The Impact of Specialty Pharmacy Mandates on the Solid Organ Transplant Population

A specialty pharmacy mandate is a rule by insurance companies requiring patients to obtain "specialty" medications from specific pharmacies. This study's objective was to evaluate the impact of these mandates on patient care and the solid organ transplantation population. Two surveys were distributed to transplant professionals within the American Society of Transplantation Communities of Practice (AST COPs) and the International Transplant Nurses Society (ITNS). In total, 167 respondents were included (n = 105 AST COPs, n = 62 ITNS). Most of the AST COP cohort identified as pharmacists (76%), followed by physicians (13%). Most respondents from the ITNS cohort identified their role as nurse/coordinator (97%). Sixty-two percent of respondents from the AST COPs and 48% of respondents from ITNS reported delays in discharge due to specialty pharmacy mandates within the past 12 months. Over 60% described delays in initiation of drug therapy related to these mandates. Additionally, 18%-34% of patients required additional outpatient visits and/or readmissions related to medication access issues in the setting of specialty pharmacy mandates. Over 50% of the time, patients paid out of pocket for medications to allow discharge if an override was not possible. Specialty pharmacy mandates delayed discharges, increased cost, and puts undue strain on the healthcare system for solid organ transplant recipients.