Lessons Learned and Considerations with Humira

Danielle Bryan, PharmD, CSP is the program director of trade relations with ofVanderbilt Specialty Pharmacy, a role that often involves her facilitating a lot of external stakeholder relationships, including with manufacturers and payers; she’s also involved with pre- and post-launch processes for new drug medications, coordinating with Vanderbilt’s clinical teams.

At Trade & Channel Strategies, she presented on “Health System Specialty Pharmacy (HSSP) Perspective: Lessons Learned and Considerations with Humira,” where she explained Vanderbilt Specialty Pharmacy’s operational model and workflow process, while offering considerations for manufacturers during development, rollouts, and implementation.

Vanderbilt Specialty Pharmacy operates in 25 specialty clinical areas, 53 clinical pharmacists, and 83 clinic-based FTEs, or full-time equivalents. In the adalimumab biosimilar launches specifically, it had more than nine clinics that were impacted and more than 30 pharmacists. Further, it’s responsible for the oral and self-administered therapy specialty medications that would be billed on the pharmacy benefit.

“As soon as the decision to treat has been made, our clinical team—who has technicians embedded in the clinic as well—they’re sitting alongside those teams and those providers who really understand what the payers are looking for,” Bryan explained. “They know what these PAs [prior authorizations] are going to require because they’re also experts in this space at this point. They would begin the benefits investigation, prior authorization, appeals, if needed (multiple levels). Peer-to-peer would fall under our bucket as well, or at least the coordination.

“Once we’ve confirmed that the patient has access to the medication and that it’s been approved, we want to make sure it’s affordable, so our teams would also take owning the process of copay cards or manufacture PAP assistance if needed. We have a team of financial counselors that also help facilitate that between the manufacturers, the patients, and the providers’ offices, making sure that the entire package is complete before it goes off to the manufacturer for approval.”

When it comes to considerations for manufacturers that are important to keep in mind during development and rollout, some clinical focus should be given toward payer coverage; patient support services (copay cards, patient assistance programs, product replacement); having contacts (a local sales rep to reach out to with any questions or for some samples, along with a field reimbursement manager); product characteristics (what might be different from the reference product, what strengths were going to be available at launch); and sample offerings.

In terms of wins, many of these revolve around copay card programs and patient assistance.

“Things that have gone really well when it comes to that area are copay card programs, PAP programs, but also the published limits [of these PAPs]. There’s been some confusion, I think around some of them, and it’s better to know on the front end. Maybe there’re a couple different options of therapy for the patient, but if we know the patient’s income level, then we can potentially go ahead and select a product based on which PAP program they may actually qualify for, so having those published is nice. Also, the patient support programs that match or exceed the reference product [is helpful]. AbbVie had an all-inclusive program, which very generous. I think that a lot of the ones that have been successful picking up have seen similar programs as to what AbbVie was able to offer.”

Reference

Bryan D. Health System Specialty Pharmacy (HSSP) Perspective: Lessons Learned and Considerations with Humira. December 11, 2024. Trade & Channel Strategies, Philadelphia. https://informaconnect.com/trade-channel/