Specialty Pharmacy - Episode 2

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Transcript

00;00;00;00 - 00;00;26;18
Unknown
You are listening to “Vital Signs: A Podcast for Sentara Providers”. Welcome to episode two of Specialty Pharmacy Series. Before we turn things over to the specialty pharmacy team, let's go over some important CME announcements. This episode has been accredited. for AMA PRA category one credits. For detailed accreditation and designation information along with disclosure information, please visit the show notes.

00;00;26;21 - 00;00;39;01
Unknown
This information can also be found on our website www.sentara.com/physicianeducation as well as always reaching us by email at physicianeducation@sentara.com.

00;00;39;01 - 00;01;09;05
Unknown
Thank you for joining us for the second podcast about Sentara specialty pharmacies. Today we are joined by Angela Jones and Tiffany Pierce Horton. We will be learning a little bit more about Proprium Pharmacies, liaison care model. The specialty pharmacy liaisons act as patient advocates and provide tremendous value to our patients. Hello, everyone. Thank you for joining our podcast today to share information around the Proprium Pharmacy liaison care model.

00;01;09;08 - 00;01;46;23
Unknown
My name is Angela Jones, and I'm here today with Tiffany Pierce-Horton, our senior manager of patient services that oversees the pharmacy liaisons deployed across this Sentara enterprise today. Tiffany, thank you for being here. Thank you for having me. I'm excited to be here to speak about the liaison program that we have with Proprium Pharmacy. Wonderful. So to begin, please just explain what is a Proprium Pharmacy liaison. Sure, our Proprium Pharmacy liaisons are typically embedded in clinics that we support, and they act as patient advocates by coordinating specialty pharmacy care.

00;01;46;25 - 00;02;13;28
Unknown
We thought they're certified pharmacy technicians with four primary roles. They perform prior authorization. They secure financial assistance, engage with patients to consider Proprium Pharmacy services. This is an opt in model, and they support patient refills along with delivery coordination for all patients billing with Proprium Pharmacy. Awesome. I appreciate you sharing that. And so to really go a bit deeper here.

00;02;14;00 - 00;02;49;25
Unknown
One main question, depending on who is joining us, may be what are prior authorizations do you mind elaborating? Sure this can be a subject of this view, I should say amongst providers and pharmacy staff very often prior authorizations are put in place by insurance companies that require an individual on the office staff side to submit additional information to the insurance company so that they will consider covering the product for the patient.

00;02;49;27 - 00;03;16;02
Unknown
Okay. Don't always like to approve. I'm sorry, Angela. Pharmacy insurance plans don't always like to cover medications prescribed by a doctor on the first try. There might be some preferred alternatives that the insurance requires. So the provider has to provide rationale surrounding that decision so that the insurance company will cover the medication for the patient.

00;03;16;04 - 00;03;45;00
Unknown
Okay. And so thinking through that, how are liaisons different than the other support staff that are offer their services from an external specialty pharmacy. Sure. Yeah, I appreciate you asking. What's great about this care model is that the pharmacy liaisons are actually embedded in the clinic. They can perform these prior authorizations to help alleviate the time that would be required for the provider or clinic staff.

00;03;45;00 - 00;04;22;00
Unknown
The liason will submit labs, additional chart notes, any studies justifying the provider's rationale to prescribe the medication. We typically do these electronically over whatever format the insurance plan provides, and we await a response which typically comes back within a couple of days. Wow. So markedly quicker than probably what many see with their their team managing it just with all the other additional duties and responsibilities that clinical team members need to perform daily.

00;04;22;02 - 00;05;02;24
Unknown
Absolutely. That's how, in my opinion, the Proprium liaison is different than other staff members at external specialty pharmacies, because the liaison has access to the electronic health record and the pharmacy dispensing system to help expedite results from the insurance company. Okay. All right. Well, kind of piggybacking on that. Yeah. Appreciate you sharing that additional information. Really just level three on what our prior authorizations and how can that liaison really position themselves for success and help improve the patient journey That that second bucket there that you talk about is financial assistance.

00;05;02;26 - 00;05;39;23
Unknown
Do you mind sharing some additional information surrounding that? I'm so glad you asked. This is one of my favorite parts of the care that liaisons provide. It does give you the warm fuzzies that I like to say. As stated earlier in the podcast surrounding Specialty pharmacy, the medications that are prescribed are defined as specialty medication, and they typically cost thousands of dollars, sometimes tens of thousands of dollars, even after getting the insurance to approved coverage of the medication with a prior authorization.

00;05;39;26 - 00;06;21;03
Unknown
Many patients still see copays that are just not affordable. Liaisons work really hard navigating all available financial assistance pathways that could be available for the patient. Many patients don't even realize that there are copay card available or commercially insured patients. There are national foundations that offer patient grants dependent on the condition being treated or the medication prescribed. And also, manufacturers often have free drug programs that the uninsured or underinsured are eligible for. The liaisons are the experts here to help navigate this very complex area of coordination of care for patients.

00;06;21;05 - 00;07;04;20
Unknown
Great. And so thinking through that with all the various pathways of financial assistance and that liaison position to really support the success and helping patients get on drugs. How do the liaison actually submit these? there's several different ways that we submit financial assistance for patients. Most manufacturers will have a drug specific application that we will try to fill out as much information as we're able to do for the patient and the provider so that it really just eases the burden on everyone involved.

