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The Increasing Roles of Pharmacists in Transplant Outcomes

By: Jenny Park, PharmD Candidate c/o 2015

Medication adherence is a big part of a patient’s success in managing their health conditions. The Annals of Internal Medicine estimated that the cost of medication non-adherence may reach up to $289 billion each year.1 It is crucial for organ transplant patients to take powerful immunosuppressants to help overcome the body’s response of the newly transplanted organ, but non-adherence remains to be a roadblock. According to Brett Sahli, PharmD, who is a manager at the pharmacy benefit manager (PBM) OptumRx, non-adherence rates among the transplant population are anywhere from 20% to 70%. This is problematic because “missing just a couple of days can cause rejection” of a transplanted organ.3

Many patients may stop taking their medications because of the undesirable side effects or because they don’t realize the importance of taking their medications. OptumRx and United Health Care have been setting up specialty pharmacies that focus on patient education in addition to dispensing medications. “We’ve seen similar outcomes in improving medication adherence and clinical results and lowering medical service costs through our specialty pharmacy programs in oral oncology, rheumatoid arthritis, and multiple sclerosis,” said lead author and vice president Suzanne Tschida, PharmD, BCPS.2 Some PBMs have implemented a “total care management” in study models to address how the patient feels in addition to the traditional drug management. This holistic approach to therapy engages and empowers patients to manage their medications and take ownership. In addition, patients who actively manage their medications are more likely to make better health decisions.1

OptumRx and United Health Care conducted a study that compares post transplant patient care in specialty pharmacies and in retail pharmacies. The difference between the two groups in outcome was statistically significant. The group receiving care from the specialty pharmacy was associated with lower transplant related medical costs, lower overall health care costs, and most importantly, higher medication adherence. There was a 30% reduction in transplant related medical costs and a 13% reduction in overall health care costs for the duration of the study, and medical costs associated with using a specialty pharmacy were $5960, whereas the costs for a retail pharmacy was $8486.2 Transplant specialty pharmacists provide people with adherence and clinical management programs. They also provide patients with education and counseling services. The goals, said Tschida, were to “reduce variability in pharmaceutical care, promote medication adherence and help members” manage side effects so they can continue taking immunosuppressants, resulting in “better outcomes and lower health care costs.”3 Through patient education, specialty pharmacists can help patients optimize their therapy and reduce healthcare costs.

Many patients in general need help understanding their medication regimens and need to be given specific directions. Patients may have difficulty understanding how and when to take their medications, and what their medications interact with. For instance, many patients do not understand that taking their medication “twice a day” means every twelve hours, or why drinking milk with certain antibiotics is “bad”. This leads to non-adherence which may prevent the treatment from reaching its maximum potential. With the help of pharmacists who specialize in their respective fields, patients will have improved health outcomes through close monitoring and education.


  1. Tschida S Improving transplant care outcomes. Specialty pharmacy times website. January 2, 2014. http://www.specialtypharmacytimes.com/publications/specialty-pharmacy-times/2013/Sept_Oct-2013/Improving-Transplant-Care-Outcomes. Accessed January 2,2014.
  2. United Health care group. Optum Study Documents Pivotal Role Specialty Pharmacy Plays in Improving Health Care Outcomes, Lowering Cost. January 2, 2014. http://www.unitedhealthgroup.com/Newsroom/Articles/Feed/Optum/2013/0627SpecialtyPharmacy.aspx. Accessed January 2, 2014
  3. Maas, A. Specialty pharmacy program can improve kidney transplant patient. AIS health website. January 2, 2014. http://aishealth.com/archive/nspn0913-02. Accessed January 2, 2014
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