Medically Integrated Dispensing Moves into Rheumatology

Q: Tell us about some of the challenges you faced with prescribing specialty medication that led you and your colleagues at Arthritis Northwest to explore partnering with House Rx?

Dr. Wright: With traditional specialty pharmacies, once a prescription is written by one of our providers, fulfillment and monitoring of adherence to therapy are taken out of our hands.  When dispensing self-administered specialty medications within the practice, we are able to have a "hands on" experience more similar to our infusion practice in terms of delivering medication to patients and monitoring any lapses or barriers to treatment adherence.  We are also able to have more frequent "touch points" with patients in order to monitor the tolerability and efficacy of their ongoing treatments, which I feel is often lost when using a third-party specialty pharmacy, many of whom are unreliable about communicating information about our patients’ therapy experience back to me.

Q: Since implementing a medically integrated dispensing program at Arthritis Northwest, what have you and your colleagues been able to do better?

Dr. Wright: Since partnering with House Rx to implement a medically integrated dispensing program, the prior authorization process has been streamlined and made easier on our office staff.  The amount of time (and frustration) spent by our staff on paperwork, online forms, and waiting on hold with insurance plans has been dramatically cut, allowing our team to focus on providing the direct care to patients that we are qualified to do.  

Keeping track of constantly shifting insurance formularies and preferred specialty pharmacies (who themselves are frequently realigning and changing their names) is confusing and time-consuming, and we have greatly appreciated the partnership of the House Rx team to expand our practice's bandwidth.  

As a result, I feel more confident that when I write a prescription, the patient will be able to start on treatment in a timely manner, or else I will be able to start making alternative plans for therapy, with the help and guidance of the House Rx pharmacy team in terms of which alternative therapies are most likely to be covered by the patient's insurance plan.

Q: What do you see as the biggest advantage of medically integrated dispensing for your patients?

Dr. Wright: Hearing feedback from patients about the convenience and reliability of receiving their medications directly from our office has been encouraging and gratifying.  Many of our patients have expressed their satisfaction with being able to deal with our office and staff, whom they already know, rather than having to bring yet another third party into the mix when filling and receiving prescriptions for their specialty drugs. 

Q: How has it felt collaborating with a pharmacy team on a more regular basis?

Dr. Wright: The partnership with House Rx pharmacists has made a significant impact in terms of keeping our office, the patient, and their insurance plan on the same page throughout the authorization process. For example, when a prescribed medication is not approved by a patient's plan, I hear about this much sooner from our House Rx team than I would have under usual circumstances, and I can make a new plan for a different therapy. That results in fewer delays when starting a new treatment, and I feel more empowered as a prescriber trying to choose a therapy for a specific patient.  

Through my experience with our House Rx partner pharmacists, I have come to trust their expertise and judgment with respect to managing self-administered specialty treatments for our patients.  I appreciate the fact that they can monitor and communicate with us in real-time through our existing EHR system, and that I have a record of the prescription, approval, and dispensing process that I can review in the future when trying to assess a patient's adherence to and response to a particular treatment.  They are responsive and easily available through EHR message, email, or phone at any time when I have a question or concern. In short, they're a part of our practice.

Beyond the individual pharmacists, the entire House Rx team has been exceptionally easy to work with when going through the process of setting up and starting our in-house specialty pharmacy.  At every step along the way they have been immediately available and responsive to all of our questions and uncertainties.  It feels like a true partnership with the health of our practice and the best clinical care of our patients as the shared priority.

Q: What would you tell fellow rheumatology practices and physicians about medically integrated dispensing?

Dr. Wright: I would highly recommend MID to any rheumatology practice that is looking to establish a closer relationship with their self-administered therapy patients, have more hands-on monitoring of patients’ self-administered therapies, and reduce the burden of the prior authorization process on their office staff so that they can focus on clinical care rather than communicating with insurance plans and specialty pharmacies.