Leslie J. Vollenweider

BACKGROUND: Noncompliance with immunosuppressive medications after renal transplantation is believed to be a major cause of allograft rejection and graft loss, with the impressive costs of these agents considered a significant reason for noncompliance. Our purpose was to determine the compliance rates of renal transplant patients who received their immunosuppressant therapy free of charge and evaluate their patterns of compliance. METHODS: All patients who received a renal transplant and received their immunosuppressant medications at our institution for their first year posttransplant were included in the study. Compliance rate was calculated and serum immunosuppressant concentrations were obtained to validate compliance assessments. RESULTS: Eighteen patients were included in the study. Approximately 48% of noncompliant patients were found to have subtarget drug concentrations, although only 14% of compliant patients had subtarget levels (chi2=12.9, P<0.001). At 5 months posttransplant, 95% of the patients remained compliant; however, by 12 months posttransplant, only 48% of the patients remained compliant. The mean time to the first noncompliant month was 9.8 months (95% confidence intervals=8.60-11.0). CONCLUSIONS: Patients who received their immunosuppressants free of charge were generally compliant within their first year of transplantation, however, compliance tended to decrease over time. This suggests that drug cost alone does not explain noncompliant behavior. Intensive efforts to increase medication compliance before month 8 posttransplantation should be implemented.

UNLABELLED: Medicare pays for 80% of the cost of immunosuppressant agents needed within the first 3 years of solid organ transplantation; however, many patients cannot afford the remaining 20%. Furthermore, many patients who are beyond 3 years post-transplantation and have prescription coverage cannot afford the co-payment for these medications. Other patients may not be able to afford their medications due to limited or no insurance coverage. The Medical College of Georgia (MCG) has been giving immunosuppressant medications to renal transplant patients if they cannot afford to pay for them. To assist MCG with drug cost for medications and maintain quality care for renal transplant patients, a clinical pharmacist-managed medication assistance program was implemented to procure immunosuppressants from pharmaceutical manufacturers. METHODS: All patients enrolled in medication assistance programs from 1 January 1998 through 31 December 1998 were included in this analysis. Medication acquisition costs with and without Medicare reimbursement and the cost of implementing the clinical pharmacist-managed medication assistance program were used to determine the value of implementing this service. RESULTS: Sixty-one patients were enrolled in manufacturers' assistance programs and a net cost avoidance of $124,793 was realized for the year of the program (benefit-to-cost ratio of 7.5:1). Assuming that the hospital collected the maximum amount allowed for patients receiving Medicare benefits, a cost avoidance of $69,233 was calculated (benefit-to-cost ratio of 4.16:1). CONCLUSIONS: A clinical pharmacist-managed medication assistance program in a renal transplant clinic produced substantial cost savings over this 1-year study period. For each dollar spent in pharmacist's time, a minimum of $4 was returned to the institution.

Journal Article Direct patient care services provided by a pharmacist on a multidisciplinary renal transplant team Get access Marie A. Chisholm, Pharm.D., Marie A. Chisholm, Pharm.D. Assistant Professor of Pharmacy University of Georgia College of Pharmacy (UGACOP), Athens, and Associate Clinical Professor of Medicine, Medical College of Georgia School of Medicine (MCGSM), Augusta Address reprint requests to Dr. Chisholm at Clinical Pharmacy Program, CJ-1020, Medical College of Georgia, Augusta, GA 30912-2450, or to mchishol@mail.mcg.edu. Search for other works by this author on: Oxford Academic Google Scholar Leslie J. Vollenweider, Pharm.D., Leslie J. Vollenweider, Pharm.D. Renal Transplant Clinical Pharmacist UGCP. Laura L. Mulloy, D.O., is Associate Professor of Medicine and Chief of Nephrology, MCGSM Search for other works by this author on: Oxford Academic Google Scholar Laura L. Mulloy, D.O., Laura L. Mulloy, D.O. Associate Professor of Medicine and Chief of Nephrology MCGSM Search for other works by this author on: Oxford Academic Google Scholar Muralidharan Jagadeesan, M.D., Muralidharan Jagadeesan, M.D. Assistant Professor of Medicine MCGSM Search for other works by this author on: Oxford Academic Google Scholar William E. Wade, Pharm.D., William E. Wade, Pharm.D. Professor of Pharmacy UGACOP, and Clinical Professor of Surgery, MCGSM. Search for other works by this author on: Oxford Academic Google Scholar Joseph T. DiPiro, Pharm.D. Joseph T. DiPiro, Pharm.D. Professor of Pharmacy UGACOP, and Clinical Professor of Surgery, MCGSM. Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 57, Issue 17, 1 September 2000, Pages 1599–1601, https://doi.org/10.1093/ajhp/57.17.1599 Published: 01 September 2000

Journal Article Direct patient care services provided by a pharmacist on a multidisciplinary renal transplant team Get access Marie A. Chisholm, Pharm.D., Marie A. Chisholm, Pharm.D. Assistant Professor of Pharmacy University of Georgia College of Pharmacy (UGACOP), Athens, and Associate Clinical Professor of Medicine, Medical College of Georgia School of Medicine (MCGSM), Augusta Address reprint requests to Dr. Chisholm at Clinical Pharmacy Program, CJ-1020, Medical College of Georgia, Augusta, GA 30912-2450, or to mchishol@mail.mcg.edu Search for other works by this author on: Oxford Academic Google Scholar Leslie J. Vollenweider, Pharm.D., Leslie J. Vollenweider, Pharm.D. Renal Transplant Clinical Pharmacist UGCP Search for other works by this author on: Oxford Academic Google Scholar Laura L. Mulloy, D.O., Laura L. Mulloy, D.O. Associate Professor of Medicine and Chief of Nephrology MCGSM Search for other works by this author on: Oxford Academic Google Scholar Muralidharan Jagadeesan, M.D., Muralidharan Jagadeesan, M.D. Assistant Professor of Medicine MCGSM Search for other works by this author on: Oxford Academic Google Scholar William E. Wade, William E. Wade Pharm.D. UGACOP, and Clinical Professor of Surgery, MCGSM Search for other works by this author on: Oxford Academic Google Scholar Joseph T. DiPiro, Pharm.D. Joseph T. DiPiro, Pharm.D. Professor of Pharmacy UGACOP, and Clinical Professor of Surgery, MCGSM Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 57, Issue 21, 1 November 2000, Pages 1994–1996, https://doi.org/10.1093/ajhp/57.21.1994 Published: 01 November 2000

Pharmaceutical company-sponsored medication assistance programs and the pharmacist's role in obtaining medications for indigent patients are discussed. Information about enrolling in medication assistance programs can be obtained through a variety of sources, including the Internet. Although some eligibility criteria may be common to many programs, each company operates independently, and the eligibility criteria vary, individuals involved in the administration of medication assistance programs should strive to ensure that correct information is reported. Pharmacists can play an important role in acquiring medications for patients by reviewing patient information, recommending patients for enrollment, and serving as a liaison between the patient or health care provider and the program administrator. Many pharmaceutical companies have programs that provide prescription medications to indigent or uninsured patients. Pharmacists can serve as a liaison between these programs and the patient or the health care provider.