Worksite pharmacies have unique advantages over local pharmacies in caring for employees with cancer. At the Fourth Annual Conference of the Association for Value-Based Cancer Care, Bill Raulerson, PharmD, director of On-Site Pharmacy Operations at Take Care Health Systems, Walgreens, described how their onsite pharmacies are meeting the needs of employees with cancer.1
At worksite healthcare pharmacies, the duties of pharmacists are expanded to include optimization of medication use, assistance with management of comorbidities, preventive care, and triaging when appropriate.
In addition, pharmacists at onsite centers have better opportunities to develop relationships with employees. “We view the role of our pharmacists in the treatment of oncology patients as an opportunity to leverage that patient relationship,” Raulerson said. The advantages are patient access to a trusted clinician, better communication, patient education, and patient advocacy.
Low medication adherence rates, which are especially common with cancer patients, may be improved through the use of a worksite pharmacy. Raulerson said that healthcare expenses associated with nonadherence can cost up to $300 billion per year in the United States.2 Raulerson noted that “Patients filling prescriptions at worksite pharmacies are about 12% less likely to have a gap in therapy” compared with those who use a mail order pharmacy.3 Moreover, Raulerson said that onsite pharmacies have a 10% higher rate of adherence than local pharmacies.
When a person with concomitant medical conditions such as diabetes, hypertension, or chronic obstructive pulmonary disease is diagnosed with cancer, management of comorbidities is essential to help patients avoid costly hospital admissions. “Sometimes these other conditions get overlooked,” said Raulerson. “The role we can play is helping them to continue to manage those conditions, because you don’t want that diabetic person to end up in the ER or admitted to the hospital and either delay their cancer therapy or lessen it.”
Worksite pharmacists are able to assist cancer patients with preventive care and triage, ensuring that high-risk oncology patients receive proper vaccinations. Teaching patients how and when to take their medications increases adherence, resulting in lower morbidity rates.
Adverse events are common for oncology patients. Onsite pharmacists can help patients recognize whether these are drug-related events or conditions of the disease, and they can often provide relief with over-the-counter treatment. In addition, they can determine the severity of the problem and refer the patient for appropriate treatment, thereby preventing the unnecessary use of resources.
Raulerson said, “I really think the role of the onsite pharmacist is leveraging that patient relationship and helping that patient navigate the complexities of oncology treatment.”
Florencio Calderon, PharmD, BCPS, clinical director at Walgreens, addressed the difficulties employers face in determining how to provide quality cancer treatment for their employees in a cost-effective manner. “I work with our employers in terms of understanding where some of the challenges are, and one of the biggest challenges is oncology,” Calderon said.
Calderon identified factors employers must consider when making employee healthcare decisions:
- Evidence-based care versus avoidable costs: Choosing quality care while also determining costs that may be avoidable can be difficult.
- Transparency of outcomes: Employers must examine the outcomes from their own programs as well as the outcomes that are available through medical data.
- Site-of-care optimization and medical benefit management: “Site-of-care disparity in terms of cost has a significant impact, not only on the employer, but to the patient, because a lot of the benefit designs have a sharing of the cost.”
- Alignment of incentives and optimizing benefit design: The benefit design should provide both the appropriate quality of care and access to that care.
- Ancillary care management: Providing access, coordination, and management for ancillary care is critical.
- Provider and network contracting: “There’s an opportunity to create high-value networks and to have care that exemplifies a best practice approach.”
Oncology care further complicates employers’ healthcare decisions. In 2013, there were an estimated 1.6 million new cancer cases in the United States.4 “When we think about the impact to the workforce, the compelling piece is that 10% of healthcare costs are attributed to 1.6% of the impact population,”5,6 Calderon noted.
The rising incidence of cancer, coupled with an aging workforce population, means that managing this disease will be a growing challenge for employers. “Just from an ability to have benefits to maintain treatment, these employees will continue to be active in the workforce. It becomes important in terms of how we are thinking of managing these patients,” said Calderon.
The use of oral oncolytics is becoming more prevalent in cancer treatment. These drugs allow patients to be managed as outpatients. “They give them the flexibility to still have a sense of a ‘normal’ life. I say that in quotes because these drugs do come with toxicity,” Calderon explained.
Toxicity creates problems like adverse effects that can lead to nonadherence. “If a patient’s not adherent, we’re going to have a disastrous outcome in many ways, not just from a patient perspective with their disease, but from a cost perspective as well, because that patient will be hospitalized and will incur higher costs,” Calderon said.
Walgreens Oral Oncology Cycle Management was created to manage the care of patients taking oral oncolytics. Calderon explained, “This came to fruition because patients are being managed, more and more, on an outpatient basis, and these drugs have a high toxicity range.” The program was established to create more intensive interactions with patients to (1) enhance the understanding, acceptance, and adherence of the patient to the medication, and (2) identify opportunities to manage, over the counter, any drug intolerance or toxicities the patient may experience, or assess the need for triage to the oncologist or the emergency department.
The implementation of this program saved $1374 per patient in reduced waste and reduced hospitalization combined,7 Calderon said. At the same time, it improved the quality of care for the patient.
References
1. Boress L, Calderon F, Raulerson B. Employer and payer perspectives on cancer site of care: oncology infusion and alternative sites. Presented at: 4th Annual Conference of the Association for Value-Based Cancer Care; May 6-9, 2014; Los Angeles, CA.
2. NEHI research shows patient medication nonadherence costs health care system $290 billion annually
[press release]. Cambridge, MA: New England Healthcare Institute. August 11, 2009. http://www.nehi.net/news/344-nehi-research-shows-patient-medication-nonadherence-costs-health-care-system-290-billion-annually/view. Accessed July 7, 2014.
3. Patwardhan A, Duncan I, Murphy P, et al. The value of pharmacists in health care. Popul Health Manag. 2012;15(3):157-162.
4. American Cancer Society. Cancer Facts & Figures 2013. Atlanta, GA: American Cancer Society; 2013. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf. Accessed July 7, 2014.
5. Pyrillis R. Cancer poses a growing challenge to employers. Workforce website. http://www.workforce.com/articles/cancer-poses-a-growing-challenge-to-employers. Published February 14, 2013. Accessed July 7, 2014.
6. Fitch K, Pyenson B. Cancer Patients Receiving Chemotherapy: Opportunities for Better Management. http://publications.milliman.com/research/health-rr/pdfs/cancer-patients-receiving-chemotherapy.pdf. New York, NY: Millman, Inc; March 30, 2010.
7. Khandelwal N, Duncan I, Ahmed T, et al. Impact of clinical oral chemotherapy program on wastage and hospitalizations. Am J Manag Care. 2011;17(5 spec no): e169-e173.