Should Cancer Centers start their own specialty pharmacy? Quality and economic data from the oral chemotherapy program at Smilow Cancer Hospital and Yale New Haven Health System.

Abstract

108 Background: Recent focus has shown that oral chemotherapy is high risk for medical error. Our QOPI certification process identified that oral oncologic processes were marked by: lack of documentation in the EMR, patients receiving refills from third party pharmacies after prescription discontinuation, incorrect self-administration of medications due to lack of education, delivery delays, high copays, and underuse of available patient assistance programs. Methods: A multidisciplinary task force developed a program to expedite drug access, standardize consent, and ensure clinical support including education, adherence and toxicity monitoring. We expanded an existing health-system pharmacy to provide specialty services. Treatment protocols were created for every oral oncologic drug, which are routed to a clinical oncology pharmacist and the specialty pharmacy. Nursing and pharmacist verify all orders. Medication Assistance Program for copay support. Day 1, 5 and 21 pharmacist to patient calls. Multidisciplinary flow sheet documentation. Results: Today, 80% of our patients receive medication within 72 hours. Specialty pharmacists monitor toxicity even for patients whose prescriptions are filled by other pharmacies. Pharmacists have prevented more than 400 prescription errors. Today, monthly revenue before cost for the oral chemotherapy program is nearly than $4 million. The total revenue since initiation in February 2015 is over $44 million, yielding an approximately $9 million margin after costs. Funding through the medication assistance program exceeded $1 million thus far in 2016, with an average of 140 patients receiving assistance each month. Conclusions: A patient-centered multidisciplinary model integrating clinical, operational, financial, and IT resources optimized care for patients receiving oral oncologic therapy. This project transferred revenue from for-profit third party pharmacies to our non-profit health system, and revenue is used to provide enhanced education, monitoring, and patient assistance. Our collaborative improvement model can be adapted to many practice settings.

Adherence to oral oncolytics filled through an internal health-system specialty pharmacy compared with external specialty pharmacies

“…13,14 Internal HSSPs have also been found to prevent prescription errors and improve toxicity monitoring. 15 Furthermore, fully integrated specialty pharmacies in health systems have reported higher prior authorization approvals, higher medication adherence, and overall greater patient satisfaction. 13 Consistent with these findings, the current study confirms reduced TTT, which highlights the inherent benefits of an integrated, internal HSSP system that is able to address prior authorization requirements and collaborate directly with the treating team.…”

A comparison of response in the presence or absence of a delay in induction therapy with bortezomib, lenalidomide, and dexamethasone

“…This may preclude patients from using in-house specialty pharmacies, which have been shown to have shorter prescription fill times than third-party specialty pharmacies. 3,4 While this study did not specifically examine burden on the healthcare system or fragmentation of care, some patients required up to five lenalidomide prescriptions to be sent to three different specialty pharmacies before medication was obtained. In a prospective study, staff in oncology clinics reported a median of 2 h (with a range of 1–5 h) spent per oral chemotherapy prescription to coordinate the various steps associated with medication acquisition.…”

“…Data have shown that average prescription fill time for a third-party specialty pharmacy is 10 days, compared with 72 h for in-house specialty pharmacies. 3,4 In practice, the delay in procurement of lenalidomide may mean that patients start therapy with only bortezomib and dexamethasone or alternative triplet therapy with cyclophosphamide, bortezomib, and dexamethasone. In MM it is well accepted that the deeper the response to induction therapy prior to ASCT, the better overall outcomes post-ASCT.…”