US Pharm. 2016;41(1):4.
The pitfalls of polypharmacy are widely known. Patients who fill their prescriptions at several pharmacies run the risk of using medications that adversely interact with other drugs, in part because the pharmacist—possibly lacking the patient’s complete drug profile—might contribute to a dangerous mix. A large percentage of the articles that I assign for publication in U.S. Pharmacist, in fact, describe adverse events stemming from drug-drug interactions.
This potentially catastrophic scenario compounds when specialty products enter the equation. Defined by IMS Health as drugs that are initiated only by a specialist, are generally not taken orally, require special handling, have a unique distribution, have a high expense, warrant intensive patient counseling, and require reimbursement assistance, specialty products present unique challenges. Examples of disease states treated by these medications include rheumatoid and psoriatic arthritis, diabetes, HIV/AIDS, multiple sclerosis, cancer, and hepatitis C. Not only might a patient’s neighborhood pharmacist not be aware that the patient is taking a specialty medication for one or more of these conditions, but the pharmacist might not know about all of the potential interactions.
To assess whether or not there are deficiencies in the dissemination of information about specialty medications, U.S. Pharmacist’s sister company, Jobson Research, recently conducted an online survey. The 434 responses broke out as follows: 44.7% Independents; 32.5% Drug Chains; 15.2% Supermarket/Food; and 7.8% Mass Merchandisers.
The results are very revealing. Nearly 82% of respondents strongly or somewhat agree that manufacturers of specialty products need to provide more product information to retail pharmacists. About the same percentage strongly or somewhat agree that manufacturers of specialty products need to do a better job of communicating with retail pharmacists.
Thanks in part to the growth of electronic health records, pharmacists are not completely in the dark about their patients’ health histories. About 70% of the retail pharmacists who responded said they were generally aware of the specialty pharmacy conditions their patients are being treated for, and 71.4% indicated it was important to be aware of their patients’ specialty condition and treatment.
Once armed with this information, how likely are retail pharmacists to put their knowledge of patients’ specialty conditions to effective use? Very likely, I would say, based on the Jobson Research survey. Nearly three-quarters (73%) of the respondents said they sometimes or very often counsel patients on their specialty conditions.
The need for information about specialty medications is likely to grow. According to IMS Health, spending on specialty medications now accounts for 35% of sales in the United States, with spending rising in eight of the top ten specialty therapy classes through June 2015. CVS Caremark projects that spending on specialty drugs will more than quadruple by 2020, climbing to $400 billion.
The top revenue-generating medication in the U.S. through June 2015, according to IMS Health, was ledipasvir-sofosbuvir (Harvoni), the first combination pill approved to treat chronic hepatitis C virus (HCV) infection. It is also the first approved regimen that does not require administration with interferon or ribavirin, two FDA-approved drugs also used to treat HCV infection. Coadministration of Harvoni with amiodarone (used to treat life-threatening ventricular arrhythmias), however, may result in serious bradycardia. (Amiodarone is used in patients who have already been treated with other medicines that did not prove effective.)
Harvoni highlights the importance of viewing customers in their totality, recognizing that they may be taking on a regular, long-term basis medications that can interact with other drugs. As the specialty pharmacy market grows, so too should the effort to communicate potential interactions. After all, pharmacists—sufficiently informed—are the best defense against adverse events.
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