A model program for pharmacist‐managed healthcare delivery: A Tixagevimab‐Cilgavimab (EVUSHELD) clinic at a VA Healthcare System

Abstract 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.