October 2012 Edition Vol.11, Issue 10

Can Practices Successfully Dispense Oral Anti-Cancer Agents In-House?

Can Practices Successfully Dispense Oral Anti-Cancer Agents In-House? (continued)

In-house Pharmacy Models

Tennessee Oncology has an in-house pharmacy that is licensed, and as a full retail pharmacy carries “everything,” says Dr. Patton. He says that they don’t try to talk their patients into getting non-oncology medications, such as anti-hypertensives, in-house, but are happy to provide one-stop shopping for patients. Patton notes that the carrying cost is lower for practices with a limited formulary, “but we are willing to provide whatever service our patients feel meets their needs.”

The in-house pharmacy at New Mexico Oncology Hematology Consultants sells oral chemotherapies and support drugs, such as pain medications or antibiotics, but no anti-hypertensive agents or other retail pharmacy products.

Northwest Georgia Oncology Centers also limits their inventory to oral oncolytics and support medications a cancer or hematology patient would need, such as anti-emetics, pain medicines, antibiotics, and some selected anti-hypertensive drugs. Dr. Gould notes that patients need to understand why they need to take their medications and what the side effects could be. He believes that patients are more likely to trust their doctor and the doctor’s office staff to guide them through their chemotherapy rather than some third party from an outside pharmacy. In his practice, all patients are informed by their oncologist about their disease, diagnosis, prognosis, the risks and benefits of treatment, specific drugs and their side effects, and their treatment plan.

Patients prescribed oral medications also meet with the practice’s specialty pharmacist who educates about how to use the medication, the side effects, and what they need to report to the practice. The practice’s pharmacy services are provided by RainTree Oncology Services.

Dr. Gould says that his practice has experienced the immediate benefits of saving money on the cost of the drugs they provide and acquiring expertise in pharmacy management. Now the group is better managing their pharmacy inventory, increasing their prescription capture, and paying more attention to compliance and persistence, e.g., making sure the patients receive their medicines and take them, and that side effects are managed properly. The practice is testing software to measure compliance and persistence. Once this has been demonstrated, the group hopes, with RainTree’s assistance, to apply for in-network benefits for patients whose insurers require use of a specialty pharmacy.

Conclusion

The practice of oncology is changing and has to accommodate changes in the types of medications available, how they are prescribed and dispensed, and how they will be paid for. The use of oral anti-cancer medications should be driven by benefits to patients, such as efficacy in their particular disease state, which could be expected to lead to improved outcomes. In-house dispensing in community oncology practices seems to have benefits for both patients and practitioners. Patients may have better access provided they can pay for their medications. Whether this access leads to improved adherence and better outcomes for patients, and how this will affect the bottom line of the dispensing practices remains to be demonstrated.

 

References

  1. O’Rourke, K. After fiery debate, physician dispensing bill passes in Utah. Pharmacy Practice News. April 2012, vs. 39 http://www.pharmacypracticenews.com/ViewArticle.aspx?d=Clinical&d_id=50&i=April+2012&i_id=829&a_id=20485
  2. Mosely WG, Nystrom JS. Dispensing oral medications: why now and how? Community Oncology 2009; 6(8):3598-361. www.communityoncology.net
  3. Andrews, M. Some states mandate better coverage of oral cancer drugs. Kaiser Health News. May 14, 2012. Available at http://www.kaiserhealthnews.org/features/insuring-your-health/2012/cancer-drugs-by-pill-instead-of-iv-michelle-andrews-051512.aspx
  4. Weingart SN, Brown E, Bach PB, et al. NCCN Task Force Report: Oral chemotherapy. JNCCN 2008;6(Suppl 3):S1-S14
  5. Meier B, Thomas K. Insurers pay big markups as doctors dispense drugs. The New York Times July 11, 2012. http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-selling-drugs.html?_r=1&ref=health
  6. Sell D, and Inquirer Staff Writer. Study says doctors increasingly fill prescriptions. The Inquirer. July 19, 2012. http://articles.philly.com/2012-07-20/business/32747935_1_doctors-prescriptions-compensation-patients
  7. American Academy of Urgent Care Medicine http://aaucm.org/Professionals/MedicalClinicalNews/DispensingRegulations/default.aspx
  8. National Conference of State Legislatures. http://www.ncsl.org/issues-research/health/2012-health-insurance-reform-state-laws.aspx
  9. International Myeloma Foundation. Equal access under the law. http://myeloma.org/ArticlePage.action?articleId=3708

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