Pharmacist role in transforming Alzheimer’s care: Anti-amyloid therapy experience at Vanderbilt University Medical Center

Purpose Anti-amyloid infusion therapies are a new and complex treatment option for patients with Alzheimer’s disease. Use of lecanemab or donanemab requires specific diagnostic criteria and frequent ongoing monitoring that requires in-depth coordination of care. We describe how neurology clinical pharmacists were an integral part of adoption of anti-amyloid therapy at our institution. With implementation of this service by pharmacists, we describe the impact on patient outcomes for those receiving anti-amyloid infusions and several aspects of impact on the health system as a whole that pharmacists should anticipate with these complex infusions. Summary Neurology clinical pharmacists dedicated to infusions therapies are responsible for many aspects of use of anti-amyloid therapies, including order entry, patient counseling, Centers for Medicare and Medicaid Services (CMS) registry submission, infusion scheduling, and coordination of magnetic resonance imaging. At our institution, the first year of anti-amyloid infusions included 58 patients starting infusions. Safety and adverse effects, including amyloid-related imaging abnormalities, were similar to those previously reported in the primary literature. The majority of patients utilized Medicare as their primary coverage for infusions, and we describe successful navigation of the unique CMS registry requirement for billing. Conclusion Adoption of anti-amyloid therapies by a health system requires unique aspects of coordination not previously encountered. Clinical pharmacists are positioned to successfully coordinate care for patients receiving anti-amyloid infusions.