Rotation 3: Specialty Ambulatory Care

Posted by Unknown at Sunday, September 09, 2018

This was my first experience dealing specifically with specialty drugs, which are commonly referred to as "high cost, high touch" drugs. The high cost part makes sense, but what was not immediately apparent to me was the concept of high touch. I soon learned that high touch simply meant that these drugs needed more hands-on management in the forms of baseline evaluations and follow-up calls with the patients, which is not like what a regular community pharmacy would do. I liked this aspect, since it gave me a sense of how patients progressed through a short-term treatment plan. In particular, I gained some familiarity with hepatitis C treatment, which was usually treated for a duration of 8 - 12 weeks. Having previously done the HIV community rotation and now this, I also developed an appreciation for how far we have come in terms of improving medications. Compared to the antiviral options we have today, the early drugs just seemed much more burdensome in every way possible, not to mention that their efficacy was also not as good. The problems with side effects, frequency of administration, and other administration considerations (e.g. with or without food) are mostly not an issue with today's options.

Another aspect of therapy that I understand a little more of after this rotation was the prior authorization process. While the majority of submissions from our service to insurance companies do get approved, occasionally we had to submit appeals after receiving the denial verdict. While writing appeals to insurance companies did not sound appealing at first, this exercise actually proved very insightful. I was forced to delve deeper into the primary literature and use the data to demonstrate that my patient truly would benefit from getting this drug approved. Depending on the insurance, I also may have needed to collect lab results to illustrate the severity of the patient's condition, and it was not just limited to the Child-Pugh score that we learned in class.

Aside from my main priority in doing baseline and follow up calls with patients mostly for hepatitis C medications, I also had the opportunity to contribute to some quality improvement projects. Specifically, I collected the data to show that compared to the national average, our specialty pharmacy financial coordinators did a great job in terms of PA and appeal approval rate. Furthermore, I also looked into the average turnaround time for prescriptions filled by Michigan Medicine versus those filled by outside pharmacies. These small side projects allowed me to look at the bigger picture of healthcare, and see that there is clearly much more to treatment than just the drugs themselves.

Although I prefer more in-person consultations as opposed to telephonic ones, this was still a valuable learning experience. I learned how to manage my time and juggle multiple responsibilities, but I also now understand that taking extra time to be meticulous about your work is important to. In other words, try to avoid speeding through tasks just to get them done, and really spend some time to think about what you're doing. All good things to take with me as I head into my next rotation (and first inpatient) at the neuro ICU here at Michigan Medicine!