Clinically integrated oncolytic dispensing: The next frontier in cancer care
By Christie Smith
How a forward-thinking dispensing model can help prioritize patient care
In the oncology landscape, can a medically integrated dispensing model make a difference in a patient’s ability to access oncolytic medication and adhere to their course of treatment—while reducing pharmacy waste? Nearly a year into a partnership with Prime Therapeutics’ IntegratedRx™-Oncology, AmerisourceBergen’s Christie Smith reflects on the potential benefits of this first-of-its-kind clinically integrated program.
For oncology patients, access to oral cancer therapies is a critical component of care. But it’s also important for patients to have autonomy over their quality of life, whether that means deciding to spend time with loved ones, traveling to a breathtaking destination, or otherwise realizing a long-held dream.
When patients have reliable, flexible access to the therapies they need most, they can better maintain their course of treatment and enjoy a higher quality of life. And when getting access to needed therapies feels easy and convenient, the patient adherence rate may tend to rise while the pharmaceutical waste percentage decreases.1,2,3,4 But how?
The payer
In late 2021, AmerisourceBergen began offering Prime Therapeutics’ IntegratedRx-Oncology to qualified Medically Integrated Dispensing (MID) practices and health system pharmacies through its pharmacy services administrative organizations (PSAOs). This new, first-of-its-kind clinically integrated program enables patients to receive medications—including oral oncolytic and companion medications—directly from their community oncologist in a clinical setting so providers can offer a more holistic approach to care.
When patients can gain access to therapies directly from their practice’s dispensing pharmacy, they can rest assured that the pharmacist filling their prescriptions has real-time access to each medical record—and can work with their physicians to make any needed adjustments instantly so patients get the medications they need, not the ones they don’t.
For providers, that means keeping a patient’s oncology prescription in house can make a big difference in reducing pharmaceutical waste4. It can also lead to better patient outcomes by making it easy for patients to begin—and adhere to—their course of treatment.1,2
In partnering with Prime Therapeutics, AmerisourceBergen’s objective was to:
- Enable faster starts for patients needing to begin a course of medication1,2
- Increase patient adherence by providing ease of access to needed therapies3
- Reduce pharmaceutical waste by ensuring that clinics access only the amount of medication their patients need1,2,4
- Decrease the overall cost of care1,2
- Enhance the quality of patient care through a streamlined prescribing process1,2
How might IntegratedRx-Oncology help lower the cost of care?
The answer lies in the holistic approach to treatment that’s facilitated through this payer partnership. When dispensing pharmacies fill prescriptions in the physician’s office, pharmacists have a closer view into each patient’s treatment journey. So even though it may be time to refill a prescription, an in-house pharmacists can know if it’s best to dispense a lesser supply until the patient has their next scan or reduce a dose if the patent isn’t tolerating their medication well.
Because these crucial changes can be addressed as needed, based on each individual’s unique medical record, it’s possible that the cost of care may be lower for those receiving medication through a medically integrated dispensing model. And because physicians and pharmacists are working in tandem to monitor their patient’s treatment journey and can quickly adapt in real time, this model could also potentially decrease hospitalization rates over time.
Since this program launched almost a year ago, practices participating in the IntegratedRx-Oncology model have been able to expand commercial access to oral cancer therapies, heighten their clinical oversight of patients in treatment, and uncover an increase in administrative efficiencies.
The patient: prioritizing care
When Prime Therapeutics began partnering with AmerisourceBergen to offer its IntegratedRx-Oncology model, the payer observed an opportunity to prioritize the patient at every step of their cancer treatment journey. This means meeting each patient where they are—literally. With AmerisourceBergen’s integrated prescription network, and over 70 dispensing practices nationwide, patients can get access to their medication at multiple locations across the country.
What does this mean for patients? Faster access to the oncolytic medication they need, which can make a critical difference in alleviating stress—because no one wants to chase down their prescription while facing a daunting diagnosis—and could potentially contribute to better patient outcomes.1,2 With this integrated model and a prior authorization in place, patients could have same-day access to their prescribed oncolytic medicine: a big difference over typical specialty pharmacy wait times of at least three to seven days.
For patients who do not have a connection within the healthcare industry, navigating hurdles to get the medicine their doctor prescribed can feel incredibly stressful and upsetting during a time when they need support the most. In partnering with AmerisourceBergen, Prime Therapeutics aims to make the process of beginning and maintaining a course of treatment as seamless as possible so patients can focus on healing instead of navigating healthcare logistics.
