Avella's Vice President of Ophthalmology, Jim Rehovsky, is featured in Specialty Pharmacy Continuum article titled, Diabetic Macular Edema: 6 Steps for Better Control.
Defining the important role specialty pharmacists can play in managing patients with diabetic macular edema (DME) does not start with drug selection, Jim Rehovsky, R.Ph, the vice president of ophthalmology at Avella Specialty Pharmacy, told Specialty Pharmacy Continuum. That’s because the dispensing arrangement for these agents differs from virtually all other specialty drugs.
“Specialty pharmacies like Avella and Drug Wholesalers sell the agents directly to the physician in a buy-and-bill model, with no prescriptions,” Mr. Rehovsky explained. “We ship the products in quantities of one to over 100, and the physician decides which agent they are going to use with which patient, looking at their insurance and all the other factors. Even with patients seeking foundation support for their drug costs, the physician would connect them. We aren’t notified about which agent they select. It was set up this way initially by the manufacturers, to maintain the cold chain.”
What, then, can specialty pharmacists do for these patients? “The No. 1 place to start is to ensure that all appropriate patients receive that all-important annual eye exam, as well as helping to control factors such as hypertension and dyslipidemia,” Mr. Rehovsky said. “Our pharmacists need to continue to preach and make sure [at-risk] patients get that exam.”
The profession also can make its mark by promoting adherence, he stressed. Longer-acting therapies, including steroid implants, extended-delivery devices and topical therapies, are now under investigation, and, ultimately, one or more of these may prove to be the next big revolution in treating diabetes-related vision loss—but these are likely at least five years away. In the meantime, adherence to the sometimes arduous regimen of monthly injections can be a barrier to adherence.
“This is a long road,” Mr. Rehovsky stressed. “People can get depressed and discouraged about having to have an injection in the eye every month. We have a lot of patients who have to have a family member take off work and drive them to the doctor’s office and then spend a few hours there, so compliance is very hard. But studies show that if you get less than six injections, it’s like getting none at all. Specialty pharmacists really need to keep these patients encouraged about sticking to their routine in order to get those visual acuity benefits, and try to help solve issues that may be interfering with their adherence.”