The Benefits of In-Practice Dispensing

The October issue of OBR included an article titled “Can Practices Successfully Dispense Oral Anti-Cancer Agents In-House?” The article concluded that in-practice dispensing can indeed provide many benefits to patients and practitioners. At Southeast Nebraska Cancer Center, we have had an in-practice dispensing solution for our patients since April 1, 2010. During our first month of operation, our pharmacy filled 85 prescriptions. Now, two years later, we average 850 fills per month, and that number continues to rise.

The decision to add an in-practice pharmacy was not an easy one. However, we’ve always believed that the pharmacy is an integral component in providing comprehensive care, which is something we felt we needed to do. Once our pharmacy opened for business, we turned our attention to promoting the convenience and service of the in-practice pharmacy to our patients. We believe that the most important benefit of having an in-practice pharmacy is the collaboration that it fosters between the physicians, midlevel providers, nurses and the pharmacy staff. With all parties involved in treatment decisions, we are able to provide our patients with the best possible care while allowing them the convenience of a “one-stop-shop”. With the pharmacy staff being able to view patient records thoroughly, there is also less chance of a prescribing or dispensing error being made. Furthermore, the pharmacy is aware of the medications and treatment protocols their physicians tend to prescribe. Thus, the pharmacy is able to keep these medications in stock, including topicals that the radiation department prescribes regularly, and which are hard to find at other local pharmacies.

Our staff is able to fill 90% of the medications prescribed on the same day. Often, when prescribers are aware of the desired oral chemotherapy medication prior to the patient appointment, the pharmacy staff is able to run the prescriptions through a third party insurance company to see what is required from a reimbursement stand point. Using this method, prior authorization paperwork can be started or alternative drugs can be discussed if needed. By proactively managing the insurance approval and analyzing the patient’s co-pay, we are able to ensure their patients receive the needed medication in a timely manner, ensuring higher compliance with the prescribed treatment plan.

While we recognize new patients do not choose our practice solely based upon our in-practice pharmacy, our patients have expressed that they appreciate the convenience, reliability and personal attention they receive from the pharmacy staff. Our six medical oncologists and three radiation oncologists take pride in providing patients with comprehensive, progressive medical care in a compassionate and caring setting. Our in-practice pharmacy helps us do this.

Opening a pharmacy has strengthened the weakest link in the healthcare process of prescribing oral oncology and ancillary medications. Providing prescriptions to patients prior to leaving the clinic has improved patient outcomes and their knowledge of the medications they are receiving. There are a number of programs in place, like ION Solutions’ Specialty Oncology Program, that can assist practices in developing a program that works for them. I highly recommend exploring whether or not this solution makes sense for your practice.

Benefits of having an in-practice pharmacy include:

  1. Physicians, mid-levels and pharmacists are able to collaborate on treatment plans.
  2. Physicians and mid-levels have quick access to the pharmacist for clinical review of medications (i.e. interactions, adverse events, etc.).
  3. Pharmacy access to real time patient medical records allows a thorough understanding of the entire patient plan (i.e. IV and oral chemotherapy, ongoing issues, other medications, etc.).
  4. Pharmacist is able to monitor patient therapy to increase adherence.
  5. Patient leaving the office with medications in hand increases the chance of compliance.
  6. Consistency in a dispensing pharmacist creates a comfortable patient relationship where patients discuss issues/concerns/questions more openly.
  7. Pharmacist understands prescribing habits and intent of prescribers, which aids in error identification and closer inventory management.

By Todd O’Connell, Chief Financial Officer, SE Nebraska Cancer Center

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