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Infusion Milestone: Breakthrough TED Treatment During Pandemic

Home infusion of teprotumumab-trbw (Tepezza), a breakthrough treatment for thyroid eye disease, was found to effectively minimize the chance of COVID-19 infection.

By Drew Hardman, Marketing Manager

In 2020, Chartwell Pennsylvania, LP, part of CarepathRx, was the first provider in the nation to administer teprotumumab-trbw (Tepezza), a breakthrough medication for the treatment of thyroid eye disease (TED), in a home-infusion setting—an incredible achievement in the treatment of a potentially debilitating autoimmune disease.

“In the wake of the COVID-19 outbreak, access to home infusion therapy is more important than ever,” said Ca COO David Benedict, PharmD, BCPS. “Many home infusion patients are considered at higher risk of severe reaction to COVID-19 due to age, chronic illness, and/or an immunocompromised condition. Treatment at home effectively minimizes the chance of infection for both patients and staff.”

Infusion Milestone

Teprotumumab-trbw is administered once every 3 weeks for a total of 8 infusions. Patients are screened on a case-by-case basis to determine their eligibility to receive the first dose in either a controlled setting, such as a hospital or outpatient infusion center, or in the home.

A number of factors play a role in determining whether a patient is a good candidate to receive the initial infusion in the home, including comorbidities such as diabetes or irritable bowel syndrome (IBS), and other factors such as age, medication allergies, and whether the patient is a smoker or plans to become pregnant.

The first patient to receive the initial dose in the home setting, representing an important milestone in the teprotumumab-trbw home infusion process, took place just 2 weeks into the state-mandated quarantine. Ophthalmology specialist Charles Kent, MD, MMM, Everett & Hurite Ophthalmic Association, served as the prescribing physician.

“During the COVID-19 crisis, home infusion just makes sense,” Kent said. “It keeps patients out of the hospital setting. Spending hours in the hospital among other patients and employees is not practical when this infusion can be administered safely in the home.”

Another prescribing physician for multiple teprotumumab-trbw patients, Jenny Yu, MD, clinical assistant professor of Ophthalmology, University of Pittsburgh, called the situation “the perfect storm” for many patients with TED. Yu, who also serves on the UPMC Orbital, Oculoplastic, and Aesthetic Surgery Service, cited not only the pandemic, but also the importance of timing in the patient’s treatment.

“The drug in treatment is time-sensitive, in terms of catching the patient in the inflammatory phase,” Yu said. “Of course, we also had COVID-19 to tend with. Home infusion limits the kind of exposure to infection that you would find in a hospital or outpatient setting. Younger patients without many other comorbidities are excellent candidates for the initial infusion in the home.”

In addition to easing the burden of care placed on hospitals and other health care facilities, home infusion creates a unique level of convenience for the patient and caregiver.


Approved on January 21, 2020, teprotumumab-trbw is the first and only FDA-approved medicine for the treatment of TED, a rare and serious autoimmune disease with vast variability in duration and symptom presentation. The term “thyroid eye disease” is often used in conjunction with Graves’ disease, an autoimmune disorder that causes hyperthyroidism, although the 2 are sometimes distinct conditions.

“It’s often interchangeable,” Yu said. “About 85% of TED patients have Graves’ Disease; the other 15% are associated with other thyroid disorders.”

TED can lead to a wide array of vision-threatening impairments, such as dry eye disease; diplopia, which is misalignment of the eyes; visual acuity and visual field defects; facial disfigurement; and optic neuropathy in 6% to 9% of patients, according to statistics from manufacturer Horizon Therapeutics.

Teprotumumab-trbw has a novel mechanism designed to block the insulin-like growth factor-1 receptor (IGF-1R), which is the key mediator of TED. The treatment received Priority Review, Orphan Drug, Fast Track, and Breakthrough Therapy designations from the FDA.

Teprotumumab-trbw is unique among other immunosuppressants, Yu explained, referencing the initial teprotumumab trials and the subsequent study published in 2017 by noted surgeons Raymond Douglas, MD, PhD, aesthetic orbital and oculoplastic surgeon, and Terry Smith, MD, professor of Ophthalmology and Visual Sciences, University of Michigan.

Announcing CarepathRx Enteral Nutrition

By CarepathRx Marketing

CarepathRx now offers comprehensive enteral nutrition services to benefit our hospital and health system partners across the nation. The U.S. market for enteral nutrition is projected to grow at a compounded annual growth rate of approximately 8% over the next 5 years. Additionally, there are approximately 190,000 pediatrics patients and 250,000 adult patients receiving enteral nutrition.

