Rheumatoid Arthritis Treatment,
Product Administration, Training and
Patient Assistance/Compassionate Use
Program Awareness for the Specialty
Pharmacist and the Collaborative
Healthcare Team
Disclaimer
The information within this CME/CE activity is for continuing
education purposes only, and is not intended to substitute for the
medical judgment of the healthcare provider. Recommendations
for use of any particular therapeutic agents or methods are based
upon the best available scientific evidence and clinical guidelines.
Reference in this activity to any specific commercial products,
process, service, manufacturer, or company does not constitute its
endorsement or recommendation.
Developer discloses that he is a speaker, consultant, and provides
research support for the National Association of Specialty
Pharmacy. He does not intend to discuss non-FDA approved
drugs or investigational use of any product/device.
Faculty Biography
Michael J Crocco,
PharmD, RPh, CSP
Specialty Pharmacy
Clinical Services
National Association
of Specialty Pharmacy
•
University of Florida 2008
•
Pharmacist in Charge – Publix Super Markets
•
National Association of Specialty Pharmacy –
Specialty Pharmacy Clinical Consultant
•
Specialty Pharmacy Education Center –
Reviewer/author of CE’s
•
Specialty Pharmacy Certification Board –
Subject matter expert in developing Certified
Specialty Pharmacy Credential
•
Certified Specialty Pharmacist
Objectives
• Recognize the various inflammatory autoimmune disorders
and their distinguishing features.
• Identify current treatment options for RA and review their
appropriate administration
• Identify the three biggest barriers to adherence & persistence
and how Specialty Pharmacists and the collaborative
healthcare team can anticipate & overcome those barriers
• Identify RA patient assistance programs from RA
manufacturers and 3rd parties
• Describe the specialty pharmacist and the collaborative
healthcare team’s role in RA condition management resulting
in cost-effective care
Other Autoimmune Diseases
(Brief Overview)
Crohn’s Disease
•
Inflammatory Bowel Disease
•
•
Lining of digestive tract (mouth to anus)
Signs/Symptoms
•
Abdominal pain
•
Severe diarrhea
•
Blood in stool
•
Ulcers
•
Reduced appetite
•
Weight loss
http://upload.wikimedia.org/wikipedia/commons/b/bf/Patterns_of_Crohn%27s_Diseas
e.svg
Ulcerative Colitis
•
Inflammatory bowel disease
•
•
Lining of large intestine
Types of UC:
•
Proctitis
•
Proctosigmoiditis
•
Left-sided Colitis
•
Pancolitis
•
Fulminant Colitis
http://specialityclinic.com/Images/Disease/Ulcerative_%20Colitis.j
pg
Psoriatic Arthritis
•
Enthesitis
•
•
Characteristic feature
Signs/Symptoms
•
Similar to RA, plus…..
•
Swollen fingers and toes
•
Foot pain
•
Lower back pain
Juvenile Idiopathic Arthritis
•
Children
•
•
6 months – 16 years old
Types of JIA
•
Pauciarticular
•
Polyarticular
•
Systemic
Juvenile Idiopathic Arthritis
•
Symptoms
•
Pain
•
Swelling
•
Stiffness
•
Swollen lymph nodes
•
Rash
•
Fever
Ankylosing Spondylitis
•
Spine
•
•
Vertebrae fuse
Signs/Symptoms
•
Lower back pain
•
Hip pain
http://www.webmd.com/back-pain/guide/ankylosing-spondylitis
Treatment Options
Rheumatoid Arthritis
DMARDs
• Methotrexate (Trexall, Rheumatrex)
• Leflunomide (Arava)
• Hydroxychloroquine (Plaquenil)
• Sulfasalazine (Azulfidine)
Methotrexate
•
Dosing
•
Once weekly
•
Oral or injection (IM or SQ)
•
Titrate up as necessary
•
Hydration
•
Monitoring
•
LFT’s
•
CBC w/diff
•
Platelets
•
BUN/Cr
Methotrexate
• SQ Injection
• 25 Gauge
• 1/2 - 5/8 inch
http://www.childrenshealthnetwork.org/CRS/CRS/pa_subinjec_art.
htm
Methotrexate
• IM Injection
• 25 Gauge
• 1 - 1.5 inch
http://www.childrenshealthnetwork.org/CRS/CRS/pa_iminject_art.
