Gabrielle Ientile, Assistant Editor

CVS Pharmacy announced a new feature within its app, which can read a specific type of label for patients who are visually impaired and are unable to read the print labels on their prescriptions. 

Spoken Rx is the first prescription reader offered within an app developed by a national retail pharmacy, according to CVS Pharmacy. CVS asserted that 1500 of its locations will be affixing special RFID labels, or smart labels, to prescription vials by the end of 2020. RFID labels will then be able to be scanned by Spoken Rx in the CVS Pharmacy app, and important information on the prescription label can be read aloud for ease of accessing patient safety and adherence information, as well as assisting those who have difficulties reading their prescription label.

App users can access scanned labels through Siri or Google Assistant on their phones; Spoken Rx will be offered in all CVS Pharmacy locations by the end of 2021.

CVS Pharmacy’s announcement was made possible through the involvement of the American Council of the Blind, which collaborated with CVS on the app and aided in testing during the development process.

Patients can enroll in the program over the phone or in store for free, where a pharmacist can assist in ensuring the app is set up properly. Spoken Rx has the capability to read a patient’s prescription label in both English and Spanish.

"Spoken Rx is a positive step that offers same-day, access for prescriptions filled in CVS stores, allowing for a greater level of privacy, safety, and independence for blind and visually impaired customers of all ages," said Kim Charlson, immediate past president of the American Council of the Blind.

More information on Spoken Rx and a list of stores currently offering the program can be found at 

CVS Pharmacy introduces new app feature for reading “talking” prescription labels. News Release. PRNewswire; July 8, 2020. Accessed July 10, 2020. 

https://www.prnewswire.com/news-releases/cvs-pharmacy-introduces-new-app-feature-for-reading-talking-prescription-labels-301089789.html

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The new app feature will also soon function with smart labels, which can be scanned and read aloud. 

CVS Pharmacy Offering New Spoken Rx App Feature

Merck announced new findings from its phase 2b clinical trial which assessed islatravir, its investigational oral nucleoside reverse transcriptase translocation inhibitor (NRTTI) in combination with doravirine (Pifeltro, Merck) in antiretroviral treatment-naïve adults with HIV-1 infection, as well as analyses from its phase 3 DRIVE-SHIFT trial.

The latest analyses of these 2 trials will be offered at 2 oral presentations taking place at the 

, which has been made virtual in response to the novel coronavirus disease 2019 (COVID-19) pandemic.

Phase 2b Sub-Analysis of Investigational 2-Drug Regimen of Islatravir Plus Doravine

The international, multicenter, randomized, phase 2b clinical trial evaluated patients with HIV-1 infection by assigning them to 1 once-daily oral treatment group: islatravir 0.25 mg, 0.75 mg, or 2.25 mg in combination with doravirine 100 mg and lamivudine (3TC) 300 mg compared with doravirine 100 mg/3TC 300 mg/tenofovir disoproxil fumarate 300 mg (TDF).

After a minimum of 24 weeks of treatment, participants receiving islatravir with HIV-1 RNA less than 50 copies/mL that had not met protocol defined virologic failure (PDVF) criteria altered treatment course to receive a 2-drug treatment, including the same dose of islatravir, as well as doravirine 100 mg without 3TC.

The 48-week treatment demonstrated decreased rates of drug-related adverse events (AEs) in participants in the islatravir groups (7.8%) compared with the doravirine/3TC/TDF group (19.4%). The study found that instances of AEs were more frequent in the first 24 weeks compared with the second half of the trial.

At week 48, PDVF rates were low; all participants who discontinued due to PDVF expressed levels of HIV-1 RNA below the clinically significant level of 200 copies/mL. Observed low-level viremia was similar to those reported in previous studies that included treatment-naïve patients. Investigators stressed the importance of continuing research in this area of HIV-1 infection treatment.

Phase 3 Sub-Analysis of DRIVE-SHIFT Trial

The latest findings from the phase 3 DRIVE-SHIFT trial, which assessed patients that had shifted treatment to doravirine/3TC/TDF, found that weight changes in patients reflected the average change reported in HIV-negative adults in the United States. Following the treatment change, patients in the Immediate Switch group gained 1.4 kg, whereas those in the 2-year Delayed Switch Group gained 1.2 kg.

“The initiation of some types of antiretroviral therapy in people living with HIV has been associated with weight gain,” said Princy Kumar, MD, chief, division of infectious diseases and tropical medicine at MedStar Georgetown University Hospital and professor of medicine and microbiology, Georgetown University School of Medicine, Washington, DC. “Our post-hoc analysis of weight changes from the Phase 3 DRIVE-SHIFT trial showed weight changes with Delstrigo comparable to the average annual weight gain observed in the general adult population.”

