We all play a part in improving patient care. Find out how Therigy enables you to better care for your patients throughout the Specialty Pharmacy journey below in this hypothetical story of a patient, her pharmacist and the specialty pharmacy's use of TherigySTM.
She is a 65-year-old female who had B-cell non-Hodgkins lymphoma. She currently has no other outstanding health conditions. She makes an effort to maintain a healthy, active lifestyle, as she has a grown daughter and grandchildren and wants to live as long as possible to see them grow up. Unfortunately for Ellie, her non-Hodgkins lymphoma has relapsed. In layman’s terms, this means the cancer has come back and is getting worse.
Ellie’s oncologist has prescribed her ZYDELIG to improve her response rate to treatment. Her physician sends the script to Hometown Specialty Pharmacy, which is using TherigySTM to manage their patients.
Ellie’s medication is delivered to her at her home and an initial counseling session with a pharmacist is scheduled for her. The pharmacist tells Ellie the goal with this new medication is to improve her response to treatment and hopefully put her lymphoma back into remission. However, the pharmacist advises Ellie this medication may cause serious or even fatal diarrhea - a risk that’s heightened by her age - and that to mitigate this side effect she needs to drink plenty of clear fluids, eat low-fiber foods, and avoid greasy/fried food. Ellie understands the benefits and risks of the medication and the pharmacist schedules a 2-week follow-up with her in TherigySTM. Ellie starts ZYDELIG along with the dietary recommendations. She experiences mild to moderate diarrhea but is able to manage it with diet.
Hometown Specialty Pharmacy is faced with COVID-19. The pharmacy is short staffed, practicing social distancing safety guidelines, and still having to care for our patient’s day in and day out, getting them their medication on time and monitoring their adherence.
This is a time where a lot of patients are non-adherent due to financial issues they are going through, depression, backordering of medication, etc. Ellie has just recently lost her job at the Marriott Hotel where she worked for many years. She has lost her insurance and is literally living on her last paycheck. Ellie’s medication and dosage for her chemo treatment is important to continue taking but she is not sure she can afford it any longer.
Meanwhile, Dr Tennyson has 2 pharmacists working in the office with 2 technicians at a time reaching out to thousands of patients daily to get their meds. With TherigySTM, Dr Tennyson advises his staff to use TherigySTM’s work queue to focus in on high risk patients, overdue for their medication refills and or have follow ups needed. Additionally, Dr Tennyson advises his staff to use TherigySTM’s mobile-enabled patient assessments for all patients that will opt in for refill questions and QOL assessments.
Ellie has opted into receiving text messages and receives a text that day that her medication refill is on order and if there have been any changes since last time she refilled. She responds to the assessment link with answers that she no longer has insurance and needs to speak to a staff member.
This message then pops into Dr Tennyson’s work queue as an action he needs to take to complete the refill activity. Dr Tennyson reaches out to Ellie and discusses financial aid options, helps Ellie stay on course of therapy and gain stability during this time. He also has the opportunity here to ask her our new COVID-19 questions within Therigy’s Clinical Intervention activity. He then hangs up with her to go into TherigyInsights to check if other patients with her medication have completed mobile patient assessments to make sure he reviews and prioritizes reviewing patients that have completed mobile assessments, reviewing if there any insurance or financial changes.
Unfortunately, things are not looking good - Ellie was admitted to the hospital last week for nausea due to her chemotherapy. After a few days she is released and allowed to return home, having been advised to start taking an over-the-counter anti-nausea medication. Hometown Specialty Pharmacy has flagged Ellie as high risk due to her recent hospitalization. Having found a lot of success in contacting elderly patients through text messaging, they contact Ellie for a PROMIS10 follow-up via text message, which she completes. The PROMIS10 dashboard in TherigyInsights, filtered to just show high risk patients, identifies Ellie as experiencing a decline in her quality of life. Dr. Tennyson - the pharmacist responsible for reviewing patient PROMIS10 scores for at-risk patients - calls Ellie to intervene because of the decline in her scores. After reviewing the management strategies within TherigySTM, Dr. Tennyson determines that all strategies have been exhausted and that Ellie needs to see her physician. Ellie promptly schedules an appointment with her doctor after this call. Fast forward a couple of weeks, Ellie has seen her doctor, been prescribed a different dosage of medication for her to take and Hometown Pharmacy has helped in administering and delivering the medication to her. Dr Tennyson proceeds with his follow up activity to check in with Ellie and finds that she is showing improvement now.
