By Dave Ferris, PharmD
Hypertrophic Obstructive Cardiomyopathy (HOCM) is a devastating disease and, until recently, had no treatment. With the introduction of mavacamten, symtoms not only improve but disease progression can be reversed. This medication poses significant drug interactions and possible complications. With medication-related expertise, pharmacists have the opportunity to improve patient safety and care for patients with HOCM who initiate this therapy. The following story details one patient’s positive experience with mavacamten and the different roles her pharmacist played in the acquistion, use, and ongoing management of her therapy.
I’m a 72 year old female who was diagnosed with HOCM about 3 years ago. This condition leaves me tired and short of breath during just simple activities.
During a visit to my heart doctor things changed. A pharmacist was in the room during my visit. They both explained that there is a new treatment for HOCM called mavacamten. This drug actually treats the disease rather than managing symptoms like my metoprolol and verapamil. They explained that the drug was approved in April 2022. It actually helps expansion and contraction of my stiff heart, making it work better. Results show that obstruction is reduced or reversed allowing me to perform activities of daily living and make me feel better. Also, I was glad to hear that the verapamil would be stopped since it made me feel even more tired.
The pharmacist showed me models and information on how the drug worked and that side effects tend to be minimal. He anwered all my questions. However, there were three requirements to be on this drug mandated by the FDA called REMS criteria. First was easy, I could not get pregnant. Second, I needed ECHOs routinely at 4, 8 and 12 weeks initially. ECHOs would be needed as long as I was on the drug every 12 weeks andmore frequenlty if dosage changed. The pharmacist explained that this was how they determine the best dose for me. I was concerned about costs for all these ECHOs, but the pharmacist assured me since the ECHOs were FDA required, Medicare would cover with my secondary insurance picking up any additional cost. The third requirement concerns drug interactions. Now I know why the pharmacist was part of my visit. Who better to talk about drug interactions than a pharmaicst. Since there are many drugs that interact with mavacamten, he took a medication history, including any over the counter medications and also asked about any herbal or supplements that I take. Since I was on a drug for my nerves and another for depression, he said he would talk to my prescribing physician to determine what is best since there may be interactions. The pharmacist provided alternatives but also suggested a “wait and see” if the mavacamten would change the effects of my medication. He thought that the possible increased metabolism of my drugs would not be enough to change the overall effects of my medications. My physician agreed and both drugs stayed the same, and I have not experienced any decrease in effectiveness. The pharmacist also reassured me that he would be available any time I’m prescribed other medications to make sure there are no interactions. He told me that he needs to report to the REMS program if there are any changes to the ECHOs or medications.
The pharmacist helped me complete the required forms to start mavacamten. He also told me that once approved, a pharmacy would call me to let me know how much my co-pay would be. He said not to have a heart attack when the pharmacy tells you it will be $300 to $1000 per month! There is help available for these high co-pays, either through foundatons or the drug company patient assistance program. His goal is to lower the co-pay to zero dollars and has been successful so far.
Since being on this drug, I feel better and even signed up for golf lessions. I’m able to do things that I haven’t been able to do in years. I tell this to my pharmacist every time I see him during my ECHOs or office visits. He still asks the same questions about any new drugs and when I scheduled my next ECHO. He has stopped asking if I’m thinking about getting pregnant though.
As can be seen from the excerpt above, pharmacists can play a significant role in the treatment of HOCM. Increased patient safety through drug interaction checking and drug monitoring along with patient satisfaction are benefits of pharmacist co-management. There are potential financail benefits as well. A co-visit with a physician and pharmacist often leads to a high level of care and an ability to code visits at a higher level. Additionally, by completing forms such as prior authorizations and REMS criteria, the pharmacist can free up a lot of time for the physician to see additional patients.
Figure 1 - Pharmacist’s Role in Hypertrophic Obstructive Cardiomyopathy
Image from: iStockphoto.com with standard license
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Dave Ferris, PharmD
Cardiovascular Medicine Associates
Middleburg Heights, OH 44130