Prescribing information for doravirine can be found 

, and prescribing information for doravirine/3TC/TDF is available 

Merck Announces New Analyses Showing Additional Safety and Efficacy Data for Investigational Islatravir in Combination with Doravirine in Adults with HIV-1 Infection. News Release. Merck; July 6, 2020. Accessed July 7, 2020. 

https://www.mrknewsroom.com/newsroom/news-releases/news-details/2020/Merck-Announces-New-Analyses-Showing-Additional-Safety-and-Efficacy-Data-for-Investigational-Islatravir-in-Combination-with-Doravirine-in-Adults-with-HIV-1-Infection/default.aspx

Both trial sub-analyses will be presented at the virtual 23rd International AIDS Conference.

Merck Announces New Trial Results for Islatravir Plus Doravirine in Antiretroviral-Naïve Adults With HIV-1

Walgreens and VillageMD announced today their commitment to making Walgreens the first national pharmacy chain to integrate physician offices at their locations on a large scale, effectively providing full-service to their patients through an integrated model.

The partnership aims to open between 500 and 700 “Village Medical at Walgreens,” a full-service clinic led by physicians, in upwards of 30 US markets within the next 5 years. Village Medical at Walgreens plans to staff an estimated 3600 primary care providers, with recruitment being led by VillageMD. Pharmacists will be uniquely integrated as critical members of the multi-disciplinary team, according to Walgreens. 

“This rollout is a major advancement of one of Walgreens Boots Alliance’s 4 key strategic priorities, Creating Neighborhood Health Destinations,” said Stefano Pessina, executive vice chairman and chief executive officer, Walgreens Boots Alliance. “These clinics at our conveniently located stores are a significant step forward in creating the pharmacy of the future, meeting many essential health needs all under one roof as well as through other channels.”

The expanded partners have been conducting a trial of this new integrated model in the Houston, Texas region, and reported favorable results since opening the test location in November; patients rated the full-service doctor office highly, with Net Promoter Scores above 90.

The prevalence of multiple chronic conditions in the United States, and thus increasingly complicated maintenance of these conditions, renders the full-service model critical in its ability to offer expanded and accessible health care options to Americans. Six in 10 Americans live with at least 1 chronic condition requiring multiple daily medications, and data stemming from Village Medical clinics have demonstrated the importance of integrating primary and pharmacy care, as it supports medication adherence and improved patient outcomes.

“In the US, we spend $4 trillion per year on health care, over 85% of that is tied to patients with chronic diseases. To improve our healthcare system and reverse the trajectory of health spending, we must meet the needs of all patients. This partnership allows us to unleash the power of primary care doctors and pharmacists, enabling them to work in a coordinated way to enhance the patient experience,” said Tim Barry, chairman and chief executive officer, VillageMD. “The results of our initial pilot clinics highlight that these outcomes are infinitely achievable.”

The clinics will accept a wide range of health insurance options, as well as comprehensive primary care across a broad range of physician services, according to Walgreens. Continual care will be available through telehealth and at-home visits. 

Walgreens and VillageMD to Open 500 to 700 Full-Service Doctor Offices within Next Five Years in a Majoir Industry First. News Release. Businesswire; July 8, 2020. Accessed July 8, 2020. 

https://www.businesswire.com/news/home/20200708005320/en/Walgreens-VillageMD-Open-500-700-Full-Service-Doctor

Village Medical at Walgreens will staff a multi-disciplinary team, with pharmacists functioning as key members of the integrated model. 

Walgreens to Offer Large-Scale, Full-Service Physician Offices At Stores

The American Society of Health-System Pharmacists (ASHP) announced the results of its annual survey of pharmacy directors from almost 5000 hospitals across the country, which delivered valuable insights on hospital and health system pharmacy practice.

American Journal of Health-System Pharmacy (AJHP), 

gauged prescribing and transcribing strategies used by hospital pharmacy and therapeutics (P&T) committees, with the most common tools including therapeutic interchange, evidence-based clinical practice guidelines, opioid stewardship, and comparing the efficacy of products when making formulary decisions. The survey also pointed to additional trends in areas of staffing and the use of mobile technology.

Lead author Craig A. Pederson of Virginia Mason Medical Center noted that the findings are not surprising, as these strategies have been proven to be effective. Of note, the results determined an increase in the use of therapeutic interchange since 2016.

