As health plans grapple with the rapidly rising cost of oncology medications and a “buy and bill” system that does not work for physicians or for the plans, they are seeking new strategies for providing these life-saving drugs to their members and for freeing up oncology and hematology practices to focus solely on caring for patients, not managing a pharmacy.
One company has stepped up to fill the void and provide the solutions that health plans need. New York–based OncoMed, The Oncology Pharmacy, is a leading pharmaceutical services company that specializes solely in oncology pharmaceuticals and has established itself as a key partner to health plans.
Blue Cross Blue Shield of Massachusetts has contracted with OncoMed to provide all oncology medications—oral, injected, and infused—to the plan members’ physicians. The plan has made OncoMed’s services optional, so that physicians who want to continue to “buy and bill” oncology drugs can do so.
In response to a surge in demand for its services, OncoMed recently opened its newest facility in New England to provide high-level oncology pharmacy services in that region, and the company has announced plans to open 4 additional new facilities this year in Arizona; Buffalo, New York; Florida; and Illinois.
“What we offer to health plans is the confidence that comes from using a dedicated oncology pharmacy partner that prepares medications according to the highest quality standards and delivers them using a process that greatly reduces waste,” said OncoMed CEO Burt Zweigenhaft. “At over $1000 per dose, neither health plans nor our healthcare system can afford to operate in a way that does not take every necessary step to reduce wasted medication.”
OncoMed, founded in 2004, is licensed to provide oncology prescriptions in all 50 states to patients covered by Medicare, Medicaid, and private health plans. “It’s a field that is constantly evolving, with research driving changes in oncology day by day,” said Kevin Askari, RPh, president and chief clinical pharmacist of OncoMed. “Our goal is to act as a virtual oncology pharmacy within the practice, and also be used as a pharmacological resource and experienced knowledge center in the oncologist’s office.”
The arsenal of oncology pharmaceuticals and biotechnology targeted drugs has grown dramatically in recent years. As recently as the 1970s, there were no biologics and few drug choices and cancer frontline treatments were mainly surgery and radiation. Many of the first chemotherapy drugs, novel at the time, are obsolete today as stand-alone drugs (although some remain effective in combination with the new targeted biotechnology drugs used in protocols).
“Given the expanding complexity of therapies and protocols, we saw there was a need for an oncology pharmacy,” said Mr Askari. “We wanted to be involved in an evolving, dynamic field. Every day, even now, you get bombarded with new information. The treatment that was the best thing yesterday may not work today.”
Amid this complexity, Mr Askari said his emphasis remains on safety and quality. As an example, he said, “we hire only pharmacists who meet our own rigorous oncology pharmacy experience standards, who are then shadowed under close supervision for 6 months before they work on the dispensing front.”
OncoMed’s oncology pharmacists are at the heart of the prescription intake process, supervising all dispensing activities. All compounding and mixing is conducted in a USP 797- compliant clean room environment. Each dose and measure goes through a 6-point quality check process done by oncology pharmacists or pharmacy technicians to ensure safety and accuracy. OncoMed goes an extra step to ensure that all of its pharmaceuticals are purchased under a publicly disclosed “Drug Pedigree Program” that specifically allows only direct documented purchases from the prime manufacturers to ensure 100% drug efficacy and inventory safety.
“Having an oncology pharmacist review and process each order ensures that all prescription regimens are routinely evaluated against the rapidly emerging standards in care, such as the National Comprehensive Cancer Network (NCCN) guidelines,” Mr Askari said. “This enables OncoMed’s pharmacists to alert physician practices to contra-indicated drugs or treatment complications in advance of therapy.”
Events such as a prescription for contra-indicated pharmaceuticals do happen and one such event occurred recently when OncoMed pharmacists received a prescription for Avastin (bevacizumab) and Erbitux (cetuximab) to treat the same patient with previously untreated metastatic colorectal cancer. In this instance the oncology pharmacist called the physician and alerted them to the very recent study that found the combination of Avastin and Erbitux, when administered alongside chemotherapy, worsens colorectal cancer outcomes among patients with previously untreated, metastatic colorectal cancer and results in shorter progression- free survival and worse quality of life. The improved patient care that results from interactions like these also generates better business outcomes for health plans.
OncoMed CEO Burt Zweigenhaft describes the company’s overall goals and vision this way: “We have established ourselves as a trusted member of the cancer care community for delivering ‘just-in-time treatment day’ oncology pharmaceuticals and care management services. We’ve done this by studying the marketplace, listening to physician practices, and providing market-proven solutions to the challenges that our 600 current oncology practice providers face in the cancer care environment today.”
“We are recognized for our rigorous clinical standards in preparing and delivering complex pharmaceutical regimens,” Mr Zweigenhaft said. “The evolving role of the oncology pharmacist is to be a cohort of the doctor’s office. This is done by assisting with critical clinical thinking during the regimen selection process. Perhaps most important, we also maximize the clinical yield of these expensive drugs through eliminating drug waste by compounding the patient-specific orders and then delivering them in treatment day doses.”
The challenges health plans are facing today in the area of oncology medication include:
- heavy administrative costs to review and authorize requested treatments
- new studies and standards in care, resulting in more drug combinations and protocols
- dramatically increasing medication cost
- lack of consistency in clinical standards for drug preparation because physician practices all operate differently, and
- oncology and hematology practices that are not accredited by the Pharmacy Compounding Accreditation Board.
With Medicare’s shift to market-based reimbursement schedules, the economic downside of “buy and bill” has become more apparent to physician practices.
“Physicians should be focused on caring for their patients and their complex disease,” said Mr Zweigenhaft. “They should not have to worry about running a pharmacy and the tasks of acquiring and maintaining an inventory of medications, the drug authorization burdens, collection of copayments and drug reimbursement, and the risk of bad debt.” Mr Zweigenhaft went on to say that “we see new challenges appearing as more state pharmacy boards seek to control enforcement of drug preparation sites using USP 797 and PCAB certifications.”
The validation of the OncoMed Oncology Pharmacy model is evidenced by the positive results that OncoMed has generated for health plans that have used the company to provide oncology medications, such as Blue Cross Blue Shield of Massachusetts. Perhaps the greatest value that OncoMed delivers, however, is the support the oncology pharmacy model can provide for health plans’ members, who face the supreme challenge of defeating their cancer.
To learn more about OncoMed or to request a presentation, contact OncoMed at 1-877-662-6633, extension 1298 or firstname.lastname@example.org, or go to www.oncomed.net.