Increasing taxonomic diversity and spatial resolution clarifies opportunities for protecting US imperiled species.

Continental- and regional-scale assessments of gaps in protected area networks typically use relatively coarse range maps for well documented species groups, creating uncertainty about the fate of unexamined biodiversity and providing insufficient guidance for land managers. By building habitat suitability models for a taxonomically diverse group of 2216 imperiled plants and animals, we revealed comprehensive and detailed protection opportunities in the conterminous United States. Summing protection-weighted range-size rarity (PWRSR, the product of the percent of modeled habitat outside of protected areas and the inverse of modeled habitat extent) uncovered novel patterns of biodiversity importance. Concentrations of unprotected imperiled species in places such as the northern Sierra Nevada, central and northern Arizona, the Rocky Mountains of Utah and Colorado, southeastern Texas, southwestern Arkansas, and Florida's Lake Wales Ridge have rarely if ever been featured in continental- and regional-scale analyses. Inclusion of diverse taxa (vertebrates, freshwater mussels, crayfishes, bumble bees, butterflies, skippers, and vascular plants) partially drove these new patterns. When analyses were restricted to groups typically included in previous studies (birds, mammals, and amphibians), up to 53% of imperiled species in other groups were left out. The finer resolution of modeled inputs (990 m) also resulted in a more geographically dispersed pattern. For example, 90% of the human population of the conterminous United States lives within 50 km of modeled habitat for one or more species with high PWRSR scores. Over one-half of the habitat for 818 species occurs within federally lands managed for biodiversity protection; an additional 360 species have over one-half of their modeled habitat on federal multiple use land. Freshwater animals occur in places with poorer landscape condition but with less exposure to climate change than other groups, suggesting that habitat restoration is an important conservation strategy for these species. The results provide fine-scale, taxonomically diverse inputs for local and regional priority-setting and show that although protection efforts are still widely needed on private lands, notable gains can be achieved by increasing protection status on selected federal lands.

Analysis of prior authorization success and timeliness at a community-based specialty care pharmacy.

BACKGROUND: Specialty medications may require a prior authorization (PA) before a patient can access the medication. Providers often identify PA approval as a burden for the practice. Pharmacists can facilitate the completion of the PA process. OBJECTIVE: The primary objective was to evaluate the time to first PA decision (approval or denial) for dermatologic medications dispensed by a community-based specialty pharmacy. A secondary objective was to compare PA timeliness (time to PA approval and time to first medication fill) between a community-based specialty pharmacy and a dermatology provider office. PRACTICE DESCRIPTION: Realo Specialty Care is a community-based independent specialty pharmacy that provides comprehensive care to patients with complex and chronic conditions such as plaque psoriasis, hidradenitis suppurativa, and atopic dermatitis. Pharmacy services include PA assistance, comprehensive medication management, patient education, and adherence monitoring. PRACTICE INNOVATION: Pharmacy dispensing system data were used to conduct a retrospective analysis of the effectiveness at resolving PA requests. PAs are traditionally completed by a provider's practice, and data are documented within the pharmacy system as a PA task. EVALUATION METHODS: Data included PA tasks for dermatology prescriptions for patients aged 18 years or older between January 1, 2017, and June 30, 2019. Initial receipt of the prescription, PA decision, and PA decision date were noted in the PA task and confirmed via fax documentation. The date of first fill was confirmed by prescription data. RESULTS: The pharmacy completed 677 PA tasks with a mean time to PA decision of 1.9 days, whereas the provider's office averaged 20.9 days (P < 0.001). The pharmacy demonstrated a mean time to first fill of 6.6 days, whereas the provider's office averaged 16.2 days (P < 0.001). CONCLUSION: Pharmacies can effectively complete PAs to expedite the filling process for patients and increase medication access. Provider practices could benefit from delegating these tasks to a partnered pharmacy.

Development of a process to improve medication adherence in patients with rheumatoid arthritis in the specialty pharmacy setting.

OBJECTIVE: To develop a disease-specific patient questionnaire to be used during monthly follow-up telephone calls ("refill calls") for patients with rheumatoid arthritis receiving a noninfused biologic medication. SETTING: Independent specialty community pharmacy in North Carolina. PRACTICE DESCRIPTION: Realo Specialty Care was formed to provide a patient-centered care approach to patients with complex, chronic conditions such as HIV/AIDS, hepatitis, rheumatoid arthritis, and plaque psoriasis. The services include medication therapy management, patient education, prior authorization assistance, adverse drug reaction monitoring, and an adherence program. PRACTICE INNOVATION: Using national guidelines, an 8-item questionnaire that addressed overall health, adherence, and adverse medication events for noninfused biologic medications for rheumatoid arthritis was developed. When an eligible patient was identified, a notification was added within the pharmacy's dispensing software. The pharmacist or technician was prompted to use the newly developed questionnaire during the monthly refill call. EVALUATION: Patients' responses were archived in their profiles within the pharmacy's dispensing software. The change in adherence was assessed by the mean medication possession ratio (MPR) before the intervention (July 2018 to September 2018) and monthly after the intervention (November 2018 to February 2019). RESULTS: A total of 29 patients were eligible on the basis of an MPR less than 90%; data from 18 patients were used. The mean MPR increased from 71% preintervention (September 2018) to 75% in the first month after the start of the intervention (November 2018). The mean MPR reached a high of 81% in the fourth month after the start of the intervention (February 2019), representing a 10% increase in the MPR. CONCLUSION: The specialty pharmacy team successfully developed and used the rheumatoid arthritis questionnaire during the monthly refill calls. The implementation of the disease-specific questionnaire led to increased medication adherence and enhanced communication with patients with regard to their health and outcome of therapy.