Pharmacist Triage Trends in ATTR-CM Care: Namarta Kalia, PharmD

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Refill coordination was the most common pharmacist intervention in a health-system specialty pharmacy (HSSP) program for patients with transthyretin amyloid cardiomyopathy (ATTR-CM), and prescribers accepted 90% of the symptom escalations pharmacists flagged, according to a retrospective study presented at the National Association of Specialty Pharmacy (NASP) inSPire2026 meeting.¹ Namarta Kalia, PharmD, BCPS, BCGP, CSP, clinical pharmacist at Shields Health Solutions, presented the findings.

The single-center analysis included 439 adults with ATTR-CM enrolled in the HSSP patient management program from November 2025 to April 2026. Over that 6-month period, pharmacists completed 68 interventions: 27 (40%) for refill coordination, 21 (31%) for symptom escalation, 18 (26%) for adherence counseling, and 2 (3%) in other categories. Mean proportion of days covered, the study’s measure of medication adherence, was 98%.

Of the 21 symptom escalations, 12 (57%) led to adjustments in supportive heart failure therapies, 7 (33%) to accelerated clinic appointments, and 2 (10%) to recommendations for emergency department evaluation. The authors concluded that pharmacist-identified symptom escalations facilitated timely clinical responses and supportive therapy optimization.

Kalia said the relatively low intervention rate reflects a stable, engaged patient population rather than interventions going undercaptured.

“I know the number may seem very small, but a lot of those interventions are very impactful across the board for patients,” she said. Because the disease-stabilizing therapies these patients take are generally well tolerated and do not require dose adjustments or accompanying laboratory monitoring, she explained, the pharmacy team can concentrate on proactive monitoring to identify subtle changes patients report before they turn into significant clinical issues.

In this interview with The American Journal of Managed Care^® (AJMC^®), Kalia walks through how her team decides which touchpoints stay at the pharmacist level and which go to the treating clinician. “We try to follow a more risk-based approach,” she said. Medication access, refill timing, and adherence concerns are handled by the specialty pharmacy, with clinicians looped in rather than having issues escalated to them.

Escalation is reserved for clinically meaningful changes in a patient’s presentation, including ones patients may not recognize as significant because they feel well and their activities of daily living have not changed. Kalia cited worsening shortness of breath, edema, and significant weight gain that could signal fluid overload as examples that should be addressed promptly rather than allowed to progress to a hospital admission.

Identifying trends matters as much as flagging single events, she said. A single brief episode of shortness of breath after a patient carries in groceries may not warrant escalation; instead, Kalia might schedule a follow-up call to check for further episodes. If those episodes recur, she relays that pattern of progression to the clinician so they can follow through with an evaluation.

Reference

1. Kalia N, Adler A, Lindner C, Stutsky M. Pharmacist interventions associated with a cardiac amyloidosis patient management program. Poster presented at: National Association of Specialty Pharmacy inSPire2026; September 22-25, 2026; National Harbor, MD. Abstract PSP79-OR.