htm
Leflunomide
•
•
Dosing
•
Loading dose of 100mg x 3 days
•
20mg daily thereafter
•
With food
Monitoring
•
BP
•
Platelets
•
WBC’s
•
Hgb/Hct
•
LFT’s
Leflunomide
•
Drug elimination procedure
•
Cholestyramine 8g TID x 11 days
•
Plasma levels <0.02mg/dL
•
•
2 tests, 14 days apart
If no elimination procedure……
•
Up to 2 years to reach <0.02mg/dL
Hydroxychloroquine
•
•
Weight based dosing
•
6.5mg/kg /day
•
Typically 200-400mg daily
Monitoring
•
Eye exams
•
•
Yearly
Keep away from children
•
Small doses fatal
Sulfasalazine
•
•
•
Dosing
•
500-1000mg Q12H
•
Up to 4000mg daily
Monitoring
•
CBC w/diff
•
LFTs
•
BUN/Cr
Caution
•
Sulfonamide allergy
•
Salicylate allergy
TNFa Inhibitors
•
Humira (Adalimumab)
•
Enbrel (Etanercept)
•
Cimzia (Certolizumab pegol)
•
Simponi (Golimumab)
•
Remicade (Infliximab)
Humira
•
Dosing
•
40mg SQ q2wk
•
40mg SQ qwk if not on MTX
•
Refrigerate
•
Monitor
•
•
Hep B antigen
•
PPD
•
s/sx TB and HBV
Cost
•
$2400-$2700
•
(2 pens/syringes)
Humira
•
Administering Pen
•
Clear/colorless liquid
•
No particles
•
Front of thighs/lower abdomen
•
Clean area
•
Gently squeeze skin and hold firmly
•
Hold pen at 90 degree angle
•
Push plum colored button until clicks
•
Hold for 10 seconds
•
Yellow Indicator = Completed
•
Do not rub area
http://1.bp.blogspot.com/2IpGLsVangU/UEktd63ThII/AAAAAAAAAJw/wmt8vVOYiC8/s1600/humira1.jpg
Humira
•
Administering Prefilled Syringe
•
Clear/colorless liquid
•
No particles
•
Front of thighs/lower abdomen
•
Clean area
•
Gently squeeze skin and hold firmly
•
Insert at 45 degree angle and let go of skin
•
After injecting, remove at same angle
•
Do not rub area
http://2.bp.blogspot.com/8QaFwE1vRfE/T819tbn5jQI/AAAAAAAAACk/gAjBd3WTGPo/s1600/humira.jpg
Humira Patient Assistance Programs
•
myHumira
•
Humira Protection Plan
•
24/7 on-call nurse support
• 1-800-4-HUMIRA
•
•
Injection training kit
•
Sharps container
•
Medication reminders
•
On-the-go kit
Abbvie Patient Assistance Foundation
Enbrel
•
•
•
•
Dosing
•
50mg SQ qwk OR
•
25mg SQ 2x/wk 72-96h apart
Storage
•
Refrigerate
•
Room temperature – 14 days
Monitor
•
Hep B antigen
•
PPD
•
s/sx TB and HBV
•
Dermatologic exam*
Cost
•
$2200-$3000
Enbrel
•
Administering SureClick AutoInjector
•
Clear/colorless liquid
•
Front of thighs preferred
•
Abdomen/outer are of upper arms
•
Clean area
•
Stretch skin to make it firm and taut
•
Hold pen at 90 degree angle
•
Press pen firmly to unlock safety guard
•
Press and release purple button
•
Hold firmly for 15 seconds
•
Purple Indicator = Completed
•
Do not rub area
http://www.rxzone.us/images/products/med/999250.j
pg
Enbrel
•
Administering Enbrel PFS
•
Clear/colorless liquid
•
Front of thighs/lower abdomen/outer upper arms
•
Clean area
•
Gently squeeze skin and hold firmly
•
Inject at 45 degree angle
•
Do not rub area
http://www.walgreens.com//images/drug/0158406043504
.jpg
Enbrel PAP
•
Enbrel Support Card
•
Education
•
Injection training
•
Medication refill reminders
•
Live nurse support
• 1-888-4ENBREL
•
Starter kit
•
Sharps mail-back program
•
Travel pack
Enbrel Support Card
•
If commercial insurance:
•
•
•
$0 for 6 months, $10 afterwards
If Government insurance:
•
Connect with independent foundations
•
Low-income subsidy assistance
If Uninsured:
•
ENcourage Foundation
Cimzia
•
Dosing
•
400mg SQ on week 0, 2, 4, then
•
200mg SQ q2wk OR
•
400mg SQ q4wk
•
Refrigerate
•
Monitor
•
•
Hep B antigen
•
PPD
•
s/sx TB and HBV
•
Dermatologic exam*
Cost
•
~$2500
http://www.pharmatopics.com/wp/wpcontent/uploads/2013/09/UCB_cimzia_.jpg
Cimzia
•
Administration
•
Room temperature
•
30 minutes
•
Clear/colorless liquid
•
Front of thighs/lower abdomen
•
Clean area
•
Gently squeeze skin and hold firmly
•
