medication safety monitoring (69%, n = 9), common side effects or toxicity management (23%, n = 3), and condition-related concerns or exacerbation (8%, n = 1) (Figure 1). Most interventions with direct cost savings (n = 9, 69%) prevented more than $1,000 each. Reasons for direct costs avoided are provided in Table 4.
TABLE 4 Reasons for Pharmacist Interventions Resulting in Cost Avoidance
Reason for interventionNumber of interventions (n = 50)a
Direct cost savings (n = 13)
  Medication dose change2
  Prevention of medication overdispensing1
  Prevention of inappropriate therapy initiation2
  Discontinuation of therapy due to side effects6
  Avoidance of unnecessary laboratory monitor2
Indirect cost savings (n = 10)
  Medication dose change2
  Discontinuation of therapy due to side effects1
  Prevention of repeat first dose observation2
  Avoided unnecessary medication discontinuation3
  Serious side-effect management1
  Prevention of inappropriate therapy initiation1
Self-care recommendations (n = 27)
  Common side-effect management24
  Vaccination counseling1
  Durable medical equipment counseling1
  Postoperative medication management1
These are the reasons associated with pharmacist interventions. Common side-effect management is the most common reason for indirect cost avoidance, whereas discontinuing therapy due to side effects is the most common reason for direct cost avoidance.
aInterventions can fall into both categories (ie, a medication discontinuation has direct cost savings due to avoidance of a drug dispense and also has indirect cost savings by preventing an adverse outcome due to inappropriate therapy).

INDIRECT COSTS AVOIDED

There were 37 interventions linked to indirect costs with an estimated total of costs avoided of $1,890 ($0-$2,504). Self-care was the most common reason for indirect cost avoided (73%, n = 27). The most common categories resulting in indirect costs avoided were common side effects or toxicity management (57%, n = 21) and safety monitoring (22%, n = 8) (Figure 1). DMTs with the most self-care interventions were dimethyl fumarate (n = 9), teriflunomide (n = 4), and cladribine (n = 4). Most indirect cost avoidance interventions (95%, n = 35) resulted in less than $100 of costs avoided per intervention. Reasons for indirect costs avoided are provided in Table 4.

Discussion

This retrospective observational cohort study found that pharmacists integrated within an MS clinic made interventions resulting in up to $156,265 in costs avoided over 6 months. To the authors’ knowledge, this is the first specialty pharmacist cost-avoidance study in an outpatient MS clinic and adds potentially valuable data on cost avoidance by pharmacist interventions in specialty pharmacy.
The interventions with the highest potential for cost avoidance were those with direct costs avoided due to pharmacist’s recommendation to discontinue or change inappropriate therapy. This is not surprising as MS DMTs are costly; thus, preventing an inappropriate medication from being dispensed would often be associated with a large cost avoided.5 AWP may be an overstatement of the direct cost of a medication; therefore, a range of AWP to AWP − 20% was used. Within specialty pharmacy, pharmacists are responsible for closely monitoring MS DMTs and are often the first to identify therapy concerns. Kozlicki et al found that 7% of DMT discontinuations and 36% of switches were a result of pharmacist recommendations.3 Lankford et al also showed that there are significant cost savings associated with pharmacists recommending discontinuing inappropriate therapies.14 Therefore, discontinuing inappropriate therapy appears to be a key role of specialty pharmacists and can contribute significantly to cost savings in the HSSP model.
