Key result
In-house pharmacy bedside delivery linked to ~22-point higher post-PCI P2Y12 inhibitor fill rates.
Why the study?
Barriers such as cost, insurance delays, and pharmacy availability hinder timely dual antiplatelet therapy initiation and adherence after PCI, particularly for newer P2Y12 inhibitors like ticagrelor.
Does integrating hospital outpatient pharmacy services with financial assistance, streamlined prior authorizations, and bedside delivery improve P2Y12 inhibitor prescription fill rates in patients undergoing percutaneous coronary intervention?
Observational (n=177)
Open-label
No
Does integrating hospital outpatient pharmacy services with financial assistance, streamlined prior authorizations, and bedside delivery improve P2Y12 inhibitor prescription fill rates in patients undergoing percutaneous coronary intervention?
Routing post-PCI P2Y12 inhibitor prescriptions through an in-house hospital outpatient pharmacy with 340B financial assistance, prior authorization support, and bedside delivery increased overall prescription fill rates from 77.3% to 99.1% and ticagrelor fill rates from 55.6% to 98.5%.
May improve post-PCI P2Y12 fill rates; hypothesis-generating and requires randomized outcome trials before adoption.
BACKGROUND: Dual antiplatelet therapy after percutaneous coronary intervention (PCI) is essential to prevent stent thrombosis and improve outcomes. Barriers such as cost, insurance delays, limited patient understanding, and pharmacy availability can hinder timely initiation and adherence. Delays are common when community pharmacies do not stock certain P2Y12 inhibitors, particularly newer, higher cost agents such as ticagrelor. PROJECT RATIONALE: We sought to reduce these barriers by integrating hospital outpatient pharmacy services into post-PCI discharge planning for both inpatient and outpatient PCI. PROJECT SUMMARY: A multidisciplinary team routed P2Y12 inhibitor prescriptions to the hospital's outpatient pharmacy, enabling financial assistance, streamlined prior authorizations, and bedside delivery before discharge. In a 2-week preimplementation audit, 5 of 9 ticagrelor, 3 of 3 clopidogrel, and 9 of 10 prasugrel prescriptions sent externally were filled. At postimplementation, 99.1% of prescriptions were filled and delivered bedside. TAKE-HOME MESSAGE: Leveraging hospital pharmacy resources for outpatient PCI patients ensures timely access to dual antiplatelet therapy, improves adherence, and reduces adverse cardiovascular events.
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Desrosiers et al. (2025) conducted an observational in Percutaneous coronary intervention requiring dual antiplatelet therapy (n=177). Hospital outpatient pharmacy routing with financial support, streamlined prior authorization, and bedside delivery vs. Standard external community pharmacy routing (preimplementation) was evaluated on Overall P2Y12 inhibitor prescription fill and bedside delivery rate before discharge. Routing post-PCI P2Y12 inhibitor prescriptions to an in-house pharmacy with bedside delivery increased overall fill rates from 77.3% to 99.1% and ticagrelor fills by 42.9% (p=0.00044).
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