Comparing rates of primary medication nonadherence and turnaround time among patients at a health system specialty pharmacy compared with external specialty pharmacies.

Abstract

Access to specialty medications prescribed for complex and debilitating conditions is often delayed or unsuccessful. Specialty pharmacies can streamline medication access and timely delivery. To compare primary medication nonadherence (PMN), the rate at which a prescription is written but not obtained by the patient, and turnaround time (TAT) between patients filling specialty medication with an integrated health system specialty pharmacy (HSSP) and those using external specialty pharmacies (non-HSSP). A retrospective single-center cohort study was performed between June 2021 and May 2022. Patients prescribed specialty medications from the Vanderbilt Health System Oncology, Inflammatory, or Multiple Sclerosis clinics were included if they had a new prescription within the study period and follow-up encounter after the prescription. The primary outcome was PMN, defined as the prescribed medication or therapeutic alternative confirmed to not be filled. TAT was defined as time from a specialty medication prescription to the first filled claim. A logistic regression model was used to test for associations with PMN and the pharmacy the medication was sent to (HSSP vs non-HSSP), controlling for age, sex, clinic, race, and insurance. An ordinal logistic regression model was used to test for associations with TAT and the filling pharmacy (HSSP vs non-HSSP), controlling for age, sex, clinic, race, and insurance. There were 1,466 patients with 1 eligible prescription (67% HSSP and 33% non-HSSP) evaluated for PMN. Of these patients, the median age was 56 (interquartile range [IQR] 41-68) years, 55% of patients were female, and 56% had commercial insurance. PMN was 6.5% for HSSP patients, and 9.9% for non-HSSP patients. Patients who had a prescription sent to non-HSSP pharmacies had 60% higher odds of having PMN (<i>P</i> = 0.027). For the TAT outcome, 1,188 eligible patients were included (66% HSSP and 34% non-HSSP). TAT for patients filling at an HSSP was a median 3 (1-6) days and a median 4 (1-10) days for patients filling at a non-HSSP. Patients who filled at non-HSSP pharmacies had 40% higher odds of having a longer TAT (OR = 1.4, 95% CI = 1.1-1.7, <i>P</i> = 0.004). Patients using commercial insurance (<i>P</i> = 0.018) and Black patients (<i>P</i> = 0.018) had higher odds of a longer TAT. Prescriptions sent to non-HSSP specialty pharmacies are more likely to not be filled or to take longer to fill than those sent to an HSSP.