Building a better specialty pharmacy experience for patients and providers

I just had a wonderful call with a patient's daughter. As we were ending the call, she said "Before I hang up, I just want to say something. My parents see several doctors. I want you to know that you guys are head and shoulders above any other we deal with. Your communication, your response times, your empathy....just everything about you guys. This has been the best experience and I wanted you to know that."

A patient had their Calquence denied, yet we were able to get the denial overturned in 3 business days. With financial assistance we secured, his copay was $43. He was very excited and said he was "acquainted with the provider and personally texted him YAHOO !!!! very appreciative of you and ESPECIALLY you guys, thank you so much for everything you do".

I have a gentleman who has had three insurance plan changes over the last six months. His specialty pharmacy has not been able to keep up with his insurance changes. I have personally spent way to much time on the phone with his specialty pharmacy trying to get his medication to him, and they have been routinely late getting him his medication. Last time, his package was left overnight in a FedEx facility. The delay resulted in the medication spoiling by the time it got to him.

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When I offered to fill his medication right in his doctor's office, he was THRILLED. He was so excited to ditch his old pharmacy and be able to conveniently and reliably get his medication from us.

I just contacted a patient for schedule her prescription for pick up at the clinic. I learned she has been out of medication for 4 weeks due to her mail pharmacy constantly causing delays and dropping the ball. She was so very appreciative that we called her to get her scheduled saying "I really appreciate you looking at me as a person and not just a number." We are expediting her order to get her medication in hand as soon as possible but she was very grateful that we are here and hopefully she never has to go back to the specialty pharmacy because we are doing such a service for her by putting her first!

I just got off the phone with a sweet elderly patient. When I spoke with her, she explained that she was previously filling at an outside pharmacy, but had to switch to using her insurance- owned pharmacy in order to have her Avsola covered. I reviewed her copay with her and explained that it would be the same for the rest of the year if she were to stay with insurance-owned pharmacy or if she decided to fill her Avsola at the clinic. She was so excited when I let her know that her copay would be cheaper next year AND she will meet this year's maximum out-of-pocket after her fourth fill. Her copay had been around $500 and this was hard for her, but her and her husband "just had to make it work." One of the big things she was most excited about was that we work closely with her rheumatologist so she didn't have to try to get through to insurance-owned pharmacy anymore!

I have a new patient that was prescribed Xtandi, but he does not have prescription insurance. I was able to get them set up with the manufacturer's assistance program through the manufacturer for the year. The patient and his girlfriend were super happy in how helpful we were in getting him his medication so fast! And were shocked that they could get it at no cost to them!!!

I spoke with a patient in May regarding her copay for medication being $1998.50. She is an 82 year old and was so upset because she could not afford the medication. I spoke with her about applying for Medicare's Low Income Subsidy several times. She finally completed the application over the phone and was approved yesterday.

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When I ran her claim, her copay is now $4.50 and she broke down and cried. She said I was the first person that hadn't given up on her and she was so thankful. She also wanted me to thank us for being so sweet every time she calls.

I called patient's wife to go over copay assistance, and advised that we can look into grants or manufacturer assistance as they don't qualify for Medicare's Low Income Subsidy and could not afford their copay. I was able to get demographics and info to sign them up for on a grant waitlist, and get her on the manufacturer's assistance program while we wait for a grant to open up. She had nothing but wonderful things to say about the clinic and how they were so thankful they made the switch. She said of her previous pharmacy "those other guys couldn't keep their stuff together, but when you guys say you will get it done, you get it done!".

I wanted to share a personal patient story I experienced last week. I was onsite at one of our oncology clinics and overheard the cutest gals discussing their cancer and specific treatments. One of the gals was younger and was talking about how thankful she was to be able to get a manufacturer copay card to reduce her monthly treatment costs. She had mentioned the convenience of having a pharmacy at the doctor's office and wish she would have been able to pick up her medications here, but her insurance forced her to use their pharmacy. The other gal was older and on a limited income. She was raving on and on about how someone from the pharmacy team was able to get her a grant and her copay went from over $1800 down to $0. She was so full of appreciation and glee, she stated she was so stressed about affording groceries and other cancer associated costs if she had to pay the high copay. This was such a big deal to her and she was very thankful for whoever played a role in her story. Her husband piped in and said they would have made it work, but things would have been tight. It was so neat to hear total strangers discuss the importance of our work. This was one of those pinch me moments to see the hard work of my colleagues in action.

