Inclusion in limited distribution drug network reduces time to dalfampridine access in patients with multiple sclerosis at a health-system specialty pharmacy

• DOI: 10.18553/jmcp.2021.27.2.256
• Publication Date: 2021-01-28T11:40:53Z
• Authors: Megan E Peter; Brandon Markley; Josh DeClercq; Leena Choi; Gabrielle Givens; Autumn D Zuckerman; Aimee Banks
• Keywords: Specialty; Prior authorization; Discontinuation

BACKGROUND: Dalfampridine improves walking speed in patients with multiple sclerosis (MS), but accessing specialty medications such as dalfampridine can be hindered by insurance restrictions, high costs, and limited distribution networks (LDNs) imposed manufacturers. Some integrated health-systems pharmacies (HSSPs) embed pharmacists clinics dispense from their internal if included within the LDN. OBJECTIVE: To assess access to at an HSSP before after gaining admission METHODS: This study was conducted Vanderbilt Specialty Pharmacy (VSP), University Medical Center (VUMC) 2 clinical embedded MS clinic. VSP gained LDN on May 1, 2018, which time began manage comprehensive therapy initiation process. We performed a retrospective review of adult who were prescribed March 2010 December 2018. Eligible prescriptions new starts (no previous use) or restarts (after use discontinuation). Prescriptions classified pre-VSP post-VSP, differentiates dalfampridine. Study outcomes approval, therapy, treatment decision medication access. used proportional odds logistic regression model for using following covariates: versus post-VSP period, prior authorization (PA) denied approved/not needed, baseline timed 25-foot walk. RESULTS: 262 290 (260 30 post-VSP). In prescriptions, 97% approved insurance, 93% started therapy. Median 22 days (IQR = 11-45) 1 day 0-3) prescriptions. model, having longer significantly higher (OR 83.219, P < 0.001) whose PA initially 9.50, 0.001); walk not significant 0.95, 0.277). CONCLUSIONS: After obtaining dalfampridine, reduced, suggesting that LDNs delay patient HSSPs. DISCLOSURES: No funding provided this study. The authors have no conflicting interests disclose. Preliminary results been previously presented American Society Health-Systems Midyear Meeting 2019, Health Systems Outcomes Research Summit August 2020, National Association Annual September 2020.