In-House Pharmacies Benefit Patients Receiving Oral Cancer Drugs, Reduce Waste and Costs

Meg Barbor, MPH

August 2016, Vol 6, No 8 - Oral Oncolytics

In-house pharmacies eliminate many of the unnecessary barriers to optimal cancer care presented by specialty pharmacies, while also providing higher-quality care to patients receiving oral cancer drugs, said presenters at a patient advocacy session at the 2016 Community Oncology Alliance (COA) meeting.

An increasing number of oral cancer drugs have entered the market in recent years, and 25% to 35% of all cancer drugs in the current pipeline are estimated to be oral. Community cancer practices have established facilities to dispense oral drugs, responding to the need of patients to receive their oral medications in an environment that is closely integrated with their overall care.

Because of the increasing cost of cancer drugs, specialty pharmacies have begun to separate oral cancer therapy from the point of care and the control of the prescribing oncologist, said Ricky Newton, CPA, Treasurer and Director of Financial Services and Operations at COA, Washington, DC. This has created barriers to the delivery of cancer care by in-house pharmacies, and even bigger barriers for patients.

Increased Patient Responsibility

The Community Oncology Pharmacy Association (COPA), a nonprofit organization operating under COA, was founded in response to the increasing number of community clinics dispensing oral cancer drugs and ancillary therapies. COPA establishes standards, provides education and resources, and focuses on patient-centered cancer care, while addressing a variety of pharmacy issues.

In-house pharmacies provide patient access that is quick, easy, and cost-effective, often delivering prescriptions to patients within 2 days of starting therapy, said Todd Murphree, PharmD, Ambulatory Pharmacy Manager, Clearview Cancer Institute, Huntsville, AL.

In a physician-dispensing program, the medical oncologist distributes the prescribed medications, and the staff members within the program work together with the oncologist. “This creates a different dynamic, because we can react quickly to changes in therapy,” said Josh Cox, PharmD, Director of Pharmacy, Dayton Physicians Network, Kettering, OH.

The influx of oral cancer drugs underscores the importance of having rapid access to the prescribing physician, he said, because patients often wrongly assume that oral chemotherapy is less toxic than intravenous chemotherapy.

“We’re now relying on patients to take medications, be compliant, and manage sometimes complicated dosing regimens at home without direct supervision and access to a healthcare provider. These medications are chemotherapy just like any other, and can have the same adverse events, so they require a lot of hand-holding, education, and rapid access to someone who can help in the event of an issue,” said Dr Cox.

Common Barriers to Care

“The biggest barrier that we run across is being in network with different payers. Gaining that access to be able to provide drugs for our patients is a huge initiative within COPA,” said Dr Murphree.

Pharmacy benefit managers will sometimes require patients to use their own specialty pharmacy, which often translates into high out-of-pocket costs and long waiting periods until the drug is delivered. One of the biggest initiatives of COPA is to increase the percentage of patients they are able to keep inside the practice.

“When a patient has a diagnosis and their physician has made a treatment decision they trust and have bought into, they want to start treatment now. That’s critical to patients,” Dr Murphree said.

Copay assistance is another main focus of COPA, whereby in-house pharmacists can access patient records and view laboratory results in real time, allowing them to anticipate dosage changes or reductions in therapy.

“This has a huge financial impact. Rather than receiving a 30-, 60-, or 90-day supply of a medication that costs $10,000 a month, we may be able to provide a week’s supply and play it by ear to make sure the patient isn’t paying a huge copay for drugs that may not be used,” said Dr Cox.

Medication Waste Is Costly

Billions of dollars are wasted annually on unused drugs in the United States, but in-house pharmacies are often able to lower medication waste in cases when a patient’s drug dose has been reduced or when a patient is switched to another medication

“A specialty pharmacy will auto-ship a refill of a specialty drug, but if a patient went to the doctor that day and their dose was reduced, that’s a wasted drug that can’t be sent back or reused, and this happens a lot,” said Dr Murphree.

Dr Cox agreed that the unnecessary waste of oral cancer drugs is a major issue. “People will come in and bring expensive unopened medications, because they’ve finished their therapy and they want it to be used for someone else. It’s very benevolent, but as soon as they leave, I put it in the trash, because state law requires that we can’t redispense once it’s left our possession,” he said.

Mr Newton and colleagues at COA are collecting patient stories to incorporate with tangible results in a paper they will present to payers, government entities, and states that prohibit physician practices from dispensing oral chemotherapy drugs.

“We’re going to show how our very tangible quality standards are better than what is documented by these specialty pharmacies that do the same work,” Mr Newton said.