A patient called on Monday regarding her Skyrizi, which required a PA... but her next dose is due tomorrow! She was very anxious and thought that she would miss her dose. Our fantastic care coordinators were quickly able to get her PA approved immediately! She is scheduled to receive her medication tomorrow and will not be missing her dose. She was very please with the fantastic service during this stressful time, amazing job everyon!

Just got off the phone with a patient who called in because his Orgovyx has brought his PSA down from 200 to 10 and he couldn't be more thrilled! In addition, He was so thankful we were able to get a grant for him to cover his copays! He stated that he has been a long time patient of the clinic and is amazed at the difference it has made having us there! He said the fact that he can call our number and speak to someone without a phone tree and reach someone who knows what they're talking about has made all the difference for him.

A patient's wife called to thank me for getting his prior authorization in place and helping him get quick access to his medication. She said no one has ever helped them like I have and she said she couldn't thank me enough.

I just spoke with patient's daughter regarding her mother's medication. They have been so frustrated with how long it takes their insurance's pharmacy to fill her medications. I advised her we could fill for her and they could pick it up at the office once a month. She said she would be happy to do that! I told her it would be ready before the end of the week and she said her old pharmacy "could not even have it typed by then"! She said she is "shocked, grateful and so happy!" I told her we pride ourselves in being better than the big chains and they were have a more personal relationship here. She took my name and our phone number and said this felt "too good to be true." I promised her it was not and I would get this set up for her for Thursday.

I've been working with a patient who is on rosuvastatin 20mg daily. The maximum dose should not exceed 10mg QD while also taking Ojjaara since this combination increases patient's risk for toxicity from rosuvastatin. Rosuvastatin was prescribed by her cardiologist, so the initial recommendation was for the patient to discuss with her cardiologist. When she called me back, she said her cardiologist did not see a need to change the rosuvastatin dose and told the her to just monitor for side effects. Having previously discussed the risks with the drug interaction, she wasn't comfortable with the cardiologist's response. I called the cardiologist and left a voicemail with my recommendation. I also notified the oncology provider team of the situation and they agreed with the recommendation to reduce her rosuvastatin. When I update the patient, she was so grateful of having had someone help with advocating for her safety when her own attempt was not fruitful.

I just got off the phone with a patient who ended the call by saying "Thank you. I just wanna express my deepest gratitude to you, my doctor, and your pharmacist Thuan. I know it was like moving heaven and earth to get this approved. This was not easy and I realize that. I am so appreciative. I'm praying extremely hard that this, along with the methotrexate, will really get me back to where I was."

We have an oncology patient who’s treatment was changed from Erleada to abiraterone. This meant he would be coming off Erleada's manuafacturer assistance program and have a copay again. Deanna secured a $3,250 PAN grant, but the patient's deductible and coinsurance copay on his first fill used up that grant. His next refill left him with a $529 copay. Another foundation opened up yesterday, and Deanna immediately signed him up for it. This brought his out of pocket back down to $0. When telling the patient the good news, I told him about my conversation with Deanna regarding his case and how Deanna had initially said "I don't know what I'm going to do about his copay" (before the new foundation opened).

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He was so touched. Stating "I love her first reaction! She treated me like an old friend, showing genuine concern for me. I know this is her job, but I am so happy that she worked so hard to take care of me. Much appreciated!" He shared that the new treatment is working for him and he actually had the energy to do some gardening and wood chopping this week. He was very happy to get some Vitamin D from the sun!

A simple but meaningful interaction I just had. A patient called in to let us know she did not want her medication until she talked to her doctor at her next appointment. When she called she went straight to telling me from the beginning of her diagnosis to now, her whole story. I patiently listened and waited to see why she was calling. At the end of the call she profusely thanked me for not cutting her off and letting her explain her whole story. Sometimes these patients just need someone to listen to them.

