Purpose The initiation of specialty medications is associated with patient access challenges and clinician burden. This intervention invested resources upstream of the prescription being written. The evaluation assessed the impact on patient and clinician experience.

Methods The specialty pharmacy intervention was designed to improve medication access within five medical specialty clinics by utilizing an embedded medication access team assigned to patients and prescribers of targeted medications. We used a multi-methods evaluative approach. Semi-structured qualitative interviews provided an understanding of clinician experience. To quantitatively assess associations between the referral process and patient experience, we analyzed the emotional valence of patient portal messages using a retrospective cohort study and an event study framework of a non-randomized, stepped wedge implementation design.

Results The intervention was associated with an increase in the net positive emotional valence of patient portal messages (AME, 5.3; 95% CI, 3.8-6.8). Except for gastroenterologists seeing patients for irritable bowel disease, patients cared for in all other specialties experienced statistically significant increases in net positive valence in the primary analysis. Regarding clinician experience, four major interrelated themes emerged from 17 qualitative interviews with prescribers and pharmacists: (1) decreased clinician burden, general praise, (2) improved experience & satisfaction, reduced anxiety & concerns, (3) rewarding praise for other prescribers/colleagues, and (4) excellent coordination, efficiency, and speed.

Conclusion Investing staff resources before, during, and after the prior authorization process greatly improves clinician experience. The positive valence of patient portal messages also increased suggesting patient experience improvements.

GB disclosures: Grant Funding through Boston Scientific; Consulting with Pfizer, Bristol-Myers Squibb, Janssen, Bayer, AstraZeneca, Sanofi, Anthos, Abbott Vascular, Boston Scientific; DSMB Translational Sciences (Clinical Events Adjudication Committee); Board of Directors, Anticoagulation Forum. SF disclosures: Grant Funding through Blue Cross Blue Shield of Michigan. Remaining authors have no potential conflicts of interest with respect to the research, authorship, or publication of this article.

This study did not receive any funding.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This project was deemed exempt by the University of Michigan Institutional Review Board as a quality improvement project.

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Yes

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harkonbrmed.umich.edu

jbhendermed.umich.edu

gavrilvamed.umich.edu

mckibbijmed.umich.edu

slbarkermed.umich.edu

wlbmed.umich.edu

lrkelleymed.umich.edu

flandersmed.umich.edu

haemimed.umich.edu

gbarnesmed.umich.edu

Financial Support: This intervention and study did not receive any funding besides operational support from the institution.

Disclosures: GB – Grant Funding – Boston Scientific; Consulting – Pfizer, Bristol-Myers Squibb, Janssen, Bayer, AstraZeneca, Sanofi, Anthos, Abbott Vascular, Boston Scientific; DSMB – Translational Sciences (Clinical Events Adjudication Committee); Board of Directors - Anticoagulation Forum. SF – Grant Funding – Blue Cross Blue Shield of Michigan. Remaining authors have no potential conflicts of interest with respect to the research, authorship, or publication of this article.

All data produced in the present work are contained in the manuscript and related supplemental materials.