Inject at 45 degree angle
•
Do not rub area
Cimzia PAP
•
Cimplicity
•
Treatment and patient support
•
Home Health Nurse
•
• 1-866-4-CIMZIA
Education
•
Injection training
•
Insurance coverage verification
•
Cimzia Co-pay Savings Card Program
•
•
Up to 12 months at no cost
Additional financial assistance
Simponi
•
Dosing
•
50mg SQ monthly with MTX
•
Refrigerate
•
Monitor
•
•
Hep B antigen
•
PPD
•
s/sx TB and HBV
•
Dermatologic exam*
Cost
•
~$8300 (5 syringes)
Simponi SmartJect Autoinjector
•
Administration
•
Room temperature
•
30 minutes
•
Clear/slightly yellow
•
Front of thighs/lower abdomen/outer area of upper arms
•
Clean area
•
Inject at 90 degree angle
•
Press firmly against skin to unlock safety sleeve
•
Press button until clicks
•
•
hold until clicks again
Do not rub area
http://d3hjf51r9j54j7.cloudfront.net/wp-content/uploads/sites/5/2010/09/Simponi-Ire-PackShot.jpg
Simponi Prefilled Syringe
•
Administration
•
Room temperature
•
30 minutes
•
Clear/slightly yellow
•
Front of thighs/lower abdomen/back of upper arms
•
Clean area
•
Gently squeeze skin and hold firmly
•
Inject at 45 degree angle
•
Hold plunger until removed from skin then release
•
Do not rub area
http://www.medhelp.org/drug_images/GOM00700.J
PG
SimponiOne Support
•
Injection Support
•
Nurse Support
• 1-877-MY SIMPONI
•
•
RN Live Link (on-line discussion)
•
7 days/wk, 8am-11pm
SmartJect Autoinjector Reusable Trainer
•
•
Included in Welcome Pack
Demonstration Videos
SimponiOne Support
•
Treatment Support
•
Simponi Welcome Pack
•
SimponiOne Safe Returns
•
•
Once a year return service
•
Holds 12 SmartJect autoinjectors
•
Holds more syringes
Travel Pack
•
Travel Advisory Card
https://www.simponi.com/ulcerative-colitis/sites/admin-simponi.jnj.com.ulcerative-colitis/themes/simponi_uc/images/transport-support-bags.p
http://www.simponi.com/hcp/sites/www.simponi.com.hcp/files/content_images/simponi_one_image_new.png
SimponiOne Support
•
Medication Cost Support
•
Commercial/Private Insurance
•
•
Government Insurance
•
•
$5/month up to $8000 benefit/yr
independent foundation
No insurance
•
Johnson & Johnson Patient Assistance Foundation
•
Other
Remicade
•
Dosing
•
3mg/kg IV on wk 0, 2, 6 THEN
•
3mg/kg IV q8wk
•
Use with MTX
•
Max dose 10mg/kg OR 3mg/kg q4wk
•
Refrigerate
•
Monitor
•
•
Hep B antigen
•
PPD
•
s/sx TB and HBV
•
Dermatologic exam*
Cost
•
$915.50 for one vial (100mg)
http://www.venus-rx.com/img/Rheumatology/Rheumatology-Janssen-Biotech-Remicade.jpg
Remicade
•
Administration
•
Colorless/light yellow
•
By medical professional
•
Infusion Center
•
At least 2 hours
http://www.gastro.higherimages3.com/wpcontent/uploads/2010/05/iStock_000010762269XSmall.jpg
Remicade PAP
•
AccessOne
•
Care Coordinator
• 1-888-Access-1
• M-F, 8am-8pm EST
•
Infusion site locations
•
Newsletters
•
Education materials
•
Appointment reminders
•
Emergency outreach services
Remicade PAP
•
•
RemiStart Patient Rebate Program
•
Co-pay assistance
•
Up to 12 months, 8 infusions, or $8000
RemiStart Extended Access Program
•
Must meet eligibility requirements
Other Biologics
• Kineret (Anakinra)
• Orencia (Abatacept)
• Rituxan (Rituximab)
• Actemra (Tocilizumab)
Kineret
•
Dosing
•
100mg SQ q24h
•
Refrigerate
•
Monitor
•
Cr
•
ANC
•
Pregnancy Category B
•
Cost
•
~$3000/28 syringes
http://www.bad-drug.net/wp-content/uploads/2012/10/209x166xkineret.gif.pagespeed.ic.5yhNnxy_j9.jpg
Kineret Prefilled Syringe
•
Administration
•
Sit at room temperature
•
60-90 minutes
•
Clear/colorless
•
Sites
•
Outer area of upper arms
•
Upper outer areas of buttocks
•
Abdomen
•
Front of the middle thighs
•
Gently pinch fold of skin
•
Inject at 45 or 90 degree angle
http://images.rxlist.com/images/rxlist/anakinra6.
