Adherence to oral oncolytics filled through an internal health-system specialty pharmacy compared with external specialty pharmacies

Academia, Emmeline C.; Jesús, Caroline M Mejías-De; Stevens, Janice R.; Jia, Lily Y; Yankama, Tuyen; Patel, Chirag; Lee, Jin-Kyu

doi:10.18553/jmcp.2021.27.10.1438

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…While previous studies have been generally limited to individual health systems or focused primarily on adherence or impact on prescription savings, 7,8 this study was able to include a mixture of health systems across the US and report the total financial impact combined among pharmacy and medical benefits. In this study, several measures related to medical charges, oral oncolytic prescription costs, and HCRU in the integrated group were lower than those in the partially integrated and non-integrated groups.…”

Section: Discussionmentioning

confidence: 99%

Impact of health system specialty pharmacies on total cost of care in cancer treatment, a multisite review

Wink,

Schroader,

Giglio

et al. 2023

J Oncol Pharm Pract

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Introduction Integrated delivery networks can use medically integrated dispensing of oral oncolytics on site through health system specialty pharmacies. There is little published research examining cost savings. Our objective was to demonstrate the financial value of health system specialty pharmacies among patients receiving oral oncolytics dispensed through fully, partially, and non-integrated dispensing strategies. Methods This was a retrospective cohort study of adult patients from Symphony Health's Integrated Dataverse® repository who filled a prescription for an agent of interest from 7/1/16–6/30/20 that was written within 25 US health systems. Outcomes included costs, healthcare resource utilization, and duration of therapy. Results In total, 36,816 patients were included; 986 patients (2.7%) integrated, 1,822 (4.9%) partially integrated, and 34,008 (92.4%) non-integrated. Mean 6-month medical charge and oncolytic prescription costs were lower for the integrated group ($36,831; $55,786) than the partially integrated ($46,304, p = 0.053; $63,295, p = 0.071) and non-integrated groups ($54,261, p < 0.001; $65,005, p = 0.004). In most healthcare resource utilization categories, the integrated group had the lowest patient percentage utilizing medical care. Duration of therapy was lower on average by ∼3 months in the integrated vs non-integrated group, which may represent closer monitoring of patient medical records and need for fills vs autoship practices. Conclusions Patients receiving oral oncolytics through medically integrated dispensing at health system specialty pharmacies may have lower medical and pharmacy costs and decreased healthcare resource utilization. This study adds to the growing body of literature supporting integrated delivery networks and integrated dispensing. Further research is needed to demonstrate the value of medically integrated dispensing through health system specialty pharmacies in the delivery of treatment to patients with cancer and other high-cost diseases.

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Section: Discussionmentioning

confidence: 99%

Impact of health system specialty pharmacies on total cost of care in cancer treatment, a multisite review

Wink,

Schroader,

Giglio

et al. 2023

J Oncol Pharm Pract

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“…23 The Role of Integrated Specialty Pharmacies Integrated specialty pharmacies play an increasing role in coordinating coverage and authorization issues, identifying OOP costs, and helping patients apply to assistance programs. 53 Trained staff can reduce time to initiation of treatment 25,54 and increase adherence rates 26 for patients who were prescribed OAMs; their efforts can lead to significant cost savings for both patients (through financial assistance programs) 55 and health systems (through reduced medication waste). 56 Compared with traditional mail-in pharmacy programs, specialty pharmacies often have staffing and resources to handle payor-and costrelated barriers and disease-specialized pharmacists with expertise on specific OAMs.…”

