Background: Due to a lack of financial clearance, patients needed to be rescheduled for neurological infusions causing a delay in treatments. 25% had to either be rescheduled or given a free dose paid for by the hospital. Duplication of efforts within nursing and pharmacy occurred in attempts to align infusion coverage with date of service (DOS). White bagging is an arrangement between payers and selected pharmacies to ship a patient’s medications directly to the site of care to achieve cost savings. Free meds are manufacturer-dependent; white-bagging has preferred sites and needs prior authorization. Buy-and-bill methodology uses a pharmacy’s own supply and can be implemented interchangeably at any of the hospitals’ sites.

PICO: For patients prescribed specialty medication infusions for chronic conditions, does interprofessional involvement in tracking opportunities for implementation of white bagging, free med, or buy & bill promote less appointment rescheduling due to lack of financial clearance?

Literature review: Specialty medications are life-changing for patients by helping to achieve lower disease activity, improved quality of life, or remission (Zuckerman et al., 2019). There has been a rapid rise in specialty medication utilization with challenges to high-cost management to healthcare systems (Zuckerman et al., 2019). The 340B drug pricing program increases access to outpatient medications for uninsured/low-income patients allowing hospitals to purchase, dispense, and administer outpatient medications at discounted prices with full reimbursement from public and private insurers (Thomas and Shulman, 2020). Comprehensive management of specialty medications includes complex processes for payer approval, financial assistance, handling, delivery, and storage (Zuckerman et al., 2019). Effective team communication with clearly defined roles are essential and fundamental for effective collaboration among nurses, physicians, and pharmacists to deliver high-quality care and to meet patient needs (De Baetselier et al, 2021).

Methodology: Continuous tracking and strategic initiatives were implemented for white bagging, free med, or buy & bill to assure timely patient adherence to prescribed treatment. Weekly interprofessional (nursing, pharmacists, and administration) meetings for sharing of the status of medication availability for upcoming appointments began on September 23, 2020.

Outcomes/conclusions: Interprofessional collaboration is effective in decreasing delays in specialty medication infusions. Sharing professional expertise for the management of specialty medication infusions is beneficial to patient experience with decreased rescheduling. Converting specialty infusions to buy & bill is cost-saving and supports organizational fiscal responsibility.

References:
1) De Baetselier, E., Dilles, T., Batalha, L. M., Dijkstra, N. E., Fernandes, M. I., Filov, I., ... & Van Rompaey, B. (2021). Perspectives of nurses’ role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses. PloS one, 16(5), e0251982.
2) Thomas, S., & Schulman, K. (2020). The unintended consequences of the 340B safety‐net drug discount program. Health services research, 55(2), 153.
3) Zuckerman, A. D., Carver, A., Cooper, K., Markley, B., Mitchell, A., Reynolds, V. W., ... & Kelley, T. (2019). An integrated health-system specialty pharmacy model for coordinating transitions of care: specialty medication challenges and specialty pharmacist opportunities. Pharmacy, 7(4), 163.

Nancy Richards DNP, MSN, BSN, AMB-BC, NEA-BC

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