IMPLEMENTATION OF SPECIALTY CLINICAL PHARMACIST IN A PREVENTIVE CARDIOLOGY CLINIC

Abstract

Disclosure: Justin Joy has received advisory board compensation from Akcea Therapeutics and Pfizer Therapeutic Area: Preventive Cardiology Best Practices Background: PCSK9 inhibitors (PCSK9i) and icosapent ethyl have been shown to significantly improve cardiovascular outcomes in select patients at increased CV risk. Bempedoic acid is a novel adjunct low-density lipoprotein cholesterol (LDL-C) lowering agent for patients at increased risk who require further LDL-C reduction. Many barriers to access exist for these medications resulting in delays in care, and nonadherence. To address these barriers, we incorporated a clinical pharmacist within our academic preventive cardiology clinic to facilitate medication access through enhanced collaboration between the clinic and hospital-based specialty pharmacy. Methods: A single center, retrospective study of patients seen within the preventive cardiology clinic whose medications were triaged by the hospital specialty pharmacy. The aim was to assess the time from prescription order to receipt of first dose for treatment-naïve patients. The medication approval rate, financial assistance use, median LDL-C reduction, and 90-day follow-up LDL-C was collected. Results: A total of 35 patients met inclusion criteria during the pilot period. Prescriptions included: 10 evolocumab, 18 alirocumab, 4 bempedoic acid, and 3 icosapent ethyl triaged by the specialty pharmacy. 19 (35%) patients had a clinical history of atherosclerotic cardiovascular disease (ASCVD). The majority of patients had commercial insurance, a median baseline LDL of 136 mg/dl, 125 mg/dl, and 146 mg/dl for evolocumab, alirocumab, and bempedoic acid respectively, and documented statin intolerance (Table 1). All prescriptions required prior authorization and were approved (4 patients required an appeal). 21 patients (60%) qualified for financial assistance: 15 required manufacture copay assistance cards, 4 required hospital charity care, 1 received foundation support, and 1 received free drug via manufacturer. The median time from prescription order to first dose was ≤ 10 days, and 22 patients (69%) on the LDL-C lowering agents had follow up labs performed within 90 days. Of these patients the median percent LDL-C reduction achieved for evolocumab, alirocumab, and bempedoic acid was 60%, 60%, and 34%, respectively (Table 2). Conclusion: At our institution, our experience highlights the value that a clinical pharmacist and health system specialty pharmacy can have on improving patient care within a multidisciplinary preventive cardiology clinic.