Other noteworthy trends on the basis of formulary management from the survey:

Thirty-one percent of hospitals reported rationing medications due to expected patient outcomes and cost of therapy, up from 25% in 2016.

Seventy-three percent of hospitals has be limited strict formulary and tight restrictions on non-formulary medication use, up from 63% in 2016.

Eighty-nine percent of hospitals provide their pharmacists the authority to write medication orders; among these locations, 94% of pharmacists are able to modify or initiate therapy by policy or protocol, whereas 6% are authorized to prescribe medications.

“Seventy-two percent of hospitals use protocols that transfer authority for product selection and dosing from prescribers to pharmacy as a strategy by P&T, suggesting that pharmacists are increasingly recognized as effective stewards of the formulary system, and at implementing formulary standards,” Pedersen said. “This is significantly less than 77% of hospitals in 2016.”

Related to pharmacogenomics, a mere 5.4% of hospitals who participated in the survey reported their recommendations for or scheduling of pharmacogenomics testing for determining drug and dosage; 90% indicated that their pharmacists experience limitations in dispensing products for pharmacogenomics drugs therapy management.

But although the survey showed limited pharmacy involvement in this area of drug management, Pederson remains hopeful that the prevalence of pharmacogenomics will only improve from here.

“There are a lot of drug products with pharmacogenomic markers,” Pederson said. “So where are pharmacists in pharmacogenomics? At this point, pharmacists play a very limited role. Some might be very disappointed in that — I think there are a lot of people that are highly invested in this. But my point is that pharmacogenomics has not yet become the pharmacokinetic monitoring of pharmacy. That’s not to say that I don’t think it will.”

On the other hand, more positive trends from ASHP’s survey were found in opioid stewardship, as 47% of hospitals had active opioid stewardship programs, compared with 41% in 2018, and 65% indicated that their pharmacists function as leaders for accountability concerning the hospital’s opioid stewardship programs.

Philip J. Schneider, co-author and professor in the College of Pharmacy at The Ohio State University, lauded these trends showing increased pharmacist participation. “The good news is that if a hospital has an opioid stewardship program, which nearly half do, pharmacists are almost always involved,” he said.

Other areas of growth in this sector included the following:

Eighty-five percent of hospitals reported educations programs or guidelines, compared to 71.4% in 2018.

Eighty-five percent have been using a prescription drug monitoring database, compared to 63.5% in 2018.

Sixty-one percent limit home discharge prescription supplies of opioid medications, compared to 46.3% in 2018.

Results from the survey also included data on hospital staffing of pharmacists, as the number of full-time pharmacist positions have grown since 2016, with a mean of 19.2 positions for each 100 occupied beds. Pharmacists also showed a vacancy rate of less than 3%; pharmacy technicians had a vacancy rate of 6.5%. Despite challenges in vacancy rates for technicians, human resource commitments to support new services are increasing, and staff credentialing continues to expand for pharmacists and technicians, the authors wrote.

Encouraging results also took form in the survey’s data concerning mobile technology. The majority of pharmacists are now using smartphones, tablets, or laptops to supplement and facilitate patient care services following the nearly universal adoption of the universal electronic health records.

“Pharmacists continue to assume greater responsibility for writing medication orders, dosing, ordering laboratory tests, and monitoring outcomes,” the authors of the survey reported. “Health-system pharmacist are taking a leading role in addressing the opioid crisis, advancing safety in compounded sterile preparations through adoption of intravenous workflow technologies, and optimizing EHR applications to leverage clinical decision support tools to improve the safe prescribing and use of medications.”

The survey was conducted prior to the COVID-19 pandemic.

ASHP National Survey Reveals Trends in Pharmacy Practice. News Release. ASHP; June 26, 2020. Accessed July 7, 2020. 

https://www.ashp.org/news/2020/06/26/ashp-national-survey-reveals-trends-in-pharmacy-practice?loginreturnUrl=SSOCheckOnly#

The annual survey hit on key health-system pharmacy insights related to formulary management, pharmacogenomics, and opioid stewardship, among others. 

Author | Gabrielle Ientile, Assistant Editor

Articles

CVS Pharmacy Offering New Spoken Rx App Feature

Merck Announces New Trial Results for Islatravir Plus Doravirine in Antiretroviral-Naïve Adults With HIV-1

Walgreens to Offer Large-Scale, Full-Service Physician Offices At Stores

ASHP Annual Survey Reveals Key Trends in Health-System Pharmacy