Related Experiment Video
Updated: May 7, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Implementation of an adherence pharmacy referral protocol for patients taking sacubitril/valsartan
Brigid Perry1, Justin Jakab1, Brittiny Robinson1
1Department of Pharmacy, Cleveland Clinic, OH.
Insights
Pharmacy staff achieved an 86% compliance rate implementing a sacubitril/valsartan workflow protocol. This protocol aims to improve medication adherence and patient benefits for heart failure patients.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Heart failure (HF) is a widespread condition linked to significant morbidity and mortality.
- Current guidelines recommend sacubitril/valsartan to reduce HF-related complications.
- Patient adherence and access to care are critical for realizing treatment benefits.
Purpose of the Study:
- To evaluate pharmacy staff adherence to a sacubitril/valsartan (Sac/V) workflow protocol.
- To determine nonclinical benefits for patients enrolled in the Sac/V protocol.
- To assess the feasibility of medication-specific workflows in mail-order pharmacies.
Main Methods:
- A triage protocol was developed for patients most likely to benefit from Adherence Pharmacy (AP) services.
- Cleveland Clinic Home Delivery (HD) and AP implemented the protocol for Sac/V prescriptions.
- Pharmacy staff compliance and patient enrollment in adherence services were tracked.
Main Results:
- An 86% compliance rate was achieved for the primary outcome (screening of 98 out of 114 prescriptions).
- Among 98 patients, adherence services included prior authorization (41.8%), copay card application (13.3%), grant funding (17.3%), and patient assistance program initiation (9.2%).
Conclusions:
- Medication-specific workflows are feasible for pharmacies.
- These workflows can ensure adherence services for high-risk patients on expensive medications.
- Implementing such protocols can improve patient access to critical HF treatments like sacubitril/valsartan.
Background:
Heart failure is a prevalent disease state associated with limitations in function, hospitalization, and death. The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines recommend medications including sacubitril/valsartan to decrease morbidity and mortality in patients with heart failure. However, if patients are nonadherent to treatment or experience barriers to care, they will forgo these benefits.
Objective:
To assess the pharmacy staff compliance rate to a workflow protocol for sacubitril/valsartan prescriptions received by Cleveland Clinic Home Delivery (HD) and Adherence Pharmacy (AP) and determine the nonclinical benefits experienced by the patients enrolled in the protocol.
Methods:
At Cleveland Clinic, there are 2 mail-order pharmacies: HD and AP. Both pharmacies offer a variety of benefits and adherence services, with each pharmacy having their own unique services offered. With numerous adherence services provided by both pharmacies, it is likely that patients with heart failure would see clinical and nonclinical benefits, such as cost savings. This project created a triage protocol for patients deemed to experience the most benefit from services offered through AP. The primary endpoint of this project was determining the feasibility of a medication-specific workflow protocol for sacubitril/valsartan prescriptions at HD and AP.
Results:
There were 114 qualifying prescriptions per the protocol, and 98 of those prescriptions were appropriately screened by the pharmacy staff, equating to an 86% compliance rate for the primary outcome. Of the 98 patients included in the workflow protocol, prior authorization was completed by pharmacy staff for 41 patients (41.8%), manufacturer copay card was applied for 13 patients (13.3%), 17 patients (17.3%) were enrolled in grant funding programs, and patient assistance program enrollment was initiated for 9 patients (9.2%).
Conclusions:
Medication-specific workflows may be a feasible option to implement for pharmacies to ensure the offering of adherence services to patients with high-risk disease states using treatment with expensive, branded medications.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:14SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
01:15Drug Dosage Regimen: Overview
Typically, the starting dose and dosing interval are guided by the manufacturer's recommendations based on clinical trials conducted during and after drug...
01:01Dosage Regimen: Fixed Dose
Fixed-dose regimens can be used for various routes of administration, including intravenous (IV) injections and oral medications. For IV administration, a predetermined amount of the drug is...
01:19Pharmacovigilance
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers