Oncology Specialty Pharmacy Promotes the Coordination of Care

TOP November 2015 Vol 8 No 4 - Practical Issues for Pharmacists
Wayne Kuznar

Washington, DC-The role of oncology specialty pharmacy in helping to streamline medication delivery for patients with cancer was the subject of a panel discussion that took place at the Fifth Annual Conference of the Association for Value-Based Cancer Care.

Moderating the discussion was Burt Zweigenhaft, BS, Co-Chair of the conference. The panelists included Melissa Ayles, MBA, Director of Partner Relations and Business Development, Patient Services, a nonprofit foundation; Jeffrey Lombardo, PharmD, BCOP, Patient Safety Officer, Patient Safety Organization, University at Buffalo; and Matt Farber, MA, Senior Director of Oncology Disease State Management at Walgreens.

Staying in touch with patients receiving complex therapies and communicating difficulties to the provider is an aspect of specialty pharmacy that can help the patient and provider through a difficult process, said Dr Lombardo.

An upfront patient safety medication review, in which the drug is reviewed as well as the disease state and comorbidities, can minimize the chance that the patient will abandon therapy, said Mr Farber. "Form a relationship with your payer, because the payer is collecting data, and it has an outreach program," he advised. "From a specialty pharmacy point of view, you may have some buy-in into that program."

Coordinated care with the oncology team is taking hold with medication therapy management. "As we work across the entire system, we bring together the patient's medication information, medication therapy management, and drug-drug interactions...to make sure that we're streamlining the overall process for the patient and hopefully avoid unnecessary costs," said Dr Lombardo.

Coordinating Patient Assistance

On the patient assistance side, Mr Zweigenhaft asked about coordinating medication delivery when only 1 drug in a multidrug regimen has an assistance program behind it. "Typically, we work in conjunction with all the other foundations," Ms Ayles said. "There are 10 such foundations out there, and we understand what their programs are. But we would direct them back to the specialty pharmacy...and it probably would get them back up to alternate payment types of programs, and maybe even a patient assistance program back at the manufacturer."

Approximately 30% of the oncology patient population has an issue with affordability, she said. "Getting them on assistance sometimes has to depend on whether or not they have an insurance policy, and we do help source alternate coverage," Ms Ayles said. "We use portals with the specialty pharmacy to ensure that they know that the assistance has been granted, they've been awarded it, and that we will pay the pharmacy."

In the event that a charitable fund runs out of money during a patient's use of a regimen, pharmacists look for alternate resources, said Mr Farber, some of which the layperson is not aware. In addition, costs outside of the cost of the drug itself (ie, transportation, lost wages) can prevent drug adherence, and pharmacists can often identify local organizations to assist with those costs.

Reimbursement: Show Overall Value of Specialty Pharmacy

On the topic of reimbursement, Mr Zweigenhaft noted declining levels to pharmacists and asked how specialty pharmacy would reorganize reimbursement.

"We need to show the overall value that the pharmacist plays in patient care, [such as] medication therapy management, drug-drug interactions, helping to find patient assistance programs, and connecting patients with resources that are in their community, and external and national to their area. Continue to do that and work as an additional part of the overall care team," Mr Farber advised.

Limited Distribution Contracts

Manufacturers may put their specialty drugs in exclusive or limited networks in which they only allow dispensing from 1 or more specialty pharmacies or wholesalers. A key part of these limited distribution agreements is data-sharing, said Mr Farber. Some drug manufacturers may request information regarding dehydration associated with one of their drugs in the agreement, for example.

"It's a constant going back and forth; it's not just about the number of scripts that are being filled, it's not just about the number of refills, and people staying on their therapy, but it's also about side effects, the severity of side effects, and adverse events," Mr Farber said. "It's a part of the adherence protocols that we [Walgreens] have in place. Ultimately, the end users of these products may not be the same people who are on the clinical trial, [but those] who are part of the approval process, so it's key for them to have that information."

"You're only able to fulfill those service requirements if you have the medical record," said Dr Lombardo. "It's part of the research that we do with this new model called physician-dispensing practices".

Enhancing the Patient (and Physician) Experience

When asked what the most important thing is that specialty pharmacy can do to enhance the patient experience and the physician experience in coordinating care, Dr Lombardo suggested:

  • Move on a regional level
  • Form innovative relationships with providers
  • Have a liaison at your local school of pharmacy to act as an advocate
  • Know when to interact with the physician
  • Stay up-to-date with the data

Mr Farber went one step further and promoted local action. "We have almost 300 local specialty pharmacies. Many of them are in cancer programs, hospitals, and hospital systems," he said. "We have many residency programs where local pharmacy students are coming into our facility."

Connectivity is important, Mr Farber added. "We have programs that work very closely,...jointly. We can fill some specialty scripts and deliver them to the bedside before the patient is even discharged," he said.

Ms Ayles responded, "Specialty pharmacy could...establish relationships with the payers, so that, particularly in oncology, a patient doesn't have to wait 2 weeks, necessarily, to get started on therapy but will get started right away. In addition to that, I think that compliance programs are important."

Last modified: February 11, 2016