Financial Impact of Medically Integrated Pharmacy Interventions on Oral Oncolytic Prescriptions

Abstract

PURPOSE: As the utilization of oral cancer medications rises, it is vital that cancer centers track costs associated with these expensive medications. This research seeks to report the cost interventions associated with medically integrated pharmacies (MIPs) and mail-order pharmacies. METHODS: Data collection occurred from October 2016 through May 2021. Volunteers input data from their oncology practice into NCODA's Cost Avoidance and Waste Tracker tool, an innovative easy-to use tool that allows practices to document any cost saving interventions or waste occurrences. RESULTS: The Cost Avoidance and Waste Tracker tool was used by nearly 50 MIPs across the country. Specifically, 26 practices submitted cost avoidance data, and 37 practices tracked waste associated with oral oncolytic therapy. Among the 26 practices, 677 cost avoidance events led to a total cost avoidance of $7,057,053.73 US dollars (USD). The net cost avoidance for the MIP's was $6,510,971.28 USD compared with $546,082.45 USD for the external mail-order pharmacies. Among the 37 practices that reported waste, 768 events were reported, leading to a total drug waste of $11,275,642.16 USD. Of that, $8,935,612.15 USD was attributed waste from external mail-order pharmacies, whereas $2,429,592.01 USD worth of drug waste was reported from MIPs. CONCLUSION: Medically integrated dispensing of oral oncolytic therapies allows for increased pharmacy oversight, leading to increased cost avoidance and reduced waste for patients and third-party payers. Although these data are difficult to compare because of the complexity of workflows at different dispensing sites, the real-world financial differences between medically integrated dispensing and mail-order pharmacies appear to be significant.

Pharmacy Assistance Programs for Oral Anticancer Drugs: A Narrative Review

“…53 Trained staff can reduce time to initiation of treatment 25,54 and increase adherence rates 26 for patients who were prescribed OAMs; their efforts can lead to significant cost savings for both patients (through financial assistance programs) 55 and health systems (through reduced medication waste). 56 Compared with traditional mail-in pharmacy programs, specialty pharmacies often have staffing and resources to handle payor- and cost-related barriers and disease-specialized pharmacists with expertise on specific OAMs. One specialty pharmacy serving 13 cancer centers developed a centralized assistance resource data set and screened all patients with a co-pay >$100 USD/fill; 22% of prescriptions received some form of assistance for a total benefit of $280,988 USD in 1 year.…”

Cancer Treatment Before and After Physician-Pharmacy Integration

“…18 Small-scale studies suggested that physician-pharmacy integration is associated with reduced waste. 4 With an on-site pharmacy, physicians can, in principle, switch therapies more quickly if adverse events arise because they can prescribe and dispense therapies for fewer days, thereby preventing waste. If this were the case, however, we should have observed a decrease in mean days' supply among pharmacy-integrated practices as physicians prescribed shorter courses.…”

“…3 On-site pharmacies could also avert waste that can occur with mail orders, whose unused supplies must be discarded when a dose is changed or a course of treatment is discontinued. 4,5 On the other hand, if physicians can financially benefit from both oral therapies dispensed at in-house pharmacies and intravenous (IV) therapies, pharmacy integration could lead to increased overall use of both oral and infused therapies as well as high expenditures. Integration could also incentivize the overuse of particularly profitable oral therapies.…”

New Federal Guidance Makes It Harder for Patients With Cancer to Access Drugs

“…Studies show that such integrated pharmacies improve patient adherence to oral oncolytics and reduce cost-for example, by checking in with a patient for side effects and toxicity before issuing refills. 2,3 By maintaining a close working relationship with the clinical team, the pharmacy team is able to carry out patient-centric activities such as applying for co-pay assistance programs, charitable grant funding, and manufacturer-provided free drug programs on behalf of patients, which additional studies have shown lead to markedly reduced prescription abandonment rates-compare a reported national average of 18% to <1% abandonment rate, even with comparable rates of financial barriers across populations. 4 Thus, the new interpretation of Stark betrays a somewhat limited understanding of the evolution in medical therapy and practice over the past decade.…”

“…Data show that quality of care, as measured by time-to-fill, adherence, waste reduction, and toxicity monitoring, is worse when patients are required to use PBM-owned pharmacies, largely because these mail-order pharmacies disrupt the closely coordinated systems that physicians and pharmacists establish to coordinate care for patients. 3,7,8 All four of us are oncologists who often prescribe oral anticancer therapies; we can certainly attest to the lack of a working relationship with pharmacists in the employ of a PBM-operated pharmacy. In fact, we would not know how to even get in touch if we needed closer assistance with a patient.…”