Section: The Impact Of Assistance Programs On Costsmentioning

confidence: 99%

Pharmacy Assistance Programs for Oral Anticancer Drugs: A Narrative Review

Ragavan,

Swartz,

Clark

et al. 2024

JCO Oncol Pract

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Oral anticancer medications (OAMs) are high priced with a significant cost-sharing burden to patients, which can lead to catastrophic financial, psychosocial, and clinical repercussions. Cost-conscious prescribing and inclusion of low-cost alternatives can help mitigate this burden, but cost transparency at the point of prescribing remains a major barrier to doing so. Pharmacy assistance programs, including co-payment cards and patient assistance programs administered by manufacturers and foundation-based grants, remain an essential resource for patients facing prohibitive co-payments for OAMs. However, access to these programs is fraught with complexities, including lack of trained financial navigators, limited transparency on eligibility criteria, onerous documentation burdens, and limits in available funding. Despite these drawbacks and the potential for such programs to incentivize manufacturers to keep list prices high, assistance programs have been demonstrated to improve financial well-being for patients with cancer. The increasing development of integrated specialty pharmacies with dedicated, trained pharmacy staff can help improve and standardize access to such programs, but these services are disproportionately available to patients seen at tertiary care centers. Multistakeholder interventions are needed to mitigate the burden of cost sharing for OAMs, including increased clinician knowledge of financial resources and novel assistance mechanisms, investment of institutions in trained financial navigation services and centralized platforms to identify assistance programs, and policies to cap out-of-pocket spending and improve transparency of rates charged by pharmacy benefit managers to a health plan.

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“…The short time to medication access seen in population of patients that filled medication at an HSSP aligns with previous research demonstrating that HSSP integration leads to fast specialty medication access. 5,[7][8][9][10][11][12][13][14][15][16][17]28 The least common reasons for PMN was unaffordable copay or that the treatment was no longer appropriate. HSSP team members help patients obtain access to the treatment through prior authorizations and/or financial assistance obtained through foundations or manufacturer programs.…”

Section: Outcomes and Analysismentioning

confidence: 99%

“…2 Integration with providers, clinics, and other services within the health system enables HSSPs to often overcome common barriers to access while meeting the needs of manufacturers and payers. [5][6][7][8][9][10][11][12][13][14][15][16][17] HSSPs have also demonstrated the ability to ensure patients can afford high-cost specialty therapies, which may be a particularly pressing concern for cancer treatments as most patients are Medicare beneficiaries that do not qualify for manufacturer assistance. 6,9,12,[18][19][20][21][22] By collaborating with other health system services, such as social workers and financial advisors, HSSPs provide comprehensive care that ensures patients can access, afford, and initiate specialty medications in a timely manner.…”

mentioning

confidence: 99%

Low rates of primary medication nonadherence in patients prescribed oral oncology agents across health system specialty pharmacies

Zuckerman,

Crumb,

Kandah

et al. 2023

JMCP

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BACKGROUND: New oral oncology medications bring novel challenges when patients are initiating treatment. Rates of primary medication nonadherence (PMN), the rate at which a medication is prescribed but not obtained, of up to 30% have been reported for oral oncology medications. More research is needed to identify causes and develop strategies for health system specialty pharmacies (HSSPs) to improve cancer treatment initiation rates. OBJECTIVE:To evaluate the rate and reasons for PMN to specialty oral oncology medications in an HSSP setting. METHODS:We performed a multisite retrospective cohort study across 7 HSSP sites. Patients were included if they had an orally self-administered oncology medication referral generated by the health system of the affiliated specialty pharmacy between May 1, 2020, and July 31, 2020. Data collected at each site using pharmacy Plain language summaryThis study found that most patients (89%) who received cancer medication to take at home from a health system specialty pharmacy start treatment. The most common reason for not starting was because of the patient's own decision not to start. Implications for managed care pharmacyRates of primary medication nonadherence as high as 30% have been reported in previous studies of patients starting oral oncolytics. With the increasing number of cancer treatments moving toward patientadministered oral therapies, it is important to understand reasons behind primary medication nonadherence and how the health system specialty pharmacy model is uniquely positioned to positively impact these rates. This study proves that patients are most likely to initiate treatment when managed by health system specialty pharmacies.

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Adherence to oral oncolytics filled through an internal health-system specialty pharmacy compared with external specialty pharmacies

Cited by 7 publications

References 13 publications

Impact of health system specialty pharmacies on total cost of care in cancer treatment, a multisite review

Impact of health system specialty pharmacies on total cost of care in cancer treatment, a multisite review

Pharmacy Assistance Programs for Oral Anticancer Drugs: A Narrative Review

Low rates of primary medication nonadherence in patients prescribed oral oncology agents across health system specialty pharmacies

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