Biotechnology Healthcare - November/December 2008 - (Page 40) concentrates manufactured not in traditional dosage forms but in varying assays. Administering higher doses than prescribed does not harm patients, but overutilization provides no additional benefit and can increase annual treatment costs anywhere from 12 to 25 percent (Skinner 2000). Managing dosage. The following examples illustrate the cost differential associated with small variances in clotting factor dosage. The availability of factor assays drives the dose that is dispensed when a prescription is written as a range. For a dose of 2,000 units +/–10 percent, 15 doses up to 2,200 units each could be dispensed and still meet the parameters of the prescription. If a small pharmacy only has a single assay of 1,095 units, then two vials would be dispensed to equal a dose of 2,190 units. A specialty pharmacy with an extensive inventory can match the target dose of 2,000 units more precisely. Assuming a clotting factor price of $1 per unit, then in this example, the specialty pharmacy saves the payer $190 on each dose, and to extend this example, a monthly use of 15 doses results in a savings of $2,850 per month. Another example involves the prophylactic treatment of a 150pound, 13-year-old boy, who has a target dose of 2,720 units of clotting factor three times a week. Assuming the same unit cost of $1 per unit, if the specialty pharmacy can maintain a 2 percent variance in the dosage rather than the 10 percent written into the prescription with more precise dose matching, the annual savings to the payer is $34,000 (Blankenship 2007). Managing sources of coverage. The 13-year-old boy in the example above would reach the coverage limits of many commercial health plans after just a few years, after which he would require some other means to pay for the clotting factor. A specialty pharmacy can assist patients and their plan sponsors in managing the costs of hemophilia treatment across both medical and pharmacy benefit plans — so that fees are charged to the appropriate plan, thereby maximizing benefit coverage. Assessment. A specialty pharmacist can review interventions and the amount of clotting factor used, then compare the results with goals for that patient’s care. If a discrepancy is evident, the specialty pharmacist can alert the treating physician to changes in the patient’s bleeding pattern, clotting factor usage, or lifestyle issues that may require changes to a treatment regimen. Beginning school and becoming an independent adult, for instance, are major changes in a patient’s life that may require adjustments in therapy. Supply needs must be taken into account for these changes, such as having clotting factor available at school. It is important that the clinical team incorporates these changes into each patient’s therapy management plan. Specialty pharmacies will report outcomes and cost savings to payers to demonstrate the value of their therapy management program. SUMMARY Managing hemophilia requires a coordinated effort by the patient, family members, the hemophilia treatment center, and the specialty pharmacy to minimize the impact of the disorder on the patient’s life. Thanks to improvements in the treatment of hemophilia, most patients have no limits on activities. The specialty pharmacy’s ability to combine therapeutic and utilization management for this high-cost condition, along with the ability to offer a holistic approach to patient care, can improve the effectiveness of hemophilia treatment — allowing patients with hemophilia to live normal lives with fewer bleeds, missed work days, and hospital visits. REFERENCES Blankenship C. Payer Dose to Assay Report. Accredo Health Group Inc. 2007. Bohn RL, Aledort LM, Putnam KG, et al. The economic impact of factor VIII inhibitors in patients with haemophilia. Haemophilia. 2004;10:63–68. Canadian Hemophilia Society. Hemophilia A&B Precautions. 2006. «http:// www.hemophilia.ca/en/2.1.10.php». Accessed Nov. 7, 2008. CDC (U.S. Centers for Disease Control and Prevention). Bleeding and clotting disorders surveillance. Summary of UDC activity. «http://www2a. cdc.gov/ncbddd/htcweb/UDC_ Report/UDC_Report.asp». Accessed Nov. 7, 2008. Ewenstein BM, Valentino LA, Journeycake JM, et al. Consensus recommendations for use of central venous access devices in haemophilia. Haemophilia. 2004;10:629–648. Gioia KP, ed. Nurses’ Guide to Bleeding Disorders. New York: National Hemophilia Foundation. 2004. Manco-Johnson MJ, Abshire TC, Shapiro AD, et al. Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia. New Engl J Med. 2007;357: 535–544. National Hemophilia Foundation. Parent FAQ. 2006. «http://www.hemophilia. org/NHFWeb/MainPgs/MainNHF. aspx?menuid=197&contentid=62& rptname=bleeding». Accessed Nov. 7, 2008. NIH (National Institutes of Health). Morbidity & Mortality: 2007 Chart Book on Cardiovascular, Lung and Blood Diseases. «http://www.nhlbi.nih.gov/ resources/docs/07a-chtbk.pdf». Accessed Nov. 7, 2008. Skinner N. Case Management Resource Path for the Patient with Hemophilia. Little Rock, Ark.: Case Management Society of America. 2000. Disclosure Crystal S. Blankenship, PharmD, is on the speaker’s bureau of Pfizer. 40 BIOTECHNOLOGY HEALTHCARE · NOVEMBER/DECEMBER 2008 http://www.hemophilia.ca/en/2.1.10.php http://www.hemophilia.ca/en/2.1.10.php http://www2a.cdc.gov/ncbddd/htcweb/index.asp http://www2a.cdc.gov/ncbddd/htcweb/index.asp http://www2a.cdc.gov/ncbddd/htcweb/index.asp http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=197&contentid=62&rptname=bleeding http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=197&contentid=62&rptname=bleeding http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=197&contentid=62&rptname=bleeding http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=197&contentid=62&rptname=bleeding http://www.nhlbi.nih.gov/resources/docs/07a-chtbk.pdf http://www.nhlbi.nih.gov/resources/docs/07a-chtbk.pdf
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