Wholesale Supply Channels: COVID-19 Impact on Cancer Care and Road to Recovery

During a recent Association for Value-Based Cancer Care (AVBCC) webcast, titled Wholesale Supply Channels: COVID-19 Impact on Cancer Care and Road to Recovery, a panel of healthcare experts discussed issues related to wholesale supply channels for the distribution of drugs and medical/surgical supplies to community oncology care providers.

Several common themes emerged as the panel explored the challenge of ensuring an uninterrupted flow of crucial materials to the areas with the greatest demand during the ongoing crisis. The thought leaders stressed that patient care must remain the most important goal in the face of the unique challenges wrought by the pandemic. They also agreed that the primary focus must be on the continued supply of drugs for patients with cancer, despite a surge in the demand for some oncology drugs that are also being used to treat manifestations of the virus.

Another common theme centered on the challenges that all stakeholders face as they attempt to sustain their own financial viability—this applies to distributors, the community practices they serve, and drug manufacturers. The experts also recognized the fact that all stakeholders are making accommodations as they all confront “the new normal.” There was consensus that financial instability anywhere in the distribution chain would have an adverse effect not only on businesses, but on the delivery of patient care.

AVBCC Founder and webcast series moderator, Burt Zweigenhaft, PhD, D.Litt, remarked that it takes an “extreme amount of coordination to produce quality cancer care,” from the manufacturers, to the representatives, to the warehouse workers who pack and ship the orders.

“One of the unusual things is that there is usually very predictive movement in the wholesale distribution chain, but there is nothing predictive about COVID; the channel has been strained from top to bottom all along the chain,” he said.

Ensuring the Supply of Oncology Drugs for Patients

“Clearly, the whole pandemic has injected—or maybe revealed—the risk in the supply chain, given the international nature of pharma and biotech ingredient sourcing and manufacturing,” said Kevan Corbett, VP/GM, GPO Services & Business Solutions, McKesson. He added that McKesson has been in constant communication with suppliers to diversify supply and carry additional inventory and to ensure that patients with cancer continue to receive their medications.

“Supply is one side, but demand spike is another and with the event of the pandemic it has spiked the demand in unprecedented ways, especially for drugs that show promise in the treatment of COVID-19,” said Mr Corbett. He noted that case studies showing that BTK inhibitors may protect against pulmonary injury in patients with COVID-19 have led to an increase in demand for those agents. Although this increased demand would ordinarily be a healthy aspect of business, “we still have an obligation to our clinic customers and their oncology patients not to disrupt their access to meds.” As a result, Mr Corbett noted, he monitors for unusual purchases to ensure that oncology treatments can proceed uninterrupted.

One consequence of social distancing is that there is a steep decline in new cancer diagnoses and new patient visits. Mr Corbett said this foreshadows a downturn in fiscal activity that will add stress to community cancer providers.

Community Practitioners Face Significant Hurdles

Brian Ansay, President, Specialty Physician Services, ION Solutions & IPN Solutions Group Purchasing Organizations, AmerisourceBergen, continued the discussion by saying that he and his associates have been spending a lot of time trying to understand the market and the pressures on community practices and monitoring the hot spots that have been hardest hit by the virus. He noted that community practices are facing unprecedented challenges, with the shuttering of medical offices, personnel shortages, and a decrease in the number of office visits. Mr Ansay noted that the months of June and July could prove to be difficult as practices attempt to get patients into surgery and treatment after the long delay, adding that “people are thinking creatively about the new challenges.” Mr Ansay also stressed that the number one goal is to ensure the continued viability of community oncology practices.

“At the end of the day, we all have a responsibility ultimately to keep practices viable to treat the vulnerable patients who are out there,” he concluded.

Addressing the Shortage of PPE for Healthcare Workers

Mick Besse, MBA, President, AmerisourceBergen, Besse Medical, discussed supply shortages related to essential personal protective equipment (PPE) for healthcare workers, including masks, gowns, gloves, and other protective gear. He noted that, to a large extent, the supply channel for these products originates outside of the United States. Although manufacturers have stepped up to meet increased demands for these products, and the supply chain is highly regulated in an effort to prevent gray-market product infiltration, some suppliers with products that are not legitimate still creep into the distribution chain. The ongoing challenge will be to identify sources for PPE that are consistent and legitimate.

In addition, Mr Besse said that although most businesses had emergency plans in place before the pandemic, those plans were designed with individual emergencies in mind, not with the expectation that everyone would need to put their plans into play simultaneously. All stakeholders in the chain are now struggling with the same problems—how to pay vendors, keep employees, and serve their shared customers and patients.

COVID-19 Antibodies Are the Best Defense

Patrick Schmidt, CEO, FFF Enterprises, used a football analogy to describe the COVID-19 crisis, saying that the virus has a “clear and unfettered path to the end zone.” He went on to say that “in the absence of active immunity…COVID-19 antibodies are our most precious national resource.” Access to these antibodies and a resulting vaccine, he maintained, is the quickest route to recovery.

Mr Schmidt explained that his team spends a great deal of time on the question of how to help when it comes to finding a weapon against the virus in what he described as “a defenseless nation.” He urged anyone who has recovered from the virus to donate plasma, stressing the fact that there has been a drastic decrease in the number of plasma and blood donations since the beginning of the crisis.

“Until a vaccine is available, our best defense are the antibodies of healthy individuals who donate plasma,” Mr Schmidt said. He also predicted that the shortage in plasma will result in a shortage of IGIV and SCIG, 2 biologic products critical to the survival of patients with compromised immune systems (including patients with cancer) who contract coronavirus.

During closing remarks, Dr Zweigenhaft said that getting supplies to the front lines was crucial in the fight against the pandemic, and that “the wholesale distribution channel is where it all happens.”

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