gif
Kineret PAP
•
KineretKare Program
•
Copay assistance
•
Up to $300/month OR
•
$3600/year
•
Delivery of medication
•
Access to KineretKare specialist
• 1-866-547-0644
• M-F, 8am-6pm EST
Orencia
•
Weight based dosing
•
<60kg – 500mg IV on wk 0, 2, 4, then q4wk OR 500mg IV x1, then 125mg SQ w/in 24hr,
then 125mg SQ qwk
•
60-100kg – same as above but 750mg IV doses
•
>100kg – same as above but 1000mg IV doses
•
Refrigerate
•
Monitor
•
•
Hepatitis panel
•
PPD at baseline
Cost
•
$2100/vial (250mg)
•
$2500/4 syringes (125mg)
Orencia Administration
•
IV
•
Medical professional
•
Reconstitute with 10ml sterile water for injection
•
Must use silicone free syringe provided
•
30 minute infusion
http://www.bmscanada.ca/static/products/en/product_photo/orencia.jpg
Orencia Administration
•
SQ
•
Clear/colorless/pale yellow
•
Room temperature
•
•
30-60 minutes
Sites
•
Front of thigh
•
Upper outer arms
•
Abdomen
•
Gently pinch skin and hold firmly
•
Inject at 45 degree angle
http://2.bp.blogspot.com/Ulnq7gEQ1NM/UqNeD7LnvSI/AAAAAAAATEo/vQpbAc01osY/s1600/orencia.jpg
Orencia PAP
•
Orencia On Call
•
Personal care counselor
• Available 24/7
• 1-800-ORENCIA
•
Copay assistance
•
Welcome pack
•
Sharps Disposal Service
•
Drug Replacement
•
•
If damaged
Insurance questions
Orencia PAP
•
Orencia Copay Assistance Program
•
Covers cost of drug only
•
Infusion patients
•
$5 out of pocket per infusion
•
$8000/year max benefit
•
NOTE: state or federally funded insurance excluded
Rituxan
•
Dosing
•
1000mg IV on days 1 and 15 THEN
•
1000mg IV q24 weeks
•
•
Q16 weeks
In combination with MTX
•
Refrigerate
•
Cost
•
~$15,600 (one 10ml vial = 10mg/ml)
Rituxan
•
Monitoring
•
HBsAg
•
Anti-HBc at baseline
•
CBC
•
Platelets
•
ECG
•
s/sx of hepatitis or HBV reactivation
Rituxan
•
Administration
•
IV infusion
•
Medical professional
•
Pre-medicate
•
APAP and antihistamine
•
Methylprednisolone 100mg IV (RA patients only)
http://jlazur.com/WEBSITES/Rituxan/professional/dosage_administration/guide/rituxan_product.gif
Rituxan Infusion Rates
•
•
Initial Infusion = 50mg/hr
•
Increase at 50mg/hr increments q30 minutes
•
Max 400mg/hr
Subsequent infusions = 100mg/hr
•
Increase at 100mg/hr at 30 minute intervals
•
Max 400mg/hr
Rituxan PAP
•
Join Rituxan and You
•
Genentech Rheumatology Access Solutions
•
Genentech Access to Care Foundation
•
Genentech Rheumatology Co-pay Card Program
•
$10,000 over 12 months
•
$5 per co-pay
•
May reuse if still eligible after 12 months
Actemra
•
•
IV Dosing
•
4mg/kg IV over 1 hour q4wks
•
May increase to 8mg/kg IV q4wks
•
Do not exceed 800mg per infusion
SQ Dosing
•
162mg SQ qwk
•
If pt <100kg, start at 162mg SQ q2wks
•
Refrigerate
•
Cost
•
$340 (4ml vial)
•
$850 (10ml vial)
•
$1725 (20ml vial)
Actemra
•
Monitoring
•
PPD at baseline
•
s/x of TB
•
CBC w/differential (ANC’s)
•
Platelets
•
LFT’s
•
Lipid profile
Actemra Administration
•
IV Infusion
•
Clear/colorless/pale yellow
•
Medical professional