Since there were change in medication dosages last time, Ellie’s prescription has come back denied from her insurance. Dr. Tennyson reviews the denial reason as script didn’t meet the drug criteria. Sometimes the health plan will require specific pre-requisites to change dosage such as test results, etc. Dr Tennyson reaches out to Ellie’s physician to see if tests are needed and receives a statement that they are not needed. Dr Tennyson files an appeal. In the meantime, Ellie needs her prescription filled. Dr Tennyson looks into financial assistance for Ellie for the drug she is on : Zydelig. Gilead has a patient assistance program for patients with Zydelig to receive dosages for free of charge to those that are in need and meet certain income requirements. Dr Tennyson is able to successfully gain approval for the program allowing Ellie to receive this medication for this dosage free of charge.
Today…there is some great news! Hometown pharmacy learned that Ellie’s job was recently reinstated at the Marriott Hotel and she was able to start just a few weeks ago with benefits effective immediately. Last month she had a change in dosage which required a new Prior Authorization that got denied due to no insurance. She had received financial assistance in the interim. Now she has insurance and her Prior auth was immediately approved. Hometown Pharmacy logged all of the details within the Referral Manager activities and within TherigyInsights, the pharmacy can see the approvals, those still pending, and denied
Hometown specialty pharmacy recently received URAC accreditation and ACHC accreditation with the help of TherigySTM and TherigyInsight accreditation dashboards. With dual accreditation now, Hometown pharmacy is able to go after additional payors and drug access.
Hometown Pharmacy has also been to take advantage of Therigy’s outcomes study on Zydelig outcome that Gilead has introduced using TherigySTM. Gilead (hypothetically) is working with TherigySTM to conduct an outcomes study on Zydelig patients who received medication during this time and side effects that occurred during therapy, along with any quality of life improvements. Ellie is a great use case for this study and Hometown pharmacy is able to collaborate with other health systems. Hometown Specialty Pharmacy is able to enhance their use of mobile enabled messaging assessments with a few additional manufacturer specific questions for Ellie to answer. The answers go directly back into TherigySTM. Therigy is then able to pull an aggregated report on results of the study to send to Gilead.
With her insurance now valid again, Dr Tennyson received approval for her medication refill with no problems. Hometown Pharmacy loves TherigyInsights new physician summary dashboard reports to provide clarity about the status of all referrals for each physician. The pharmacy sends weekly reports over on status of referrals to the physicians they work with including Ellie’s doctor and status of her recent PA approval. Hometown Pharmacy is also taking full advantage of Therigy’s mobile messaging assessments and recently implemented a patient satisfaction survey. Dr Tennyson has sent out a patient satisfaction survey out via mobile to Ellie to fill out at her convenience. Ellie completes it and the survey results immediately populate in TherigySTM for review. Hometown Pharmacy can review the Patient Satisfaction Survey dashboard reports to see results of their pharmacy survey via TherigyInsights.
Several months have passed, with Ellie taking her medication regularly. She has been feeling lots better! Just recently, the physician did a CT scan and stated miraculously she shows no signs of cancer. Ellie is officially in remission!
Although there are chances her lymphoma could still come back, it is not currently active. Ellie will have routine checkups with her physician but all in all, she can go on to enjoy life with her daughter and newly born grandchild. Hometown Specialty Pharmacy will still regularly check in with Ellie to see how she is doing, administer a different medication to manage her ongoing remission if necessary, and check in on her quality of life with regular follow-ups scheduled through TherigySTM.
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