A model program for pharmacist-managed healthcare delivery: A tixagevimab-cilgavimab (EVUSHELD) clinic at a Veterans Affairs healthcare system

Background: Pharmacists are under-utilized as caregivers who can improve patients' access to medical treatments. In this study, effectiveness of a multidisciplinary pharmacist-managed clinic in delivering tixagevimab-cilgavimab pre-exposure coronavirus disease 2019 (Covid-19) prophylaxis was determined.Methods: An observational study at the Veterans Affairs (VA) Pittsburgh Healthcare System tixagevimab-cilgavimab clinic from January 1, 2022 to January 1, 2023 was conducted. Pharmacists identified immunocompromised Veterans system-wide, performed active (telephone) or passive (mail) outreach to those in three highest-risk categories and a more moderate-risk category, respectively, and prescribed and dispensed tixagevimab-cilgavimab.Results: Eligible Veterans were stratified into Categories 1 (highest-risk; 18% [193/1089]), 2 (2% [18/1089]), 3 (17% [188/1089]), or 4 (most moderate-risk; 63% [690/1089]). Most common underlying conditions were rheumatologic (33%, 356/1089), oncologic (20%, 214/1089), and organ transplantation (18%, 197/1089). Twenty five percent (268/1089) of patients received >= 1 tixagevimab-cilgavimab dose. Acceptance in Categories 1-3 was 63% (121/193), 78% (14/18), and 37% (70/188), respectively (51% overall). Acceptance in Category 4 was 9% (63/690; p < 0.0001 vs. Categories 1-3). To put data into context, <2% of immunosuppressed persons in the United States were reported to receive tixagevimab-cilgavimab. Acceptance was greater among Veterans with rheumatologic or oncologic diseases than those with transplant-related or neurologic diagnoses (p < 0.0001), and among Covid-19-vaccinated versus non-vaccinated Veterans (27% [261/952] and 5% [7/137], p < 0.0001). Six percent (15/268) and 5% (42/821) of treated and untreated patients, respectively, were subsequently diagnosed in-system with Covid-19.Conclusions: A pharmacist-managed clinic effectively delivered tixagevimab-cilgavimab to immunocompromised Veterans, in particular those at highest Covid-19 risk. This program is a model for pharmacist-led clinics for other therapeutics or diseases.