Interventions with indirect costs were more common (74% of all cost-avoiding interventions) but contributed much less to the total costs avoided in this study. Only 1 was linked to avoiding a potential emergency department visit and 27 were linked to self-care. The method used to calculate indirect costs avoided by pharmacist interventions included a conservative estimate, which may underestimate the true costs avoided. Additionally, the self-care category was assigned a $0 cost avoidance to account for the uncertainty involved with determining the possibilities of what would have happened had the pharmacist not intervened. Based on guidance in performing cost-analysis studies, even if an event was very likely to have happened without the pharmacist intervening, it was assigned a probability of 0.5 (50% chance of occurring).15 Additionally, the current study excluded interventions that could have significant costs avoided by helping with medication adherence and administration, preventing fragmentations and gaps in care, coordinating therapy with outside entities, and improving medication access and affordability. With this calculation method, we are confident that indirect costs avoided are a conservative estimate of the true value pharmacists bring in decreasing downstream health care utilization.
These results support the financial value that pharmacists bring in a multidisciplinary setting. They also emphasize the many interventions pharmacists make that cannot be linked to costs avoided but have the potential to improve patient safety and quality of life. Although only 39 of the 485 unique interventions reviewed were linked to costs avoided in the current study, we expect the real-world impact to have been much greater. Many of the excluded interventions had the potential to improve patient safety, quality of life, and medication adherence and persistence on therapy.6,19 Previous research has shown that HSSP pharmacist involvement results in high DMT adherence and persistence. The current study did not include interventions related to adherence because the impact of the pharmacist intervention on a patient’s medication-taking behavior cannot reliably be assigned a probability. Safety laboratory monitoring was another common intervention that was often not determined to have the ability to result in cost savings. These interventions were only considered cost avoiding when they resulted in a discontinuation or dose change. HSSP pharmacists frequently coordinate laboratory monitoring completion to ensure DMTs remain safe and appropriate. Although important for patient safety, most patients required no intervention based on routine laboratory results. The interventions that were not included in the cost-savings analysis highlight that although pharmacists perform important patient care activities, it is challenging to assign costs to the value they bring to the multidisciplinary team. Importantly, more than one-third of interventions with cost-savings potential were performed in patients filling prescriptions at outside specialty pharmacies, demonstrating that HSSP pharmacists are integral members of the care team beyond filling specialty medications.
As it is difficult to conduct return-on-investment calculations for pharmacists’ work to justify new positions, including direct and indirect cost avoided, calculations can be beneficial in making a case beyond reimbursement for dispensing. Some organizations have evaluated the impact of the pharmacist on quality metrics and accreditation standards.20 Calculating direct costs avoided is less subjective and easier to calculate than indirect costs avoided, making it a good starting point for organizations interested in showing the cost savings pharmacists bring. Organizations may benefit from focusing on standardized documentation of interventions that lead to direct cost avoidance. For organizations looking to demonstrate indirect cost savings, it is recommended to create a panel of investigators to balance the subjective nature of the calculations.15 The adapted Patanwala method is a good starting point for measuring the potential savings that come with having an embedded MS pharmacist and using it to justify additional positions. Despite the small sample size, pharmacist interventions had a large financial impact. The patients described in Table 2 are a good representation of a typical patient seen at the institution’s MS clinic. Any patient on DMT may benefit from pharmacist intervention, as evidenced by the fact that cost-saving interventions were seen in patients with varying durations of disease, length of time on MS therapy, and health care utilization in the past year.