“Currently, most hospitals and health systems are outsourcing enteral nutrition patients to a third-party provider due to the perceived complexities associated with this type of therapy,” explained CarepathRx Chief Strategy Officer Keith Crawford. “CarepathRx offers a simple, turnkey program that enables health systems to establish their own home nutrition support offering that improves continuity of care, enhances patient satisfaction, and allows the hospital to generate new revenue streams.”

Still outsourcing your Enteral Nutrition patients to a third party?

Keep those patients within your health system while generating new, high-margin revenue streams with CarepathRx’s Enteral Nutrition program. Our comprehensive list of services includes:

  • Patient Intake
  • Dieticians On-Call 24/7
  • Clinical Oversight
  • Monthly Replenishment
  • Insurance Verifcation
  • Billing
  • Account Services

“CarepathRx is there every step of the way,” said Marilee Fritsch, RD, Clinical Nutrition Coordinator at CarepathRx. “We work directly with the prescribing physician to manage first dose, refills, and any change of service.”

Click the link below to download our new CarepathRx Enteral Nutrition flyer.

*Statistics from Allied Market Research

Polishing the Stone: Healthcare Innovation and Technology

By John Figueroa, Chairman & CEO, CarepathRx

The COVID-19 pandemic has proven healthcare organizations, even in a crisis, need to tirelessly forge ahead with innovation to be successful. Senior-level healthcare executives need to follow the macro-trends driving the healthcare and pharmacy technology industry forward.

“A gem cannot be polished without friction, nor a man perfected without trials.” This proverb from ancient Roman philosopher Lucius Seneca is a profound reminder for senior executives that excellence is born out of tribulation.

In a similar way, the COVID-19 pandemic has proven healthcare organizations, even in a crisis, need to tirelessly forge ahead with innovation to be successful. For CEO-level healthcare professionals and the organizations they serve, the current era of disruption is pushing healthcare into the future at a blistering pace.

At the heart of transformation are new technologies and innovative applications. While senior-level executives should not be expected to know every new application or upgrade, they need to follow the macro-trends. Here are five that will drive the industry forward:

Personalized medicine. Already healthcare executives are planning for a day in which care is based on specific, personal, genetic information versus physical exams, patient complaints or symptoms alone. Researchers are hard at work identifying ways to collect data that will one day enable highly tailored healthcare.

Virtual care. The innovations and pharmacy technology brought on by managing the COVID-19 pandemic has accelerated virtual care. The practice of telemedicine — once limited primarily to individual online consultations — has broadened to include coordinated and comprehensive virtual care. This convergence will continue to evolve to include data capture through wearables, video environments and post-acute monitoring. Senior-level executives should understand new capabilities, especially those powered by augmented information and artificial intelligence.

Pharmacy technology. Instead of making medications for diseases, drug makers will make treatments that work for the individual patient, taking specific needs into account. Data will also play a critical role in areas like clinical trials, in which several treatments are tested simultaneously and take place at home. This also extends to pharmacies where, according to pharmaceutical distributor McKesson, patients will benefit from smart drug packaging to improve adherence, digiceuticals to help patients with their drug therapies, point-of-care testing medical supplies and advances in equipment. In fact, services like these already exist at ExactCare, for more than 80,000 chronically ill patients living at home.

Cloud computing. COVID-19 dramatically increased the rate at which healthcare organizations moved information ecosystems to the cloud. In order to improve care, increase agility and protect data, healthcare providers shifted data centers to the cloud in droves — and there are no signs of that trend slowing. According to consulting firm Accenture, 66% of healthcare executives say they will be operating within the cloud within the next year and 96% within three years. Senior healthcare executives don’t need to know the intricacies of cloud computing, but they do need to have trusted partners who can aid in adopting a cloud approach without compromising data.

Divisional structures. In the future, biotech companies will not be one organization, but a sum of multiple parts (like technology company Alphabet, the parent company of Google). Each company will operate separate units using a unified technology platform and mission. Innovative biotech companies will grow companies from scratch while making long-term investments in innovations and technology that enhances the entire organization. Senior executives will need to understand this new business model and how to fit in as a division, partner, or supplier.

To be sure, public health crises like COVID-19 are not the only frictions in healthcare. The push for expanded access to care, an escalating nationwide physician and nurse shortage and the unending call to bend the cost curve will continue to test the traditional limits of the U.S. healthcare system.

As all these variables rub together with increasing force, the rough corners and faults will be polished out. A shimmering future lies ahead for those willing to keep pace with innovation.