Improving access to novel heart failure agents through a defined multidisciplinary pathway

Abstract

Background Novel emerging heart failure medication therapies, particularly sacubitril/valsartan and corlanor, have shown promise in improving patient outcomes and decreasing hospitalizations and death in our heart failure population. Patient access and prescription coverage for these novel heart failure medication therapies can be a huge barrier for allowing heart failure patients to have access to these new medications. Recognizing this barrier, our medical center has developed a multidisciplinary pathway to help guide our institution in helping enable our patients to having access to the most cutting edge guideline-directed medical therapy though a defined pathway. Methods Our heart failure clinic at The Ohio State Wexner Medical Center in collaboration with our hospital-based pharmacy clinic has developed a defined pathway to allow access to the newest guideline-directed medical therapy in heart failure to our patients. Without this pathway and multidisciplinary approach, these life changing medications would likely be unobtainable secondary to many reasons particularly high costs and time (ex. inability for clinic to keep up with high prior authorization demands etc.). Most importantly, we believe that this pathway that we have developed can not only be utilized for heart failure medication therapy, but can also be generalized to many disciplines including DM and COPD/emphysema management that similar to heart failure, include treatment with many novel medicines that are inaccessible to patients secondary to similar barriers such as high cost and tedious prior authorization processes. Our pathway defined in steps is the following: 1. Clinic patient identification: The physician or nurse practitioner will identify the appropriate heart failure patient either in the outpatient setting in the heart failure clinic, or in the inpatient setting through our heart failure consult team or our heart failure inpatient service as a candidate for a novel heart failure medication. 2. Clinician prescription: A prescription for the novel medication is sent to our in-house pharmacy through our EMR requesting prior authorization and cost details for the particular medication. 3. Pharmacy technician: The pharmacy technician who receives the prescription will run claim through patient's insurance. There is a note in the EMR to send a message to our prior authorization coordinator on every patient that is being started on a novel heart failure medicine. 4. Prior authorization coordinator: Prior authorization (if needed), cost issues and medication assistance is addressed at this point in the pathway. Many resources are available dependent on patient insurance coverage including copay grant and manufacturer assistance. At this point, patient is contacted to ensure cost is acceptable. 5. Heart failure nurse pool: Our prior authorization coordinator routes message to our heart failure nursing pool through EMR requesting the final ok to fill prescription, and questioning what patient education is needed (ex. repeat labs, stop Ace/ARB). 6. Pharmacist call: Patient is contacted by a pharmacist from our institution who gives counseling and education on new medicine. At times, the pharmacist will also help transfer medicine to another pharmacy if needed. 7. Medication delivery: Medicine is typically sent through UPS in 1-2 days or delivered to patient if local and/or urgent. 8. Patient. Conclusions Despite considerable therapeutic advances and emerging device therapies, heart failure remains a tremendous medical and socioeconomic problem. There is a compelling need for improved clinical treatment for this complex population, and novel heart failure medication therapies has shown tremendous promise in improving health outcomes and quality of life in these patients. By defining a multidisciplinary pathway that has allowed access to these new, promising heart failure agents, our institution has allowed access to medication therapies that typically were not being filled and/or prescribed at other clinics and hospitals secondary to high costs or increased workload on staff secondary to prior tedious authorizations. We believe this multidisciplinary pathway approach can generalized and used in any area of medicine to help with obtaining novel therapies. (*I am in the process of getting the data from our pharmacy and EMR team here regarding the fill rate and nonfill rate at our institution of sacubitril/valsartan and corlanor since FDA approved but unfortunately will not have these numbers until early November. If approved, I will include in this poster presentation) Results Our defined multidisciplinary pathway: