She is a 65-year-old female who had B-cell non-Hodgkins lymphoma. She currently has no other outstanding health conditions. She makes an effort to maintain a healthy, active lifestyle, as she has a grown daughter and grandchildren and wants to live as long as possible to see them grow up. Unfortunately for Ellie, her non-Hodgkins lymphoma has relapsed. In layman’s terms, this means the cancer has come back and is getting worse.
Initial Counseling
Ellie’s oncologist has prescribed her ZYDELIG to improve her response rate to treatment. Her physician sends the script to Hometown Specialty Pharmacy, which is using TherigySTM to manage their patients.
Ellie’s medication is delivered to her at her home and an initial counseling session with a pharmacist is scheduled for her. The pharmacist tells Ellie the goal with this new medication is to improve her response to treatment and hopefully put her lymphoma back into remission. However, the pharmacist advises Ellie this medication may cause serious or even fatal diarrhea - a risk that’s heightened by her age - and that to mitigate this side effect she needs to drink plenty of clear fluids, eat low-fiber foods, and avoid greasy/fried food. Ellie understands the benefits and risks of the medication and the pharmacist schedules a 2-week follow-up with her in TherigySTM. Ellie starts ZYDELIG along with the dietary recommendations. She experiences mild to moderate diarrhea but is able to manage it with diet.
Side Effects
Over the course of the next two weeks, however, Ellie’s symptoms start to get worse. She experiences severe abdominal pain and cramping and even notices a few drops of blood in her stool. Her daughter notices her distress one night and tries to take her to the hospital, but Ellie tells her that she doesn’t want to go, fearing the high costs of an ER visit. This incident is definitely not the first time Ellie’s had issues since beginning her ZYDELIG treatment, and she decides to skip her nighttime dose and sleep on it until the next day.
Follow up Consultation
The next morning, Ellie receives a phone call from Dr. Tennyson, a pharmacist at Hometown Specialty Pharmacy. She had been prompted in TherigySTM to follow-up with Ellie about her medication. Still concerned about her issues the night before, Ellie wants to know what can be done about the difficult and painful side effects of her medication. TherigySTM has a list of all ZYDELIG’s common side effects and management strategies listed, and Dr. Tennyson uses this information to identify that Ellie’s diarrhea classifies as severe (Grade 3), which could potentially result in extreme dehydration. For an older patient like Ellie, this is too dangerous to ignore. Dr. Tennyson instructs Ellie to use OTC anti-diarrheal treatment and to interrupt ZYDELIG treatment until the diarrhea resolves. She then triggers a clinical intervention to contact the oncologist for a dose reduction so Ellie can continue treatment. Dr. Tennyson makes a note of what they discussed during the call in Ellie’s patient profile, and follows-up with the oncologist for a new prescription so the pharmacy can ship Ellie the new dose and decrease the gap in treatment.
The specialty pharmacy’s work does not end here though – Ellie is not the first patient served by Hometown Specialty Pharmacy to report side effect issues while taking ZYDELIG. Dr. Tennyson runs a TherigyInsights report on the pharmacy’s entire oncology patient population currently taking ZYDELIG to find out how common this side effect is across the board. Meanwhile, Ellie is relieved that she can still benefit from treatment for her lymphoma without having to discontinue completely. She is grateful the pharmacy regularly reaches out to check up on her and is highly satisfied with the quality of her care.
TherigySTM's Impact
Dr. Tennyson was able to perform a successful clinical intervention and report the results thanks to TherigySTM. The pharmacy was able to be proactive in reaching patients, as opposed to reactive – only acting once the patient had become non-adherent.
Dr. Tennyson was prompted to reach out by the same system that records her patient’s responses, provides in-depth clinical information, and also runs comprehensive reports – cutting down on what would have otherwise been substantially more back-end work. With TherigySTM, Dr. Tennyson has the time to contact and consult with more patients than she would otherwise – patients just like Ellie, who may be suffering from painful and possibly even life-threatening side effects. The patient saves money by not having to go to the ER due to side effects and receives the proper care needed to reduce her doses and still keep her on ZYDELIG.
Ellie also appreciated the proactive and high touch care she received from Dr Tennyson to help her reach out to her oncologist and schedule a follow-up, increasing her satisfaction and trust with Hometown Specialty Pharmacy.