LIMITATIONS

This study was not without limitations, as it is a single-center study with a relatively small sample size. Owing to the unique specialty pharmacy model evaluated, it is possible that these results may not be generalizable to all other institutions. The retrospective nature of the study relies on documentation within the specialty pharmacy patient management software and the electronic medical record; thus, there is a chance that some pharmacist interventions performed were not captured for the analysis. The analysis did not account for pharmacist labor costs and for probability of trajectory change.15 The primary limitation is the likelihood of bias in assigning the potential consequence and probability of the consequence occurring without the pharmacist interventions. To address this, 3 investigators were used to evaluate each intervention individually and agreed on a final determination.

Conclusions

Integrated health system specialty pharmacists can provide significant health care savings through interventions that avoid inappropriate medication dispensing and unnecessary health care utilization. Although pharmacists perform many interventions, not all can be tied to cost-avoidance opportunities. There is an opportunity for specialty pharmacies to use direct and indirect costs avoided from pharmacist interventions to justify additional resources.

ACKNOWLEDGMENTS

The publication described was supported by CTSA awards No. UL1 TR002243 and UL1 TR000445 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. The authors would also like to acknowledge Bridget Lynch, Kristen Whelchel, Aimee Banks, and Megan Schneider for their expertise throughout the study.

REFERENCES

1.
Wallin MT, Culpepper WJ, Campbell JD, et al; US Multiple Sclerosis Prevalence Workgroup. The prevalence of MS in the United States: A population-based estimate using health claims data. Neurology. 2019;92(10):e1029-40.
2.
De Angelis F, John NA, Brownlee WJ. Disease-modifying therapies for multiple sclerosis. BMJ. 2018;363:k4674.
3.
Kozlicki MZ, Markley B, Shah NB, DeClercq J, Choi L, Zuckerman AD. A cross-sectional analysis of persistence to disease-modifying therapies in treatment naïve and experienced patients with relapsing multiple sclerosis at a health-system specialty pharmacy. Mult Scler Relat Disord. 2022;63:103860.
4.
Asche CV, Singer ME, Jhaveri M, Chung H, Miller A. All-cause health care utilization and costs associated with newly diagnosed multiple sclerosis in the United States. J Manag Care Pharm. 2010;16(9):703-712.
5.
Bebo B, Cintina I, LaRocca N, et al. The economic burden of multiple sclerosis in the United States: Estimate of direct and indirect costs. Neurology. 2022;98(18):e1810-7.
6.
Banks AM, Peter ME, Holder GM, et al. Adherence to disease-modifying therapies at a multiple sclerosis clinic: The role of the specialty pharmacist. J Pharm Pract. 2020;33(5):605-11.
7.
Hanson RL, Habibi M, Khamo N, Abdou S, Stubbings J. Integrated clinical and specialty pharmacy practice model for management of patients with multiple sclerosis. Am J Health Syst Pharm. 2014;71(6):463-9.
8.
Tan H, Yu J, Tabby D, Devries A, Singer J. Clinical and economic impact of a specialty care management program among patients with multiple sclerosis: A cohort study. Mult Scler. 2010;16(8):956-63.
9.
Groeneweg M, Forrester SH, Arnold B, et al. One-year outcomes of an integrated multiple sclerosis disease management program. J Manag Care Spec Pharm. 2018;24(5):458-63.
10.
Bagwell A, Kelley T, Carver A, Lee JB, Newman B. Advancing patient care through specialty pharmacy services in an academic health system. J Manag Care Spec Pharm. 2017;23(8):815-20.
11.
Barlow J, Faris R, Wang W, et al. Impact of specialty pharmacy on treatment costs for rheumatoid arthritis. Am J Pharm Benefits. 2012;4(6):SP49-56.
12.
Hellems SS, Soni A, Fasching D, Smith BS, McManus DD. Association between health system specialty pharmacy use and health care costs among national sample of Medicare Advantage beneficiaries. J Manag Care Spec Pharm. 2022;28(2):244-54.
13.
Yung E, McNicol M, Lewis D et al. Economic impact of pharmacist interventions in pediatric ambulatory care clinics. J Am Pharm Assoc (2003). 2021;61(2):198-205.e1.
14.
Lankford C, Dura J, Tran A, et al. Effect of clinical pharmacist interventions on cost in an integrated health system specialty pharmacy. J Manag Care Spec Pharm. 2021;27(3):379-84.
15.
Patanwala AE, Narayan SW, Haas CE, Abraham I, Sanders A, Erstad BL. Proposed guidance on cost-avoidance studies in pharmacy practice. Am J Health Syst Pharm. 2021;78(17):1559-67.
16.
Agency for Healthcare Research and Quality. Statistical Brief #517: Expenses for Office-Based Physician Visits by Specialty and Insurance Type, 2016. Accessed October 9, 2023. https://meps.ahrq.gov/data_files/publications/st517/stat517.shtml
17.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.
18.
Harris PA, Taylor R, Minor BL, et al; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
19.
Pickard AS, Johnson JA, Farris KB. The impact of pharmacist interventions on health-related quality of life. Ann Pharmacother. 1999;33(11):1167-72.
20.
Mahmoudjafari Z, Hough S. Expanding oncology pharmacist teams: Justifying the return on investment. J Oncol Pharm Pract. 2022;28(6):1381-7.

Information & Authors

Information

Published In

cover image Journal of Managed Care & Specialty Pharmacy
Journal of Managed Care & Specialty Pharmacy
Volume 30Number 4April 2024
Pages: 336 - 344
PubMed: 38555624

History

Published online: 31 March 2024
Published in print: April 2024

Authors

Affiliations

Darina Georgieva, PharmD
Department of Pharmaceutical Services.
Brandon Markley, PharmD
Department of Pharmaceutical Services.
Josh DeClercq, MS
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
Leena Choi, PhD
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
Autumn D. Zuckerman, PharmD* [email protected]
Department of Pharmaceutical Services.

Notes

*
AUTHOR CORRESPONDENCE: Autumn Zuckerman, 1.615.936.6353; [email protected], @AutumnZuckerman
Dr Zuckerman discloses receiving research support paid to institution from AstraZeneca, Pfizer, Beigene, and Sanofi. Dr Markley discloses receiving payment for participation on an advisory board for Sanofi, Sandoz, and EMD Serono. Dr Georgieva, Mr DeClerq, and Dr Choi report no disclosures.

Metrics & Citations

Metrics

VIEW ALL METRICS

Citations

Export citation

Select the citation format you wish to export for this article or chapter.

View Options

View options

PDF

View PDF

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

Figures

Tables

Media

Share

Share

Copy the content Link

Share with email

Email a colleague

Share on social media