I have a new patient who was just diagnosed with prostatic cancer and is extremely overwhelmed emotionally and mentally with all the information that he has been inundated with. He was so appreciative that everyone he has been in touch with from the clinic to the dispensary staff has been so supportive and passionate with helping him as he navigates this new diagnosis. It's conversations with patients like this where what we do has such a huge impact and reaffirms how much value we all contribute to a patient's care.

A new patient was started on Humira, but could not afford his copay. I worked with him to get him approved for a patient assistance program. He was very happy with the quick turn around, and to finally start treatment for his RA. He was a truly grateful gentleman and really appreciated our service.

I've been working with a patient who required financial assistance to afford his Enbrel. His application was submitted during the time the manufacturer was rolling out new forms and new enrollment guidelines for new patients. This caused some delays and headaches, but I got him approved. I've gotten to know this patient well, even though he is rarely able to answer his phone (he is on the road for work constantly). Knowing phone calls are a challenge for him, I sent him an email when I wasn't able to connect via phone. He just replied with "THANK YOU SOOO MUCH ! It was a heck of a fight, but we did it. Wish I could send you a pizza or a dozen tacos!"

I just had the pleasure of helping a sweet older woman whom has tried so many medications, but nothing seems to be working like Enbrel.  Unfortunately, her copay was extremely high and simply couldn't afford it. I just called her to inform her she was approved for a Patient Assistance Program.

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She was so excited to be able to keep improving! She ended her phone call with; ..."Okay, sweetie, Like I said I could not have done any of this without you. I couldn't have gotten this medicine without your help along the way. You've really been my life line. Since I started Enbrel, I'm moving more and doing a lot better with this. I'm so thankful for you honey."

I have a cancer patient has not received their Eligard in over a year because copay was too high. Our last attempt at prostate cancer grant closed in the middle of the application, but I wasn't deterred. As fate would have it, a new foundation opened up a couple days later for a different grant and I was able to secure it for him. This grant will cover his copay through the end of the year! I felt particularly motivated for this patient not only because of how long he was waiting for treatment but they are from my hometown in Hawaii which doesn't have alot of resources available for the community. It really made me happy to feel like i was helping my community and really drove home why I came to House Rx in the first place!

I just received an email from a patient whom I have been working with. We chatted about everything from past jobs to kids to hobbies. He sent me a sweet New Year's email to which he stated: "We especially want to thank you for your patience and diligence in working to resolve the problem with the prescription renewal, which finally was approved! If you hadn't gotten involved, it would have taken us much longer to get it approved! We hope that you and your family had a very Merry Christmas! Have a safe, prosperous, and Happy New Year!" I LOVE connecting and building report and most importantly, gaining trust from patients.

I've been working with a patient who has had a very unfortunate turn of events this year. She lost her job, her house, and was denied disability. She has been without medication for a period of time, and has been 'couch surfing' and trying to make ends meet. I was asked to step in and help secure funding/medication for the patient.

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We helped her apply for the manufacturer's assistance program, but was giving her the run around as they reported there were discrepancies in her application. I had made multiple calls to them these last two weeks for clarification and to ensure they were going to award her free drug. I just found out today she was approved! She thanked me profusely, and, with a frog in her throat and said, "you've been the best advocate for me, I am so thankful you are on my team. Thank you for going to bat for me!" What we do is so important. This is such an honor to be apart of these patient's journeys.

I've been working with a patient who is struggling to afford her Enbrel. Her copay was over $2000. She stated that she feels like she is the poster child for Enbrel as she does not tolerate any other medications. I was just able to secure a grant for her that will cover her copay through the end of the year. She was so SHOCKED! She thanked me for my persistence and hard work.

I have an elderly patient with metastatic prostate cancer patient was just started on a new medication. His doctor specifically told him to call the pharmacy team and ask for me, as he had faith in me to secure him some funding. His first copay was extremely high. Due to his cancer progression and declining health, he was faced with a decision to move to a retirement home and pay rent.... or pay for his medication copays. He couldn't afford both. He has been so stressed when thinking about coming up with the money for his copay. I have been diligently working to get him a grant for his high copay over the last month. I have applied 3 times when prostate cancer funding opened up, and all 3 times the foundation closed in the middle of his application.

