A Look at Medically Integrated Dispensing, Part One: How Practices and Patients Benefit
By Lisa Harrison |
Roughly half of U.S. oncology practices fill cancer-therapy prescriptions for their patients1 through “medically integrated dispensing,” an updated way of describing in-office dispensing. This subtle—but significant—terminology change more accurately reflects where today’s practices are headed in patient treatment.
A key factor in the shift has been the rise of oral cancer drugs, which represented 39 percent of the $27.8 billion spent on targeted oncologics in the United States in 2015 (up from 26 percent in 2010).2 When dispensing oral oncolytics, practices maintain continuity of patient care to the same extent previously achieved with in-office intravenous or infused therapies.
Additionally, patients can be put on therapy faster through medically integrated dispensing than if their prescriptions were coordinated through a separate entity, such as a specialty pharmacy.
In this first installment of a three-part series, we examine how medically integrated dispensing works to the benefit of independent oncology practices and the patients they serve. Subsequent articles will cover current challenges for independent oncology practices and recommendations for getting started with medically integrated dispensing.
Why Medically Integrated Dispensing Matters
Within ION Solutions’ GPO network, the number of dispensing oncology practice sites has grown dramatically from 140 in 2013 to approximately 260 today.3 Participating practices have found that the inability to provide oral oncolytics often results in patients filling their prescriptions through a specialty pharmacy. When that happens, practices have difficulty coordinating patient care with outside entities—which ultimately leads to delays in patients receiving care.
In particular, if a payer requires prior authorization (PA) to determine whether it will cover all or part of a drug’s cost, then the prescribing physician must supply supporting documentation. A dispensing practice can readily pull such information from its electronic medical record (EMR) system. In contrast, when a specialty pharmacy handles a prescription requiring PA, the pharmacy must coordinate with the prescribing physician to request information from the practice EMR in order to complete the required paperwork and send it back to the payer. This cumbersome additional step can add days, if not weeks, to the PA process while the patient waits for his or her medication.
Also, in an advanced payment framework like the Centers for Medicare and Medicaid Services (CMS) Oncology Care Model (OCM), which currently includes 184 practices and 14 payers nationwide,4 practices commit to providing enhanced services to Medicare beneficiaries throughout episodes of care. As with any advanced payment model, CMS provides incentives for OCM-participating practices to improve care quality while containing costs.
In particular, OCM’s Monthly Enhanced Oncology Services (MEOS) payment offers $160 per beneficiary per month to help practices effectively manage and coordinate care for oncology patients, including those on oral therapy, during 6-month episodes of care.5 OCM practices that outsource dispensing of oral oncolytics to specialty pharmacies lose control over factors such as timing of dispensing, refills, prescription holds and dosage changes. Any cost overruns incurred by an outside pharmacy are attributed to the original provider. In contrast, dispensing practices under OCM maintain their ability to manage vital care activities in a cost-effective manner.
Another important factor in moving to medically integrated dispensing is waste reduction. The National Community Oncology Dispensing Association (NCODA) tracks specialty pharmacy shipments to patients who have been released from therapy, had their dose changed or had their therapy put on hold. NCODA reports accumulated dollar amounts to date for cost avoidance and waste as $3.5 million and $3 million, respectively.6 Dispensing practices can reference the NCODA information when negotiating with employers and payers. With evidence of wasted drugs that have already been paid for, practices ready to take on dispensing make a powerful argument for passing along savings to employers and health plans.
Finally, non-dispensing practices — especially in rural areas — may inadvertently hinder patient access to needed cancer therapies. In contrast, bringing dispensing in-house helps practices remain viable as community sites of care through access programs sponsored by drug manufacturers. What’s more, dispensing practices can actively steer patients toward financial assistance for oral medications that otherwise might be unaffordable. Options include grants or foundation assistance available to Medicare patients.
Helping Patients Where They Live
Care coordination, when led by a community oncology practice, makes a huge difference in getting and keeping patients on therapy, and working through any side-effect challenges they may have. Viewed in whole, medically integrated dispensing is essential to delivering high-quality oncology care to patients in their own neighborhoods.
The next installment in this series will examine what happens when oncology prescriptions are handled by pharmacy benefit managers’ preferred specialty pharmacies and why dispensing pharmacies may be shut out of certain networks.
Lisa Harrison is vice president of practice business solutions for AmerisourceBergen’s Specialty Physician Services organization.
1. OncLive. In-Office Dispensing is Better Value. https://www.onclive.com/publications/oncology-business-news/2016/august-2016/inoffice-dispensing-is-better-value
2. IMS Institute for Health Informatics. Global Oncology Trend Report: A Review of 2015 and Outlook to 2020. https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/global-oncology-trend-report-2016.pdf
3. ION Solutions internal data.
4. Centers for Medicare and Medicaid Services. Oncology Care Model. https://innovation.cms.gov/initiatives/oncology-care/
6. National Community Oncology Dispensing Association. Cost Avoidance and Waste Tracker Tool. https://www.ncoda.org/cawt/