00;07;04;22 - 00;07;49;19
Unknown
And also, there are some instances where grant foundations will have open access that we apply for financial assistance on the patient's behalf. I will underscore this conversation by saying patients must consent to financial assistance and the coordination of care that the pharmacy liaison provides. Okay. Understood. And then you also, early on in this conversation, you had spoke again about this opt in, especially for those that are being seen by a Sentara provider liaison supporting their their needs as it relates to the prior authorizations, financial assistance.

00;07;49;19 - 00;08;30;01
Unknown
And so for those that are available to consider the Proprium or that Sentara's Speciality pharmacy to consider Proprium as their pharmacy to help with their medication management. You had noted that opt in. Do you mind sharing additional information for the audience here? Listening to what that truly means? Sure. Patients that are eligible to fill with Proprium Pharmacy with their insurance plan are educated on the advantages that our care model provides to them.

00;08;30;03 - 00;09;16;24
Unknown
Proprium Pharmacy will deliver patients medications to their home free of charge. We typically typically have a turnaround time of about 2.6 days after they receive the order. Liaisons will follow patients and their refills, not just calling patients to have their medication filled for them prior to then running out each month we actually follow how many refills are left on the prescription so that we can proactively request refills from the provider as well as expiration dates and prescription so that we can get those refill prescriptions ahead of time.

00;09;16;26 - 00;09;42;29
Unknown
For patients that do fill with Proprium Pharmacy, the liaison gets an alert about seven days ahead of when the patient will be out of medication. We do began calling the patient to make sure that we're able to fill that prescription and have it delivered prior to the patient needing the medication so that they do not miss any doses unintentionally.

00;09;43;02 - 00;10;13;01
Unknown
Liaisons will confirm that the insurance is still active each month that they speak to the patient and that the cause remains what the patient is expecting before we set up those deliveries. Great. And so with the patients, when they are eligible to fill at Proprium, how do you obtain consent for patients to join the model? Is it telephonically?

00;10;13;01 - 00;10;41;15
Unknown
Is it written, verbal, in person? Trying to let the audience understand that piece of it? Sure. Well, my favorite way of connecting with patients was always in office just because I really enjoyed that face to face connection and being able to explain with patients while they're there to see the provider. I do think that this care model works best when it is hand in hand with the providers that we assist in office.

00;10;41;18 - 00;11;02;07
Unknown
If we are not able to see the patient while the patient is being seen by the provider, we will try to connect with them over the phone as well as my chart messaging to provide every opportunity for the patient to get back in touch with the pharmacy liaison. Okay. Well, it seems like that could be an area of challenge.

00;11;02;07 - 00;11;27;24
Unknown
Right. I think just even from my own point of view. Speaking with, you know, various health care team members, it's always hard to get them on the phone. And so do you find that to be a challenge for liaisons of just at least engaging with patients to discuss the model? Sure, that can be a bit of a challenge?

00;11;27;25 - 00;12;05;24
Unknown
Absolutely. But as I had stated previously, we do try to embed ourselves as the pharmacy expert within the clinics that we support and we try to encourage the providers and the staff within the office to lean on us to assist those patients when they most need it. We will take every effort to reach patients to let them know that their prior authorization has been approved, or if there is going to be any delay with getting an approval or prior authorization as well as communicating their co-pay.

00;12;05;27 - 00;12;33;04
Unknown
We don't want to make any assumptions of what is affordable or unaffordable for our patients. So any co-pay over $5 will result in a patient receiving a phone call from a pharmacy liaison. So any and any additional teamwork that we can get from the provider's office and staff surrounding, just letting the patient know that a pharmacy liaison will be reaching out is absolutely beneficial to our program.

00;12;33;09 - 00;13;06;19
Unknown
Again, this is an opt in model. The pharmacy liaisons are going to be assisting patients, all of the patients within the clinics that they support with their specialty medications, regardless of their opt in status for those first two, quote/unquote buckets of work, meaning the prior authorizations and financial assistance. Awesome. I appreciate you sharing this and all the information today is super helpful. From your own personal opinion for the audience listening in.

00;13;06;22 - 00;13;42;14
Unknown
If you had to, you know, advise on the most important information you went over today, for them to take back with them and help even with their practice or understanding the care model, what would that be? Sure. Specialty medications are life changing, life changing drugs for many patients. And they are anxious to get started on medications. But we all know that there is quite an administrative burden that comes with prescribing specialty medications for your patients.

00;13;42;16 - 00;14;06;01
Unknown
If you do have a liaison that is embedded in your office, I would just encourage you to lean on the Speciality Pharmacy liaisons and take full advantage of all of the expertise that they have to offer, not just to the practice but to the patients. And if you have any questions about the pharmacy liaison model, I can be reached via email.

00;14;06;01 - 00;14;36;19
Unknown
I do have a Sentara email. I'm happy to list that for you guys. That is tdpierc1@sentara.com, or you can reach me on Teams. It's Tiffany Pierce-Horton. Awesome. Well, thank you so much for the time today. To the audience for Tiffany thank you for going through this and in a lot of detail it's been very valuable and helpful for me.

00;14;36;21 - 00;14;40;20
Unknown
It's been my pleasure. Thank you so much. Thank you. Bye.

00;14;40;20 - 00;15;04;12
Unknown
Thank you for listening. Thank you for joining us and be on the lookout for our next episode. You've been listening to Sentara Health Vital Signs, a podcast for Sentara providers. As a reminder, read today's show notes for information about claiming your continuing education credits. Well, that's it for now. But we will be back soon with another episode of Vital Signs: A Podcast for Sentara Providers.

00;15;04;14 - 00;15;10;15
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