As a result of these efforts, Dr. Shapiro says the approval process for an off-label drug usage request is expedited. In fact, the letters have been so effective that Dr. Farrell contracted with the ACR to provide template letters members can download and tailor to their needs. Current available letters include adalimumab (Humira) for sarcoidosis and rituximab (Rituxan) for myositis.
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Added Care & Benefits
Because she works with all of the practice’s providers and sees a larger number of patients, Dr. Farrell has developed expertise in medication management in special populations, such as patients with rheumatoid arthritis (RA) who are pregnant or breastfeeding. “By staying up to date on the latest research, I can counsel these patients on the risks vs. the benefits and help them make evidence-based decisions regarding medications,” she says.
The pharmacy team also reports adverse reactions to the U.S. Food and Drug Administration’s MedWatch program, which is time consuming for physicians. This change has increased the practice’s efficiency in reporting these events. Dr. Farrell also provides regular pharmacy updates tailored to the practice’s needs, which serves as a quick reference for busy clinicians and staff.
Dr. Shapiro feels very fortunate to have partnered with the pharmacy school, because the practice doesn’t have to pay for the pharmacy services. He would advise other rheumatology practices to pursue such an arrangement. “The larger your practice, the greater the argument you have for adding a pharmacist,” he says. “If you have a pharmacy school in your city, I suggest working to establish an affiliation.”
If a school isn’t nearby and hiring a full-time pharmacist isn’t feasible, Dr. Farrell recommends considering a part-time pharmacist. By simply assisting with insurance authorization, she believes a pharmacist can potentially free up a rheumatologist’s time to see more patients or spend more time with complex patients and provide better overall care. This increased efficiency may result in increased revenue because the practice will have time to see more patients—offsetting the pharmacist’s cost. In addition, Dr. Farrell uses incident-to physician billing for medication counseling visits, which generates revenue.
Although Dr. Farrell didn’t have rheumatology expertise when she first started at the practice, she acquired it by working with providers and staying abreast of current medication trends in rheumatology. Now, she even speaks regularly—both locally and nationally—on medication management in rheumatic diseases.
Karen Appold is a medical writer in Pennsylvania.