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Today when the foundation opened up, he was the first patient I went and secured a grant for. When I told him I secured him a grant, he was SPEECHLESS! He states "thanks to your hard work, I can focus on quality of life for my time remaining on this earth". He went on to say he can move to the retirement community now and afford the rent! He was so appreciative that I cared about him enough to help him and he recognized all my hard work and effort.

I have an oncology patient whose copay for bexarotene is $400. This, plus all of his other cancer copays were really weighing him down. I was able to find a foundation grant that he qualifies for... BUT it has to be done over the phone and the foundation closes at 1pm eastern. Since this clinic and I work Hawaiian time, the foundation closes before we start our day! Not one to be deterred, I coordinated with @Jessica Simpson and @Corinne LaBonte to help with grant due to time zone difference. We secured a $4000 grant for him, which will cover his medication copays for the rest of the year.

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When I called patient's daughter back and advised of copay, she was extremely happy as they were struggling to figure out how to budget for medication and groceries and now will not have to worry about that going forward! Couldn't have been done without the teamwork here at House Rx to help my patient! It can be a struggle for our Hawaii clinics with the time zone differences so we are so happy to get whatever grants we can!

A shout out to Charlotte who spent 30 minutes with a patient this morning explaining the potential side effects and contraindications of Otezla, and how they apply to her. She addressed all of her concerns and questions. When I spoke to the patient after Charlotte, she was shocked to learn it was already approved! She was under the impression it would take months!

I just had a call from a patient who is struggling to find coverage at an affordable cost for her Amjevita. She could not stress enough how much she appreciated how compassionate, understanding and kind that @Amy R. and myself are when it comes to her situation. Her husband is working 4 jobs, she is on disability and they are trying to find a solution that will allow her to afford her medication. She kept saying how kind we were and how other parties she spoke to showed no kindness or understanding to her situation, but she can CLEARLY tell the difference with our team and she really appreciates that we are working to go above and beyond for her during this difficult time. Such a sweet lady, going through a tough time, but wanted us to be recognized for our big hearts and taking the time to help her. Way to go @Amy R.! Spreading that love year round!

While working 2024 prior authorization renewals I noted this patient was taking three Imbruvica 140mg tablets to equal a 420mg dose. I couldn't find evidence of why he wasn't taking just one 420mg tablet in the chart so I called the patient. He stated MD originally prescribed it that way because he titrated up in the beginning starting with one tablet per day, working up to 3 tabs per day. He has been stable the 420mg dose now for awhile. When I told the patient he could take just 1 tablet per day instead of 3, he was delighted as he has to take a lot of pills due to his other conditions! I checked with providers and they were fine with me changing it to one 420mg tablet daily instead of 3 x 140mg tablets.

I called one of our cancer patients to schedule her refill and to let her know that her copay card had been depleted and didn't have enough money to cover her copay of $4600. She said she had a feeling it was coming and said her son would put it on his credit card. I offered to help her apply for a grant, but she was reluctant because she thought it would take weeks to get an answer - and potentially delay her treatment. After a little encouragement, she agreed to try.
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I was able to get her approved while she was on the line! Her copay is back to $0! She was sooooo excited and grateful. She said I made her Christmas and now she can call her family and let them know she can get them all at least one gift this year!

I reached out to offer financial assistance to a patient whose copay was $5700 month. I was able to secure her a copay card that brought her copay down to $5 a month. When I called her back to let her know, her response was "In one hour you gave me the worst news of my life and now you are giving me the best news. I might have a glass of wine in your honor to celebrate! Do you want to know what I put your name in my phone as? Amy the Ibrance girl!" This cracked me up. Glad she doesn't have to fork over huge sums of money to pay for life saving medications. It's the little things we do that mean the most to some people.