Hometown Specialty Pharmacy is faced with COVID-19. The pharmacy is short staffed, practicing social distancing safety guidelines, and still having to care for our patient’s day in and day out, getting them their medication on time and monitoring their adherence. This is a time where a lot of patients are non-adherent due to financial issues they are going through, depression, backordering of medication, etc. Ellie has just recently lost her job at the Marriott Hotel where she worked for many years. She has lost her insurance and is literally living on her last paycheck. Ellie’s medication and dosage for her chemo treatment is important to continue taking but she is not sure she can afford it any longer.
Meanwhile, Dr Tennyson has 2 pharmacists working in the office with 2 technicians at a time reaching out to thousands of patients daily to get their meds. With TherigySTM, Dr Tennyson advises his staff to use TherigySTM’s work queue to focus in on high risk patients, overdue for their medication refills and or have follow ups needed. Additionally, Dr Tennyson advises his staff to use TherigySTM’s mobile-enabled patient assessments for all patients that will opt in for refill questions and QOL assessments.
Ellie has opted into receiving text messages and receives a text that day that her medication refill is on order and if there have been any changes since last time she refilled. She responds to the assessment link with answers that she no longer has insurance and needs to speak to a staff member.
This message then pops into Dr Tennyson’s work queue as an action he needs to take to complete the refill activity. Dr Tennyson reaches out to Ellie and discusses financial aid options, helps Ellie stay on course of therapy and gain stability during this time. He also has the opportunity here to ask her our new COVID-19 questions within TherigySTM's Clinical Intervention activity. He then hangs up with her to go into TherigyInsights to check if other patients with her medication have completed mobile patient assessments to make sure he reviews and prioritizes reviewing patients that have completed mobile assessments, reviewing if there any insurance or financial changes.
TherigySTM's Impact
Hometown Pharmacy alone has sent over 1,000 texts to their patients since TherigySTM has released the mobile patients’ assessments, received over 300 answers, AND 150 answers since this COVID-19 health crisis. Without TherigySTM, the pharmacy would be going through patient to patient, contacting them via phone and spending a lot of time gaining a better understanding on changes in various aspects of the patient’s life.
Unfortunately, things are not looking good - Ellie was admitted to the hospital last week for nausea due to her chemotherapy. After a few days she is released and allowed to return home, having been advised to start taking an over-the-counter anti-nausea medication. Hometown Specialty Pharmacy has flagged Ellie as high risk due to her recent hospitalization. Having found a lot of success in contacting elderly patients through text messaging, they contact Ellie for a PROMIS10 follow-up via text message, which she completes. The PROMIS10 dashboard in TherigyInsights, filtered to just show high risk patients, identifies Ellie as experiencing a decline in her quality of life. Dr. Tennyson - the pharmacist responsible for reviewing patient PROMIS10 scores for at-risk patients - calls Ellie to intervene because of the decline in her scores. After reviewing the management strategies within TherigySTM, Dr. Tennyson determines that all strategies have been exhausted and that Ellie needs to see her physician. Ellie promptly schedules an appointment with her doctor after this call. Fast forward a couple of weeks, Ellie has seen her doctor, been prescribed a different dosage of medication for her to take and Hometown Pharmacy has helped in administering and delivering the medication to her. Dr Tennyson proceeds with his follow up activity to check in with Ellie and finds that she is showing improvement now.
TherigySTM's Impact
With TherigyInsights, pharmacies can identify which patients are stable and which patients need immediate follow-up. Without TherigyInsights, pharmacies might not be able to monitor the health of their patient population as a whole. With TherigySTM, staff are prompted to perform follow-ups via the work queue. Without TherigySTM, staff might fail to follow-up with patients in a timely manner. With mobile-enabled assessments, pharmacies can check patient status frequently without staff labor. Without TherigySTM, pharmacies probably don't have a way to check patient status without labor. With the combination of TherigySTM and the EHR via the integration, staff are prompted to collect important data and perform important actions resulting in in-depth insights that can be sent to physicians. If a pharmacy chooses to use only the EHR, staff might forget to do certain things (see key stats below) or might find it difficult to collect uniform data to send to physicians for all patients.
Since there were change in medication dosages last time, Ellie’s prescription has come back denied from her insurance. Dr. Tennyson reviews the denial reason as script didn’t meet the drug criteria. Sometimes the health plan will require specific pre-requisites to change dosage such as test results, etc. Dr Tennyson reaches out to Ellie’s physician to see if tests are needed and receives a statement that they are not needed. Dr Tennyson files an appeal. In the meantime, Ellie needs her prescription filled. Dr Tennyson looks into financial assistance for Ellie for the drug she is on : Zydelig. Gilead has a patient assistance program for patients with Zydelig to receive dosages for free of charge to those that are in need and meet certain income requirements. Dr Tennyson is able to successfully gain approval for the program allowing Ellie to receive this medication for this dosage free of charge.