The provider
Providers participating in the IntegratedRx-Oncology model report experiencing increased efficiencies, reduced pharmaceutical waste, and—most importantly—an overall benefit to their patients.1,2,4 Having the ability to begin patients on a course of treatment more quickly than ever before leads to an increase in patient adherence3 and, ideally, leads to better patient outcomes. By aligning with the payer through a medically integrated dispensing model, providers can better serve their patients by dispensing medication that meets their immediate needs, despite potential shifts in their treatment journey.
Practice feedback
For several years, a patient at an oncology practice in the Northeast was receiving their prescription oncolytic through a specialty pharmacy, which filled and mailed the medicine on a regular schedule. Then, at a scheduled appointment in March 2022, the patient gave the pharmacy 180 tablets of their prescription to destroy. The fill dates were in November 2021 and January 2022 for 90 tablets each.5 According to the pharmacy director at the practice, the pharmacy staff had lots of questions, including:
- What medicine had the patient been taking for the last six months? (The pharmacy staff did not have an opportunity to ask the patient.)
- Was the patient no longer taking the prescription and the mail order pharmacy was unaware? (The pharmacy staff reviewed the chart notes and found no mention of stopping the prescription due to adverse effects or a change in therapy.)
- How was the patient taking their medicine? Were they skipping days, or forgetting to take it consistently?
- Was the mail order pharmacy sending the prescription sooner than every 90 days, causing an excess? (Based on the fill dates, this was a possibility.)
The pharmacy staff had other concerns. Because returned medication cannot be reused, the excess medication led to pharmaceutical waste. Destroying the medication also creates a monetary loss for the mail order pharmacy (purchasing, processing, and mailing the medication), the insurance company (processing fees), the employer (medication cost), and the patient (copay).
Imagine the difference if the prescription had been filled in the practice’s dispensing pharmacy. By speaking with the patient directly and accessing her chart in real time (with notes, fill dates, and pickup dates), pharmacy staff would have been able to confirm and manage treatment adherence, reduce pharmaceutical waste4, and potentially guide the patient to a better outcome.
Today, the practice reports the patient’s disease state has changed and the prescriber is adjusting the patient's therapy. After speaking with the prescriber, the patient’s prescription is now being filled at the practice’s dispensing pharmacy for a cash price, and the patient reports being happy to receive their medication at their appointment.5
With IntegratedRx-Oncology, cancer care remains patient-oriented, convenient, and cost effective—helping physicians focus on their patients, not the process.
Learn more about IntegratedRx™-Oncology
This new model is currently available to AmerisourceBergen’s partnering community oncology physicians and health systems participating in Blue Cross plans; participating practices must have an accreditation within a year. If your practice is interested in participating in this new medically integrated dispensing model now or in the future, contact your pharmacy services team at practicedispensing@amerisourcebergen.com.
References
- Dillmon MS, Kennedy EB, Anderson MK, et al. Patient-centered standards for medically integrated dispensing: asco/ncoda standards. J Clin Oncol. 2020;38(6):633-644.2.
- Hellems SS, Soni A, Fasching D, Smith BS, McManus DD. Association between health system specialty pharmacy use and health care costs among national sample of Medicare Advantage beneficiaries. J Manag Care Spec Pharm. 2022;28(2):244-254.3.
- Marineau A, St-Pierre C, Lessard-Hurtubise R, et al. Cyclin-dependent kinase 4/6 inhibitor treatment use in women treated for advanced breast cancer: Integrating ASCO/NCODA patient-centered standards in a community pharmacy. J Oncol Pharm Practice. 2022;1-10. 4.
- Darling J, Starkey A, Nubla J, et al. Financial impact of medically integrated pharmacy interventions on oral oncolytic prescriptions. JCO Oncology Practice. American Society of Clinical Oncology, 2022. Accessed August 4, 2022: https://ascopubs.org/doi/full/10.1200/OP.22.00022.
- Scanlan, Nancy. Practice feedback: Hunterdon Hematology Oncology and IntegratedRx™- Oncology. Submitted to AmerisourceBergen May 23, 2022.
Topics:
Oncology
Specialty pharmacy
Patient care
