Pilot Program Shows Rituximab Infusion Can Be Switched to Private Clinics, Reduce Costs

VBCR - October 2013, Volume 2, No 5 - Health Economics

By Rosemary Frei, MSc

A Canadian pilot program that required patients with rheumatoid arthritis (RA) to use their private and/or public insurance to cover the costs of rituximab (Rituxan) for RA and switch its site of administration from in-hospital to a private clinic may provide a good example for the United States on moving infusion out of the hospital and saving costs in the management of patients with RA. This move from administering rituximab in the hospital to private clinics for patients with RA reduced the overall hospital’s rituximab-associated costs by a total of $323,825 over the 3-month span of the pilot program.

This new approach also required a great deal of preparation for the project team, and physicians now have to spend significantly more time doing administration and paperwork. Yet, the project team constantly improved the process throughout the pilot program, and as a result, approximately 70% of staff and other stakeholders responding to a survey said that they felt positive about the pilot program and agreed that this approach could be emulated in other clinics.

“We heard from a rheumatologist who said, ‘from my own perspective, things have been running very smoothly with this program, and I commend you and your team for tweaking the process’,” explained project lead Bernadette Chevalier, BSc Pharm, Drug Utilization Pharmacist and Pharmacist Education Coordinator, Pharmacy Services, Capital District Health Authority, Halifax, Nova Scotia, Canada (Chevalier B, et al. Healthc Q. 2013;16:42-47).

The goal of the program was to reduce the rituximab drug costs, which have increased considerably over the past 5 years, and to make the best use of resources at the hospital, which is part of the Canadian Capital District Health Authority. The plan was to have rituximab-naïve patients with RA receive their first dose of rituximab at a medical day unit in the hospital. If they tolerated that first dose well, they then received the rest of their doses in private infusion clinics.

The Pilot Program
It took 5 months of planning and preparation to launch this pilot program. One of the major moves during this phase was the hiring of a rheumatology medication resource specialist (MRS). Other steps included in-servicing for nurses, physicians, and pharmacy of the medical day unit and the rheumatology clinic, and establishing contacts with a private infusion clinic and with a company hired by Roche, the drug manufacturer, to administer the company’s Patient Assistance Program. The Patient Assistance Program covers the administration costs of rituximab infusions in the private clinic and up to 30% to 100% of patients’ insurance copayments and deductibles. The hospital acted as payer of last resort for any leftover costs; patients were not expected to pay anything for their rituximab treatment.

The program was launched in June 2012. The MRS worked with patients and rheumatology clinic staff to ensure that patients had private or public drug insurance in place, to enroll them in the Patient Assistance Program, and to help them transition to the private infusion clinic.

Despite ongoing improvements in the reimbursement processes by Ms Chevalier and the team, patients experienced a significantly longer median time between the writing of the prescription and the first infusion than before the program.

Streamlining continued after the pilot program, resulting in considerably shorter delays. One aspect of the streamlining entailed the MRS and the rheumatologists coordinating and anticipating upcoming patient infusions so the paperwork could be done in advance.

During the 3-month program, the hospital avoided $304,700 in drug costs, and an additional $19,125 for the 51 infusions that were given in private clinics and paid for by the manufacturer’s Patient Assistance Program. This also meant that other patients at the hospital were able to receive infusions with less delay.

Of the 20 patients who completed an online satisfaction survey, most indicated that they were satisfied with the new approach. In addition, 21 of the 42 hospital staff and external stakeholders involved in the program completed the survey; approximately 70% of them said they felt positive about the pilot and that they thought it could be successfully implemented in other clinics besides rheumatology. In addition, 62% said they had an increased workload with the switch.

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