New Specialty Pharmacy Model Meets the Evolving Needs of Oncology Practices

Over the last decade, many new oral oncolytics have been developed, giving patients promising new treatment options. In 2015, nine oral cancer drugs were approved by the FDA,1 and the future looks even brighter. Biopharmaceutical companies currently have 836 medicines and vaccines for cancer in clinical development, and 25 percent of those are oral agents.2

 

While it is exciting to see so many oral drugs in the pipeline or already on the market, ensuring that patients can gain access to these promising new therapies can be a challenge for community oncology practices. Drug manufacturers often restrict distribution to specific channels, blocking access for the practice's in-office dispensing pharmacy. Even if the drug can be obtained by the practice, getting reimbursement from payers can present a problem, as the payer approved pharmacy network is often very restrictive. Consequently, oncology practices turn to specialty pharmacies to gain access to the lifesaving drugs that are vital for their patients.

Specialty pharmacies need to provide more expertise and services

Given the evolving healthcare landscape, stakeholders in the cancer community?including providers, payers, drug manufacturers and patients?need specialty pharmacies that can go beyond just providing access to drugs. Oncologists want and need a pharmacy provider with extensive therapeutic expertise and experience in oncology?one that understands cancer is not just a single disease, but rather 300 different types of very complex sub-diseases. Oncologists need a specialty pharmacy collaborator that will support their treatment plans, alleviating their administrative burden so they can focus on treating patients. They want a pharmacy provider with the skill, expertise and resources to understand and help manage the clinical, financial and emotional complexities associated with cancer treatment.

Managing clinical complexities can include such things as educating patients on how to properly take their medications, controlling side effects, helping patients deal with late stage therapies, and other intricacies that impact this niche patient population. There are also financial barriers associated with oral cancer medications that must be dealt with, since these drugs are very costly. Many patients, especially those in late stage therapy, have already had a difficult journey, both physically and financially, so having a pharmacy provider that can access copayment foundations and help the patient solve financial issues is very beneficial.

Lastly, oncologists want a pharmacy provider who understands the emotional plight of patients and has empathy for them, as well as a willingness to provide a very high level of service to help ensure the best possible patient experience. Time to first fill is paramount because of disease progression and the emotional anxiety that goes along with cancer. Getting their medications in hand gives patients hope and reduces stress. Quality of care can be greatly enhanced by having a pharmacy provider who understands how speed of delivery impacts patient care.

Payers, manufacturers and patients are also seeking additional expertise and services from specialty pharmacies. Payers want an expert with therapeutic proficiency who can ensure the treatment is appropriate for each of their cancer patient members, that care is properly executed according to label and treatment guidelines, and that the therapeutic cycle is completed, all of which contribute to an optimal outcome. Manufacturers want to entrust their products to an oncology expert who can collaborate on a care plan that enables the best possible outcome, elevating both the patient and provider experience with the brand. Similarly, patients and their loved ones want access to an expert who can provide guidance anytime day or night, helping to ease anxiety. Specialty pharmacies that offer a high touch care model to patients can impact and elevate results, helping patients have the best possible experience and outcome.

A new model: A specialty pharmacy as an extension of the practice

While specialty pharmacies are often viewed as a necessary evil by oncology practices, a new type of specialty pharmacy model has emerged with the goal of becoming a valuable resource for practices, as well as payers, drug manufacturers and patients. Studiomaca Specialty Pharmacy Solutions includes Biologics' Oncology Pharmacy Center of Excellence (COE) that not only provides access to drugs, but actually strives to become a valued member of the provider's care team. By having likeminded patient outcome goals, by providing deep therapeutic expertise in cancer care, and by offering a wealth of patient-centric services to drive better outcomes, Biologics strives to be an extension of the practice.

The COE is designed to help oncology practices effectively and efficiently manage critical patient needs with a high touch/high care multidisciplinary operating model. The COE makes patient access, education and support a priority, along with clinical assistance to the care team. Additionally, pharmacy data management and performance reporting capabilities help provide quality care and collect business intelligence to support sound decision making while building a strong foundation for the transition to value-based care.

Deep therapeutic expertise and support is provided to the practice by oncology certified nurses, board certified oncology pharmacists, and specialized care teams who focus on both blood and solid tumors, providing oncology clinicians an unparalleled level of support. Patients receive support throughout their treatment from specialists in patient on-boarding, benefits and financial assistance programs. These highly skilled professionals efficiently coordinate medication delivery, reducing time for first fill and rearranging workflow if necessary to accelerate certain patients through the system who have a critical timing need for the medication. The COE also maintains a comprehensive library of information that staff can tap into to show necessity for the patient, quickly overcoming payer objections and speeding authorizations and delivery. Pharmacists, oncology certified nurses and certified pharmacy technicians strive to build a strong relationship with the patients they serve, helping them understand complex dosing instructions as well as addressing side effects, easing the burden on practice clinicians.

The COE also has broad and deep analytic capabilities, with over 350 unique data fields available to customize per patient. This provides practices accurate, timely data that translates into actionable insight to support operational and clinical efficiencies that support high-quality care, as well as drive the transition to value-based care. This information is incredibly valuable to all stakeholders in the cancer community, as the healthcare landscape evolves to focus more on population health and value-based care.  

The specialty pharmacy as part of an ecosystem of excellence

The Biologics Center of Excellence is designed to help drive the creation of an ecosystem of excellence in which the practice is an expert in all of the different components necessary to deliver quality care, and in which all components are aligned to achieve optimal outcomes. The COE is not an island by itself, but rather a part of this ecosystem that delivers the highest level of care possible to the patient. Its part in this ecosystem is to go beyond the typical role of a specialty pharmacy, becoming a valuable resource to help manage the clinical, financial and emotional complexities associated with cancer care.

As oncology care evolves in the new healthcare landscape and practices are required to take on more risk and responsibility for outcomes, this ecosystem concept will become extremely important. The alignment of interest in patient care by everyone providing a service to the patient will be crucial. In this environment, practices will need a likeminded specialty pharmacy that can enhance their operation, providing not only access to drugs, but also deep therapeutic expertise in oncology and a wealth of comprehensive supportive services that drive optimal outcomes for patients.

References:

1 “ .” The American Journal of Managed Care. Published Online: March 18, 2016. Accessed November 3, 2016.
2 Ibid.

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About the author

Dan Duffy is the Vice President and General Manager of Pharmacy Solutions for Studiomaca Specialty Health.