I spoke to a wonderful patient today who had fractured her back in October of 2022. I called her about her Tymlos prior authorization and cost. She stated that she has not been taking the medication due to her copay ($888). Her previous pharmacy told her that nothing could be done about the price. I explained that wasn't true, and I'd be more than happy to help her afford this medication! I was able to secure her a grant that will cover her copay for the entire 24 months that she is to be on it. She was beyond thrilled! Telling me "Sincerely thank you. You have honestly brought me to tears and your made my day." I got all the feelings when I hung up with her! It's moments like this that remind me why we do what we do!

I've been working with an elderly patient who has been on numerous infusion medications and self injectables. Her copays have always been really high and she has just accepted it. Her copay today for Actemra was over $400! She was worried she wouldn't be able to afford Christmas presents for her grandchildren, since her money was going to her infusions. She had considered stopping therapy and "just dying an old crippled lady".

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Not on my watch! I got her approved for a patient assistance program that covers her Actemra for the next year. She called me crying just to thank me! Makes all the hustle and bustle worth it!

I have a patient whose grant ran out with her fill last month. I have had her on my radar ever since. So when a new grant opened this month, I was able to get her funding through the end of the year! When I spoke with her today she was so excited and couldn't thank me enough for helping her. She said "I am giving you a hug right now. Thank you so much".

This gentleman has been off Humira for 4 months. We received a new prescription from his doctor and I submitted the PA right away. When I called to let him know, he expressed that he could barely move and was desperate for some help. After speaking with him, I called his insurance and had his case expedited due to quality of life issues. Today (1 day after I submitted the prior authorization) I received a fax from his insurance stating it was approved. When I called him back he was ECSTATIC!

I've been communicating with a patient's son about a new medication, Jaypirca. Everything was ready for pick up, however patient ended up having an acute gout flare up and was put on colchicine. There is a drug-drug interaction that can increase the concentration of colchicine. This, plus the patient's impaired kidney function would be a potentially dangerous combination. The doctor was off that day, so the clinic reached out to us for a recommendation, which i gladly provided. Both the clinic and the patient were so thankful for our help in adjusting the dose and avoiding a bad reaction!

We have been working for weeks on to get a denial overturned for one of our oncology patients. I sent 2 appeal letters, left multiple VM for a peer to peer, called the insurance over 10 times to follow up. FINALLY, after talking directly with a medical doctor at the insurance company, they approved his medication. And it's a $0 copay! This is why we do what we do!

I called patient’s son to let him know I wanted to check a clinical issue with the provider before dispensing her medication. He wanted to know more details on why. I advised him that due to her age and kidney function, the medication should be started at a lower dose. He was happy that we took the extra step to not only check her kidney function, but to also call him and explain what was going on. He praised us for communicating so well and was happy that the clinic has a pharmacist on staff for these issues.

We had a prostate cancer patient who was struggling to afford his Xtandi (~$365 a month). He rationed his prescription by taking half the dose to. This stretched his one month prescription to two months. After seeing no contraindications, I suggested to the physician that we could try abiraterone (a medication in the same class). His physician agreed and so did the patient. He is now able to receive treatment at a therapeutic dose! The cherry on top - his copay went from $300 to $26!

Having just launched the dispensing program at this clinic, I called a patient to offer our services. He was elated at this offer. He had been having numerous issues with his outside pharmacy and loved the idea of being able to get all of his care at the clinic. Even better? We were able to offer financial assistance that reduced his copay from over $1000 to only $191.

I have a patient who almost choked to death swallowing a tablet as a child, which resulted in a lifelong phobia of swallowing pills. Her fear is so strong that she previously avoided oral chemotherapy. Unfortunately, her cancer has progressed and her options are now quite limited. There is no official information published on if Braftovi capsules have to be swallowed whole, or if they can be opened and sprinkled on applesauce or mixed in liquid. With some oral chemotherapies, altering how the medication is administered can effect the safety and efficacy of the medication.

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I was able to get ahold of the manufacturer and they were able to confirm that Braftovi administration via sprinkling on applesauce has been studied - and it is safe and effective. Now patient can use Braftovi as an option without having to worry about her fear of swallowing capsules.