•
Room temperature
•
Infuse over 60 minutes
•
Use separate IV line
https://www.besse.com/PublishingImages/Actemra/Actemraprod.j
pg
Actemra Administration
•
SQ
•
Room temperature
•
•
30 minutes
Sites
•
Front of thigh
•
Outer area of upper arm
•
Abdomen
•
Gently pinch skin
•
Inject at 45 or 90 degree angle
•
Release pinched skin and inject
Actemra PAP
•
Actemra Access
•
Sampling Program
•
•
ACT Fast Program
•
•
SQ patients
6 months free
Support for Medicare Part D patients
•
Refer to LIS Program
•
Genentech Access to Care Foundation Extension
Actemra Access
•
Actemra and You
•
Symptom Tracker Calendar
•
Doctor Discussion Guide
•
Nurse Help Line
• 1-800-ACTEMRA
• 6am-12am EST
•
•
SC Injection tools
•
Travel Pack
•
Sharps Container
•
Injection Reminder Service
Treatment Tracker
Actemra Access
•
•
Genentech Rheumatology Co-pay Card Program
•
$10,000 per 12 months
•
$5 co-pay
Genentech Rheumatology Access Solutions
JAK inhibitor
•
Xeljanz (Tofacitinib)
Xeljanz
•
Dosing
•
5mg PO BID
•
With or w/o food
•
Room temperature
•
Monitoring
•
•
CBC w/diff
•
Lipid panel
•
LFT’s
Cost
•
~$2,000 (60 tablets)
XelSource
•
Private Insurance
•
Free Trial Offer
•
Personal Support
• 1-855-493-5526
• M-F, 8am-8pm EST
•
•
Xeljanz Copay Savings Card
•
$0 copay
•
$8,000 benefit per calendar year
Uninsured
•
XelSource Patient Assistance Program
Xeljanz
•
•
Government Insurance
•
Personal Support
•
Financial Assistance
•
State Pharmaceutical Companies
•
Low-income subsidies
•
Charitable foundations
•
Hardship support
Xeljanz + You
•
Welcome Kit
•
Refill reminders
•
Tips, Tools, and Resources
Other Patient Assistance Programs
•
NeedyMeds
•
Diplomat’s Co-pay Assistance Navigator
•
HealthWell Foundation
•
Patient Access Network Foundation
•
Bristol-Myers Squibb Patient Assistance Foundation
•
•
Orencia
Pfizer Pfriends
•
Xeljanz
Other Patient Assistance Programs
•
Partnership for Prescription Assistance
•
•
MedLink Prescription Assistance
•
•
Enbrel
Janssen Prescription Assistance
•
•
Humira
Simponi, Remicade
Johnson & Johnson Prescription Assistance Foundation
•
Remicade
Barriers to Adherence
•
•
Cost
•
Direct
•
Indirect
Administration
•
•
Transportation/Time
•
•
Complicated/intimidating
Infusions
Side effects
•
Cancer
•
Infertility
•
Pain
Overcoming Barriers
•
Treatment management
•
Counsel/Educate
•
•
Side effects
•
Self injections
Insurance
•
No more pre-existing condition
•
Use assistance programs
•
Home health nurse
•
Specialty Pharmacist
Conclusion
•
Multiple treatment options
•
Biologics are expensive
•
All have assistance programs
•
•
Make patients aware
Need to educate/counsel all patients
References
Mayoclinic. Crohn’s Disease. http://www.mayoclinic.com/health/crohnsdisease/DS00104. Accessed on November 19, 2013.
Crohn’s and Colitis Foundation of America. What is Crohn’s Disease?
http://www.ccfa.org/what-are-crohns-and-colitis/what-is-crohns-disease/. Accessed
on November 19, 2013.
