Pharmacy Technician Impact on Access to High-Cost Heart Failure Pharmacotherapy

Abstract

Background:

It is challenging for patients with heart failure to obtain all core classes of guideline-directed medical therapy (GDMT), especially because sacubitril-valsartan and sodium-glucose cotransporter 2 inhibitors (SGLT2i) are cost-prohibitive for many. Pharmacy technicians in an outpatient heart failure clinic can provide support for medication access.

Objective:

The objective of this study was to determine the impact of a pharmacy technician on access to high-cost GDMT for patients with heart failure.

Methods:

This retrospective, pre-post cohort study evaluated adults with heart failure who were eligible for treatment with both sacubitril-valsartan and SGLT2i and had a heart failure clinic visit prior to the addition of a pharmacy technician (September 1, 2022, through February 28, 2023) or after the addition (September 1, 2023, through February 29, 2024). Excluded patients were pregnant, incarcerated, Veterans Affairs patients, had an estimated glomerular filtration rate <20 mL/min/1.73 m², or received a heart transplant. The primary composite outcome was a binary variable identifying if patients were prescribed and filled sacubitril-valsartan and/or SGLT2i, evaluated using logistic regression controlling for patient prescription drug coverage. Secondary outcomes included affordable access to ivabradine and vericiguat and 30-day hospitalization rate. Pharmacy technician time spent was evaluated in the post-cohort.

Results:

There were 192 patients included; 96 in each cohort. Access to sacubitril-valsartan and/or SGLT2i increased from 71.9% pre-cohort to 86.5% post-cohort (OR = 2.46, 95% CI = [1.18, 5.34]; P = 0.02). No differences were observed in secondary outcomes. The pharmacy technician spent an average of 66.4 minutes per patient assisted (n = 21/96).

Conclusion and relevance:

This study demonstrated a significant increase in access to sacubitril-valsartan and/or SGLT2i after the implementation of a pharmacy technician. Larger, prospective studies are needed to evaluate the impact of a pharmacy technician on clinical outcomes in this population.