TherigySTM's Impact
Now lets take a look at Results made possible by TherigySTM …..TherigySTM’s referral manager can help Hometown pharmacy with monitoring prior authorization process, PA Denial reasons, Appeal outcomes, Reasons for denials, Financial assistance activities, Financial assistance outcomes, Financial assistance funds. Without TherigySTM, the pharmacy quite possibly could have no insight or monitoring process for, a place to review and monitor Denials, Financial assistance and outcomes, and finally Ellie could have possibly been stuck with a significant out of pocket expense if Dr Tennyson didn’t get proactively get involved.
Today…there is some great news! Hometown pharmacy learned that Ellie’s job was recently reinstated at the Marriott Hotel and she was able to start just a few weeks ago with benefits effective immediately. Last month she had a change in dosage which required a new Prior Authorization that got denied due to no insurance. She had received financial assistance in the interim. Now she has insurance and her Prior auth was immediately approved. Hometown Pharmacy logged all of the details within the Referral Manager activities and within TherigyInsights, the pharmacy can see the approvals, those still pending, and denied
Hometown specialty pharmacy recently received URAC accreditation and ACHC accreditation with the help of TherigySTM and TherigyInsight accreditation dashboards. With dual accreditation now, Hometown pharmacy is able to go after additional payors and drug access.
Hometown Pharmacy has also been to take advantage of TherigySTM’s outcomes study on Zydelig outcome that Gilead has introduced using TherigySTM. Gilead (hypothetically) is working with TherigySTM to conduct an outcomes study on Zydelig patients who received medication during this time and side effects that occurred during therapy, along with any quality of life improvements. Ellie is a great use case for this study and Hometown pharmacy is able to collaborate with other health systems. Hometown Specialty Pharmacy is able to enhance their use of mobile enabled messaging assessments with a few additional manufacturer specific questions for Ellie to answer. The answers go directly back into TherigySTM. TherigySTM is then able to pull an aggregated report on results of the study to send to Gilead.
With her insurance now valid again, Dr Tennyson received approval for her medication refill with no problems. Hometown Pharmacy loves TherigyInsights new physician summary dashboard reports to provide clarity about the status of all referrals for each physician. The pharmacy sends weekly reports over on status of referrals to the physicians they work with including Ellie’s doctor and status of her recent PA approval. Hometown Pharmacy is also taking full advantage of TherigySTM’s mobile messaging assessments and recently implemented a patient satisfaction survey. Dr Tennyson has sent out a patient satisfaction survey out via mobile to Ellie to fill out at her convenience. Ellie completes it and the survey results immediately populate in TherigySTM for review. Hometown Pharmacy can review the Patient Satisfaction Survey dashboard reports to see results of their pharmacy survey via TherigyInsights.
TherigySTM's Impact
With TherigySTM, Hometown Pharmacy was able to successfully achieve dual accreditation easily. They are able to use TherigyInsights in their favor to send pharmacy reports to gain new payor contracts. Additionally, Hometown Pharmacy is able to take part in an outcomes study with other health systems and achieve results.
Several months have passed, with Ellie taking her medication regularly. She has been feeling lots better! Just recently, the physician did a CT scan and stated miraculously she shows no signs of cancer. Ellie is officially in remission!
Although there are chances her lymphoma could still come back, it is not currently active. Ellie will have routine checkups with her physician but all in all, she can go on to enjoy life with her daughter and newly born grandchild. Hometown Specialty Pharmacy will still regularly check in with Ellie to see how she is doing, administer a different medication to manage her ongoing remission if necessary, and check in on her quality of life with regular follow-ups scheduled through TherigySTM.
TherigySTM's Impact
Overall TherigySTM has helped proactively manage millions of patients nationwide in their specialty journey.
This all in all is a HUGE testament to how much you matter in helping better patients lives each and every day using TherigySTM. Thank you for all that you do!
Throughout these stories, TherigySTM helped Dr. Tennyson be aware, informed, and proactive about Ellie’s unique needs. We hope that through Ellie’s patient journey, you are able to see that you are a part of the bigger picture. What you do day in and day out helps save patients from going to the ER, extends their quality of life, and, most importantly, enhances patient outcomes.
In short – You matter! Every employee, clinician, pharmacist, and analyst is interwoven with the patients’ journey. TherigySTM’s impact reaches far beyond our software and, ultimately, to the future and greater good of specialty pharmacy.