{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:00:13Z","timestamp":1790067613829,"version":"4.0.1"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Purpose<\/jats:title>\n To describe clinical experience and patient outcomes with orally administered fecal microbiota spore (FMS) capsules, live-brpk, for prevention of recurrent Clostridioides difficile infection (rCDI) after workflow implementation into a local health-system specialty pharmacy (HSSP) model.<\/jats:p>\n <\/jats:sec>\n \n Summary<\/jats:title>\n rCDI carries substantial morbidity, and the approval of orally administered FMS capsules introduced a novel prevention option with new challenges in medication access, prior authorization, and cost. To meet this need, an HSSP workflow was adapted to support acquisition of FMS for adults receiving a prescription order. Over the period from June 1, 2023, through December 31, 2024, a total of 72 FMS prescriptions were generated for 50 patients, of which 29 (58%) ultimately obtained the medication. Patients reflected a real-world population, the median (IQR) age was 70 (55-79) years, 55% were men, the median (IQR) number of previous CDI episodes (including the proximal episode) was 2 (1-3), and 25% were immunocompromised. Among patients who received FMS, rCDI occurred in 2 (7%) patients at eight weeks. Of the 21 prescriptions obtained through the HSSP, 62% required a single prior authorization (PA) attempt, and the median (IQR) time to dispensing from prescription generation was 16 (12-20) days. Copayments ranged from $0 to &gt;$2,500, with most patients (18, 86%) receiving FMS for less than $6.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Implementation of an adapted HSSP FMS medication workflow resulted in medication access for more than half of patients and offers a practical, adaptable model for integrating high-cost microbiome therapies into specialty pharmacy practice.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/ajhp\/zxag293","type":"journal-article","created":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T11:23:11Z","timestamp":1789903391000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical Experience with Oral Fecal Microbiota Spores (Vowst\u00ae) in a Health System Specialty Pharmacy"],"prefix":"10.1093","author":[{"given":"Stormmy R","family":"Boettcher","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services, Henry Ford Health , Detroit, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M","family":"Kenney","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Henry Ford Health , Detroit, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan A","family":"Everson","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Henry Ford Health , Detroit, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Kashat","sequence":"additional","affiliation":[{"name":"Community Care Services, Pharmacy Advantage , Rochester Hills, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Soyad","sequence":"additional","affiliation":[{"name":"Community Care Services, Pharmacy Advantage , Rochester Hills, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Tengler","sequence":"additional","affiliation":[{"name":"Community Care Services, Pharmacy Advantage , Rochester Hills, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1677-3994","authenticated-orcid":false,"given":"Mayur","family":"Ramesh","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Henry Ford Health , Detroit, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5967-5211","authenticated-orcid":false,"given":"Michael P","family":"Veve","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Henry Ford Health , Detroit, MI ,","place":["USA"]},{"name":"Wayne State University , Detroit, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,22]]},"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxag293\/71301871\/zxag293.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxag293\/71301871\/zxag293.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:07:22Z","timestamp":1790064442000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article\/doi\/10.1093\/ajhp\/zxag293\/8826403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxag293","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"article-number":"zxag293"}}