2026 Southeastern Residency Conference

Authors: Amanda Dunlap, Dillion Frazier, and Cy Sims

Background: Tafamidis and vutrisiran are novel therapeutics shown to improve mortality rates and reduce hospitalization among cardiac amyloidosis patients. However, these medications are associated with substantial costs and prescribing challenges. Considering the high cost, lack of data in a rural healthcare system, and the increasing role of pharmacists in specialty pharmacies, there is a significant administrative interest in gaining a better understanding of the impact these medications have within our community. This project investigated the real-world adherence and outcomes of tafamidis and vutrisiran in a rural setting.

Methods: Tafamidis patients were identified using reports from Therigy. Reports included new starts of tafamidis from January 1, 2022-July 31, 2025, pharmacy turnaround times, and missed doses reported during follow-up. Vutrisiran patients were identified from Soarian Financials by filtering patients who received a prescription for vutrisiran from June 1, 2025-July 31, 2025. Patient charts were reviewed and followed for 6 months prior to treatment initiation and 6 months after the first prescription. The primary outcome of the study was to determine adherence to tafamidis and vutrisiran. Adherence was defined for tafamidis based on pharmacy dispensing records used to calculate the medication possession ratio greater than 80% signified adherence. Adherence for vutrisiran was based on documentation of administration in the patient medical record within 7 days of the next scheduled dose. Secondary outcomes were cardiovascular related hospital admission rates within the same patient 6 months pre-and post-drug initiation, the time from receiving the prescription to dispensing, the number of patients converted from tafamidis to vutrisiran, discontinuation of therapy as documented in the medical record or no fills within 60 days for tafamidis or a missed scheduled injection for vutrisiran, and insurance coverage.

Results: Of 153 patients included in the tafamidis group, 142 patients (92.8%) were found to be adherent. 11 patients (7.2%) were nonadherent with MPR score ranging from 66%-78%. In the vutrisiran group 4 of 13 patients were found to adherent, 7 were nonadherent as they did not receive a dose within 7 days post next scheduled dose, and 2 unable to obtain as the prescription was transferred to a different facility. Vutrisiran administration timing between doses ranged from 90-109 days for the 8 patients who received more than 1 dose, and 1 patient receiving 3 doses. Cardiovascular-related hospital admission rates were similar in the pretreatment group 9.8% vs 7.7% (tafamidis vs vutrisiran) while posttreatment admissions were higher in the vutrisiran group 13% vs 30%. The average time from receiving a prescription for tafamidis to the medication being dispensed from the pharmacy was 4.5 days and 32.2 days for vutrisiran. 13 tafamidis patients were additionally prescribed vutrisiran, and 3 patients were converted from tafamidis to vutrisiran. 7 tafamidis patients discontinued therapy while 3 vutrisiran patients discontinued. 152 patients in the tafamidis group had insurance coverage while 1 patient received 340b pricing. All vutrisiran patients had insurance coverage.

Conclusion: Tafamidis demonstrated high adherence rates, 92.8% of patients achieving a medication possession ratio ≥80, and had short pharmacy turnaround times. The findings highlight important adherence and operational challenges associated with specialty drugs especially in a rural setting. While also demonstrating the importance of specialty pharmacists optimizing access, minimizing delays, supporting adherence, and coordinating care for these patients.