Specialty Pharmacists Flag Symptoms, Sustain Adherence in ATTR-CM

Pharmacist-led touchpoints within health system specialty pharmacy (HSSP) programs for transthyretin amyloid cardiomyopathy (ATTR-CM) were associated with near-complete medication adherence and timely escalation of worsening symptoms, according to 2 posters presented at the National Association of Specialty Pharmacy's (NASP) inSPire2026 conference in National Harbor, Maryland.^1,2

ATTR-CM, in which abnormal transthyretin protein deposits in heart tissue cause restrictive cardiomyopathy, is underdiagnosed and mostly affects older adults.³ Because HSSPs interact with patients at every refill, the poster authors noted they are positioned to identify problems early.^1,2

Refill Coordination Accounted for 40% of Pharmacist Interventions

The first poster, a single-center retrospective evaluation, characterized pharmacist interventions among adults with ATTR-CM who were enrolled in an HSSP patient management program and filled a specialty medication between November 2025 and April 2026.¹ Under the program's workflow, a pharmacy liaison handles refill activities every 30 to 90 days, while pharmacists complete an initial assessment at therapy start, a check-in at days 7 to 10, and clinical reassessments every 2 to 10 months.

Pharmacists documented 68 interventions across 439 unique patients during the study period. Refill coordination was the most common category (40%; n = 27), followed by symptom escalation (31%; n = 21), adherence counseling (26%; n = 18), and other interventions (3%; n = 2). The mean proportion of days covered (PDC) was 98%.

Of the 21 escalations to clinic providers for patient-reported worsening symptoms, 57% (n = 12) resulted in an adjustment to concurrent therapy, 33% (n = 7) led to an accelerated clinic appointment, and 10% (n = 2) involved a recommendation for emergency department evaluation. Providers accepted 90% of these escalations, which the authors said enabled timely clinical responses.

About 74% of Patients Saw No Shift in Treatment Perception

The second poster examined how patients perceived their treatment for ATTR-CM over time.² The retrospective analysis included 1032 treated adults through a national HSSP network between May 2019 and February 2026 and had a baseline and at least 1 follow-up New York Heart Association (NYHA) class on record. At every routine refill, pharmacy liaisons asked a single, nonvalidated question rating how well the medication helped patients manage their condition on a 5-point scale, with responses grouped as positive, neutral, or negative.

Patients had a mean age of 80 years at initial fill, 76% were men, and most had NYHA class II (40%) or class III (48%) symptoms at baseline. Overall, 74% never changed perception category during therapy, 2% had only decreases, 2% had only increases, and 22% had both increases and decreases.

Adherence stayed high across all groups, with a mean adjusted PDC of 97.9% over a mean of 603.5 days on therapy. Patients averaged 6.2 pharmacist touchpoints, spaced about 103 days apart. Those with both upward and downward shifts had the most touchpoints (mean, 7.4) but also the longest time on therapy (mean, 878.5 days), compared with 5.9 touchpoints over 528.4 days among patients whose perception never changed.

The authors framed the findings as descriptive practice insights rather than a validation of patient-reported measures, noting that recognizing perception changes may support tailored counseling.

Taken together, the posters frame the specialty pharmacy refill cycle as a recurring checkpoint for adherence, symptom surveillance, and care coordination in an older, medically complex population. Because both analyses were retrospective without a comparison group, however, they cannot show that pharmacist involvement caused the outcomes observed.

References

1. Kalia N, Adler A, Stutsky M, Lindner C. Pharmacist interventions in a cardiac amyloidosis patient management program. Poster presented at: NASP inSPire2026; September 22-25, 2026; National Harbor, MD.
2. Stutsky M, Luder H, Napolitano T, Chun YC. Patient perception of treatment experience observed during routine specialty pharmacy interactions for ATTR-CM. Poster presented at: NASP inSPire2026; September 22-25, 2026; National Harbor, MD.