2025 Southeastern Residency Conference

TITLE: Justification of a Specialty Pharmacy Discharge Medication Reconciliation Program: 
A Descriptive Study 
Caroline Joncas, Taylor Wells 
 
BACKGROUND: Specialty pharmacies provide medications for patients living complex medical conditions including cancer, Human Immunodeficiency Virus, Multiple Sclerosis, and rheumatology conditions. These medications account for 55% of the United States medication expenditure. While previous literature has established the value of medication reconciliations at time of hospital discharge in patients on chronic medication therapy, minimal literature is available describing the impact on patients receiving medications from specialty pharmacies . The purpose of this study was to retrospectively identify opportunities for pharmacist interventions at time of discharge in patients receiving specialty medications and determine the type, severity, and cost savings associated with these interventions.   
 
METHODS:  This single-center retrospective descriptive study included patients with a documented fill history of a specialty medication at Cape Fear Valley Specialty Pharmacy for HIV or an oncologic disease state within 1 month of an inpatient admission between January 2022 and January 2024. Discharge summaries and specialty follow-up visit notes were reviewed for medication discrepancies. The primary endpoint was the number of opportunities for pharmacist intervention and associated cost avoidance, defined as number of errors found and the associated cost based on error severity. A validated scale was used to grade the severity of errors from no error to potentially lethal. 
 
RESULTS: A total of 90 patient encounters met inclusion criteria. Of these encounters, 76 (84%) were associated with cancer, 6 (7%) with HIV, and 8 (9%) with other diagnoses. Overall, 9 (10%) encounters had a medication error at time of hospital discharge. The majority of errors were identified as significant (78%), with one serious error and one potentially lethal error. The most common type of error was inappropriate omission (78%). The cost avoidance associated with these errors was $14,960 over the two-year study period.  
 
CONCLUSION: This study indicates that while some cost savings are possible through targeted medication reconciliations at time of discharge for specialty patients, the overall opportunity is not large enough to justify a medication reconciliation position specific to specialty pharmacy. However, this service would be a beneficial addition into the specialty pharmacy workflow, as there were significant cost savings considering the small number of issues identified by this study.