Mayoclinic. Ulcerative Colitis. http://www.mayoclinic.com/health/ulcerativecolitis/DS00598. Accessed on November 19, 2013.
Crohn’s and Colitis Foundation of America. What is Ulcerative Colitis.
http://www.ccfa.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis/.
Accessed on November 19, 2013.
American College of Rheumatology. Psoriatic Arthritis.
http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/
Psoriatic_Arthritis/. Accessed on November 21, 2013.
Mayoclinic. Psoriatic Arthritis. http://www.mayoclinic.com/health/psoriaticarthritis/DS00476. Accessed on November 21, 2013.
References
Mayoclinic. Juvenile Rheumatoid Arthritis.
http://www.mayoclinic.com/health/juvenile-rheumatoid-arthritis/DS00018.
Accessed on November 21, 2013.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. What is
Juvenile Arthritis?
http://www.niams.nih.gov/Health_Info/Juv_Arthritis/juvenile_arthritis_ff.asp.
Accessed on November 21, 2013.
WebMD. Understanding Juvenile Rheumatoid Arthritis.
http://www.webmd.com/rheumatoid-arthritis/understanding-juvenilerheumatoid-arthritis-basics. Accessed on November 21, 2013.
Mayoclinic. Ankylosing Spondylitis. http://www.mayoclinic.com/health/ankylosingspondylitis/DS00483. Accessed on November 22, 2013.
American College of Rheumatology. Methotrexate.
http://www.rheumatology.org/Practice/Clinical/Patients/Medications/Methotre
xate_(Rheumatrex,_Trexall)/. Accessed on November 22, 2013.
References
Brooks PJ, Spruill WJ, Parish RC, Birchmore DA. Pharmacokinetics of methotrexate
administered by intramuscular and subcutaneous injections in patients with
rheumatoid arthritis. Department of Pharmacy Practice, University of Georgia
College of Pharmacy, Athens. Arthritis Rheum. 1990 Jan;33(1):91-4.
Mayoclinic. Leflunomide. http://www.mayoclinic.com/health/druginformation/DR601555. Accessed on November 24, 2013.
Sanofi-Aventis. Arava Package Insert. http://products.sanofi.us/arava/arava.html.
Accessed on November 24, 2013.
Mayoclinic. Hydroxychloroquine. http://www.mayoclinic.com/health/druginformation/DR600761. Accessed on December 5, 2013.
Mayoclinic. Sulfasalazine. http://www.mayoclinic.org/drugssupplements/sulfasalazine-oral-route/description/drg-20066179. Accessed on
December 5, 2013.
References
Patient Assistance Programs. www.needymeds.com. Accessed January 20, 2014 –
February 27, 2014.
Humira Product Information and Patient Assistance Programs. www.humira.com.
Accessed on January 15, 2014.
Enbrel Product Information and Patient Assistance Programs. www.enbrel.com.
Accessed on January 15, 2014.
Cimzia Product Information and Patient Assistance Programs. www.cimzia.com.
Accessed on January 16, 2014.
Simponi Product Information and Patient Assistance Programs.
www.simponi.com. Accessed on January 16, 2014.
Remicade Product Information and Patient Assistance Programs.
www.remicade.com. Accessed on January 18, 2014.
Kineret Product Information and Patient Assistance Programs. www.kineret.com.
Accessed on January 24, 2014.
References
Orencia Product Information and Patient Assistance Programs. www.orencia.com.
Accessed on January 31, 2014.
Rituxan Product Information and Patient Assistance Programs. www.rituxan.com.
Accessed on February 10, 2014.
Actemra Product Information and Patient Assistance Programs.
www.actemra.com. Accessed on February 12, 2014.
Xeljanz Product Information and Patient Assistance Programs. www.xeljanz.com.
Accessed on February 15, 2014.
Micromedex® Healthcare Series [Internet database]. Greenwood Village, Colo:
Thomson Healthcare. Updated periodically.
Epocrates. 2013. Epocrates Mobile Application. Retrieved from
http://www.epocrates.com/mobile/android.
Q &A
This program has been brought to you by The National Association of
Specialty Pharmacy and its education provider The Specialty Pharma
Education Center.
Claim Credit Instructions:
Visit www.specialtycme.org & type session code:
(session codes are also located in your program guide on the activity sheet page)
*All users must complete the pre AND post test to receive statement of
credit. Credit must be claimed within 30 days of this program.