A pilot program in which specialty pharmacists monitored hemoglobin levels in patients whose physicians had requested refills of erythropoiesisstimulating agents (ESAs) resulted in some dosing changes and significant drug costsavings for payers.
The program was run by the Accredo Health Group in Memphis, TN, and took place for 4.5 months between June 2009 and October 2009. When an ESA refill was requested, specialty pharmacists requested hemoglobin levels from prescribers. If data were more than 8 weeks old, or if the hemoglobin level was ≥12 g/dL, the pharmacists called prescribers to discuss US Food and Drug
Administration warnings, recommend therapy changes, and document prescribing decisions.
Requests for hemoglobin measures were made for 6572 ESA refills, and 713 hemoglobin levels were not obtained. Of the total 6572 refills, 1447 (22%) required specialty pharmacist intervention (746 for elevated laboratories, 421 for outdated laboratories, and 280 others). Of the 1447 refills, 610 (42.2%) were not dispensed because of therapy holds (416), dose changes (107), cancellations (85), or other (2) reasons. Therapy was continued in 337 patients, despite elevated/outdated hemoglobin levels. The authors estimate that $3761 was saved per therapy hold, and $2498 per dose change; $555 was saved per member per month for therapy dose changes.
For each program month, the total drug costsavings was estimated at $398,796; total savings during the course of the program was estimated at $1,794,529.
Although the pilot program has officially ended, ESA monitoring continues, and the authors report continued favorable acceptance by providers to supplying laboratory values and to the entire intervention.