Ticagrelor Affordability Assessment Prior to Hospital Discharge: A Pharmacist-Driven Initiative

The PLATO trial demonstrated that ticgrelor significantly reduced deaths from cardiovascular causes among patients with acute coronary syndrome (ACS). Our institution developed a standardized ACS protocol in which patients are preferentially started on ticagrelor rather than clopidogrel. A generic form of ticagrelor is currently unavailable, therefore cost may be a barrier to patient access in the outpatient setting. We developed a pharmacy driven process to assess patient specific cost for ticagrelor and facilitate switching to clopidogrel prior to hospital discharge in those who would be unable to afford ticagrelor in the outpatient setting. Objectives: (a) describe pharmacy personnel processes for assessing ticagrelor cost and accessibility (b) identify the number of patients who require switching to an alternative antiplatelet agent prior to discharge from the hospital (c) identify reasons and patient characteristics associated with switching agents. Half of patients started on ticagrelor required a switch to clopidogrel prior to hospital discharge. The most common reasons for switching include cost, triple therapy, and switching prior to pharmacist assessment. Patients who were unfunded or with federally funded insurance were more likely to require a switch to clopidogrel, while those with private insurance were more likely to continue ticagrelor. Collaboration with clinical pharmacy personnel can help identify patients unable to afford ticagrelor early in their hospital stay and facilitate switching to an appropriate alternative prior to discharge to prevent treatment interruption.