2025 Southeastern Residency Conference

Title: Pharmacist-Led Interventions to Improve Medication Access to Rifaximin in the Treatment of Hepatic Encephalopathy
Author: Jenny Hollingsworth
Objective: The primary outcome will be the identification of optimal processes specialty pharmacy can utilize for the improvement of workflow to impact the time to rifaximin medication acquisition for patients. Secondary outcomes include patient barriers to starting therapy and the number of patients requiring assistance through manufacturer patient assistance programs.
Self-Assessment Question: What is one method specialty pharmacists can utilize to benefit medication acquisition to patients?
Background: The current standard of practice for monitoring adherence of rifaximin in the treatment of Hepatic Encephalopathy (HE) is lacking. This study’s purpose is to evaluate the effectiveness of community-based specialty pharmacist interventions in enhancing medication adherence and improving patient access. This study aims to identify best practices that pharmacists can employ to optimize therapeutic outcomes and support patient management of rifaximin therapy in a specialty pharmacy setting. 
Methods: Data is anonymous and does not contain patient-specific data points. This is a prospective study utilizing patients who will fill their prescription at a community-based specialty pharmacy located within a health system. Inclusion criteria for patients include those with a confirmed diagnosis of HE, a valid prescription of rifaximin as a new start, and are 18 years of age or older. Exclusion criteria for patients include contraindications to rifaximin or taking rifaximin for treatment other than HE or patients refilling rifaximin. Pharmacist-Led interventions in this study will include coordinated efforts with prescribers to aide in the prior authorization process and utilize patient assistance and copay cards for patients unable to afford rifaximin.
Data collection of these interventions will be conducted over a period of six months from March 1st to April 1st with sample size of 69 patients. Quantitative items in the data will include the number of insurance approval rates, the number of patient applications and approvals or denials for assistance, prescription refills, and the time from prescription receipt to receiving their first fill. The data will be analyzed using descriptive statistics to assess adherence rates with interventions.
Results: The number of prescriptions received throughout the data collection time period was 69. Of the 69, 62 needed prior authorizations which were completed. All 62 prior authorizations received approval with 10 of them needing patient assistance program support. The total number of patients with insurance through Medicare was 27. The total number of patients with insurance through commercial plans was 34. The total numbers of patients with insurance through Medicaid was 7. The total number of uninsured patients was 1. Regarding patient assistance program applications, 16 total applications were submitted and utilized for Medicare patients exclusively. No patient assistance programs were utilized for commercial plan patients.
Regarding time to medication acquisition, the average time from receipt of prescription to medication delivered to patient was 13.7 days. The lowest time was 0 days as represented by receipt of prescription and bedside delivery to patient within the same day upon discharge from the hospital. The longest time was 80 days. The time frame which appeared the most throughout the data collection process was 3 days.
Conclusions: By utilizing the steps outlined in the implemented process of rifaximin acquisition, a quicker medication acquisition time has been demonstrated for patients to begin optimal therapy for treatment with hepatic encephalopathy with a value of 12.5 days, thus demonstrating an improvement in workflow processes. It furthermore displays the avenues in which patients can receive medication by utilizing guided pharmacist support in prior authorizations and patient assistance programs. This study illustrates the importance of pharmacist-led interventions in the community space and showcases pharmacists’ impact on positive patient outcomes in optimization of therapy with rifaximin.