PURPOSE: Omalizumab is indicated for treatment of asthma. It is known that there exist barriers to the start of treatment once a clinical decision to use omalizumab is made. We tried to quantify the difficulty in arranging treatment for patients.
METHODS: The process involved in arranging omalizumab for treatment of asthmatics was obtained from about 10 consecutive patients after a clinical decision was made. Time from prescription to setup of the new starts’ first injection, number of insurance contact episodes, number of persons involved and need for appeal was extracted retrospectively. The same parameters were used for patients who were already on omalizumab and needed to have their medication renewed for ongoing treatment.
RESULTS: Recent new starts of omalizumab n=11 required 7.73 (±4.58 std.dev) contact episodes, 4.1 (± 2.56 std.dev) persons involved, and 25.64 (± 13.82 std.dev) days. Including 3 of 11 patients requiring appeals. For those patients recertifying omalizumab n=10 had an average of 5.6 (± 6.62 std.dev) episodes, 3.6 (± 2.41 std.dev) persons involved, and 12.8 (± 19.39 std.dev) days. There was 1 patient requiring appeal. There is considerable use of resources in an office setting for the arrangement of omalizumab resulting in delay of treatment and potentially high office overhead cost.
CONCLUSIONS: The arrangement of high cost medications may impact overhead cost in office practices and may need to be addressed with payors for reimbursement. Because of high Hassle factors involved in arranging omalizumab, patients may have delay in treatment or may make treatment inaccessible though clinically indicated.
CLINICAL IMPLICATIONS: Time study analysis and economic parameters may need to be done to properly assign economic value needed to avoid delays in patient care. We propose a procedure code reflecting the Hassle factor and look forward to professional organizations such as the American College of Chest Physicians in helping address fair reimbursement issues to help avoid delays in patient care.
DISCLOSURE: Mary Zaremba: Consultant fee, speaker bureau, advisory committee, etc.: Novartis/Genentech
Sridhar Reddy: Consultant fee, speaker bureau, advisory committee, etc.: Genentech
The following authors have nothing to disclose: Kristin Elliott, Alicia Redford, Syed Ali, Nipurn Shah
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