(Management Case Study) Utilization of a Clinical Surveillance Platform in an Outpatient Pharmacy to Evaluate High-Cost Medications Prior to Patient Discharge

Purpose: Pharmacists in our Outpatient Pharmacy discovered several medications that frequently had high copays for patients. These sometimes unaffordable copays were not discovered until the patient's discharge plan had been finalized and prescriptions had been sent to the Outpatient Pharmacy to fill through the Meds to Beds program. Interventions in therapy at this time, often resulted in delays in discharge. This case describes the methods by which our Outpatient Pharmacy implemented a high cost medication review intervention utilizing a clinical surveillance platform to improve the affordability of medications and reduce delays in discharge for patients at a regional referral center.

Methods: The Pharmacist in Charge of the Outpatient Pharmacy and the Clinical Coordinator of the Inpatient Pharmacy compiled a list of medications that frequently had high copays for patients. An intervention was created in the pharmacy's clinical surveillance platform to identify when these medications where initiated during the inpatient stay. Pharmacists in the Outpatient Pharmacy evaluated these notifications to determine if the patient would require a new prescription for these medications at discharge, and ran a test claim to determine the patient's copay if appropriate. The results of these claims were communicated to Inpatient Clinical Pharmacists, Care Managers, or Providers to assist in decision making for the prescribing of medications at the time of discharge. Manufacturer coupons, assistance programs, or charity organizations were identified to assist patients with obtaining these medications if necessary.

Results: Identification of high cost medications at the time of therapy initiation allowed Outpatient Pharmacy staff to communication potential issues with medication affordability to members of the health care team earlier during the patient visit. Barriers to obtaining medications could be resolved while both the patient and provider were in the hospital, and easier to access for communication. This resulted in less need to contact providers after the finalization of a patient’s discharge plan, which could potentially cause a delay of discharge.

Conclusion: The identification of high cost medications utilizing a clinical surveillance platform allows for intervention to improve affordability for patients without delaying discharge.