Pharmacist Lesley D'Albini
Lesley D'Albini, PharmD
Director, Specialty Clinical Product Management
Jun 23, 2023

Hemlibra Revolutionizing Hemophilia A Treatment

Each year, new FDA-approved specialty medications come to market with the potential to alter the lives and treatment plans of people with chronic, complex conditions. In 2018, Hemlibra® (emicizumab- kxwh) was launched as a new treatment option for hemophilia A, which affects up to 33,000 males in the United States. Hemlibra prevents bleeding episodes in adults and children with hemophilia A. This new specialty medication comes with less-invasive and less-frequent administration than traditional clotting factor, but the dosing and vial sizes of Hemlibra can introduce some complexity that the specialty-trained pharmacists at Accredo have been working to address.

Weight-Based Dosing and Vial Size Optimization

Hemlibra can be self-injected and is administered subcutaneously every one to four weeks. Traditional clotting factors must be administered intravenously up to three times per week. This shift in both route and frequency of administration can significantly improve a patient’s quality of life – and Hemlibra has been proven a safe and effective treatment. Complexities with this innovative medicine can come into play due to weight-based dosing and limited commercially available vial sizes. Because Hemlibra is dosed by weight, every dose and every patient are going to be different. Hemlibra comes in four vial sizes – so when writing a prescription, prescribers need to quickly identify how many of the available vial sizes to combine to get to the target dose. This is just for one medication treating one condition, not to mention all the other medications the physician or agent regularly prescribes. For example, when a prescriber writes for a 150mg vial, but the patient needs only 120mg of medication, they are discarding 30mg of Hemlibra with every dose. Of more concern, the use of partial vials may cause patients confusion about dosing when self-injecting their medication. Research shows that patients may make fewer mistakes when the regimen avoids the need to use only a partial vial. In this particular example, had the prescriber written for two 60mg vials, both medication waste and potential patient confusion could have been avoided.

Accredo's Dose Calculator for Optimizing Hemlibra Injections

Accredo clinicians began evaluating Hemlibra regimens using a proprietary algorithm in 2020. This algorithm was designed to ensure patients were getting the right dose delivered with the most cost-effective combination of vial sizes. Step one requires the pharmacist to confirm that the dose is clinically appropriate. Step two assures that the most optimized combination of vial sizes is leveraged for the required dose to minimize waste. Accredo also developed a proprietary dosing calculator and established clear, consistent guidelines for when pharmacists should reach out to a prescriber about dose optimization. In a recent Accredo study published in the Journal for Managed Care Pharmacy, Accredo evaluated 367 Hemlibra regimens per the proprietary algorithm and almost half failed – meaning the patient wasn’t prescribed the most optimal dose and/or the regimen required the use of partial vials, leading to potential administration errors or unnecessary drug waste.

Collaboration with Physicians for Enhanced Patient Care

While Accredo continues to work directly with physicians to ensure patients are on the optimal Hemlibra regimen leveraging the most cost-effective vial combination, we work toward offering the patent-pending dose calculator to prescribers to help get patients on the right regimen the first time and eliminate unnecessary steps in the dispensing process.

Learn more about how Accredo is optimizing dosing with hemophilia A or contact your physician engagement representative to hear about our clinical protocols.

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