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Therapeutic

Interchange

Process

Updated Bioequivalent & Biosimilars

09/26/2019

BENEFITS OF THERAPEUTIC INTERCHANGE

PHARMACY & THERAPEUTICS

  • Facilitate systematic interchange of appropriately similar and/or equivalent medications.

  • Increase workflow efficiency for providers and clinical staff

  • Reduce drug cost to patients and insurance payors

  • Improved value based care outcomes

BIOSIMILAR

BIOSIMILARS

Drugs designed to have active properties similar to a reference drug

MVASI (bevacizumab-awwb)

  • biosimilar to Avastin

  • identical dosing

  • identical administration

KANJINTI (trastuzumab-anns)

  • biosimilar to Herceptin

  • identical dosing

  • identical administration

BIOEQUIVALENT

BIOEQUIVALENT

Generic drugs which must have the same quality, safety profile, and efficacy of their brand-name drug and are therefore therapeutically interchangeable

FOSAPREPITANT

  • bioequivalent to Emend

  • identical dosing

  • identical administration

REGIMEN

ENTRY

REGIMEN ENTRY

1

WORKFLOW

REGIMEN ORDER

Physicians & Nurse Practitioners

Order queues to Clinical Pharmacist for review, pharmacist makes appropriate therapeutic interchange

#1

#3

#2

Physician enters treatment plan into EHR

Order queues to Revenue Cycle for insurance eligibility & authorization

REVENUE CYCLE

REVENUE

CYCLE

2

AUTHORIZATION

INSURANCE AUTHORIZATION

Revenue Cycle & Financial Counselors

Regimen reviewed against medical policy of specific insurance plan

#1

#3

#2

Order queues to revenue cycle team for insurance authorization

Order queues to Financial Counselors for meeting with patient, consideration for financial assistance

PHARMACY

3

DRUG AUTHORIZATION

DRUG AUTHORIZATION

Revenue Cycle Team & Pharmacy

Auth team alerts pharmacy if regimen is off-label or a reimbusement risk

#1

#3

#2

Clinical Pharmacist works with physician if regimen changes are needed

Eligibility & authorization completed with insurance plan

ORDER PREP &

ADMIXTURE

ORDER PREP & ADMIXTURE

Infusion Nursing & Pharmacy Techs

Verify active authorization for treatment prior to turning order into pharmacy -- notify patient financial rep for activation status if missing!

#1

#3

#2

Turn order into pharmacy. Pharmacists double check admixture, finish preparation for nursing pickup

Review treatment order with second RN -- follow safety double check protocol

NURSING

4

NURSING

4

PATIENT EDUCATION

PATIENT EDUCATION

Access My Workspace App

Nurses & Nurse Practitioners

  • Click on Clinical Portal, go to Patient Education, select regimen-based education & appropriate drug regimen

  • MVASI (biosimilar for Avastin) is as effective as Avastin in clinical trials, and has similar side effects

  • KANJINTI (biosimilar Herceptin) is FDA approved for all of the same indications, proven as effective as Herceptin in clinical trials, with similar side effects
  • Patients can be transitioned to Kanjinti even if they have already started therapy with Herceptin

ORDER PREP &

ADMIXTURE

ORDER PREP & ADMIXTURE

Infusion Nursing & Pharmacy Staff

Verify active authorization for treatment prior to turning order into pharmacy -- notify patient financial rep for activation status if missing!

#1

#3

#2

Review treatment order with second RN -- follow safety double check protocol

Turn order into pharmacy. Pharmacists double check admixture, finish preparation for nursing pickup

TREATMENT ADMINISTRATION

TREATMENT ADMINISTRATION

Infusion Nurses

Perform safety double check with second RN at patient chairside

#1

#3

#2

Collect patient treatment from pharmacy

Administer treatment per protocols

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