A holistic, focused approach to patients ensures that pharmacy needs are met and optimal treatment results are achieved. The close coordination of the entire health care team for individual therapeutic care is the goal.
Changes to oncology medications and therapy protocols make the specialty marketplace almost unrecognizable from a decade ago. A flood of newly approved cancer medications have hit the marketplace, along with medications that have received FDA approval for expanded indications. Additionally, the growing number of late-stage clinical trials indicates that the pipeline of infusible and oral oncology medications is not slowing any time soon.
While these newly emerging oncology medications offer patients more treatment choices than ever before, they generally also come with distinct and difficult-to-manage toxicities. Specialty pharmacies are uniquely suited to handle the necessary prevention, monitoring, and individualized management of oncology medications. In addition to the drastic changes to the menu of oncology medications, there are also huge changes to oncology benefits—from the swan song of the buy-and-bill method to the growing challenges of health plans trying to manage off-label uses.
“We are well aware of all these oncology changes and challenges, which is why our Oncology RxAssist program at BioPlus works to smooth the path for both physicians and patients,” said Elvin Montanez, PharmD, senior vice president of BioPlus Specialty Pharmacy. “For example, with the numerous changes to payer plans, we work even harder to make sure physicians and patients have reimbursement support to aid in obtaining prior authorizations, benefit investigation, and verifying copays. Then on the clinical side, we’re there to provide therapy management, refill reminders, and patient care coordination.”
BioPlus offers a therapy-management focused approach that helps to produce optimal treatment outcomes. The key to BioPlus’ successful patient outcomes lies with the dedicated team of doctors of pharmacy and clinical support staff who develop individual therapeutic care plans for each patient and monitor the entire treatment continuum. This individualized care plan starts as soon as a prescription is received when a member of the clinical support staff contacts the patient with information about the upcoming oncology therapy regimen. Once a baseline with the patient has been established, subsequent calls keep the member on course for medication adherence during his or her cancer treatment. This continuous follow-up means that side effects are readily managed, adherence is improved, and the best possible outcome is achieved.
BioPlus views its patients from a holistic perspective and tries to ensure all pharmacy-related needs are provided for. This often means that BioPlus can also provide for any infusion needs the patient may have (such as IgG). In addition, family members are welcome to have their prescriptions filled at BioPlus as well, to allow for all of the family’s pharmacy care to be conveniently provided at 1 pharmacy.
DECREASING MEDICAL ERRORS, ENHANCING COMMUNICATION THROUGH TECHNOLOGY
Technology offers numerous ways to increase compliance for patients, which in turn maximizes treatment outcomes. Technology improves patient outcomes, reduces risks, promotes collaborative communication among the entire medical pharmacy care team, and controls costs.
Recently, BioPlus introduced the Therapy Access Portal application (TAP App), which connects the prescriber with other members of the care team and gives them full visibility to their patients while being serviced by BioPlus. This web-based app can be used on smartphones, tablets, and laptops, and is accessible anywhere in the world, day or night. Prescribers are finding their work is easier with TAP App since they can use it to e-prescribe, monitor their patients, and review all necessary pharmacy data. Prescribers can see data related to drug treatment response, compliance, interventions, and proactive drug interaction screens.
Technology also decreases medical errors. The widespread problem of medical errors became a major topic of discussion more than a decade ago when the Institute of Medicine published a now-famous report entitled To Err Is Human. After detailing the appalling statistics of this issue, the report set an ambitious goal for the United States to significantly lessen the number of people injured by medical errors and adverse events.
How far has the US medical community come in the 10+ years since that goal was set? According to recent studies, the answer is “not very far.”1
First, a review of injuries stemming from medical errors shows that the number of affected patients has stayed virtually the same in a recent 8-year period. Second, a report from the Inspector General of the Department of Health and Human Services outlined substantial harms to Medicare patients in US hospitals. Third, a study found that nearly 1 of every 3 patients is harmed while hospitalized.
A major downfall in current efforts by the medical community to curtail patient errors is that most methods look for problems after they occur instead of engaging clinicians at the time of care delivery. Errors cannot be prevented by looking for signs of patient harm. This is where technology plays a powerful role. Technological advancements result in a lesser risk of medication errors due to illegible or incomplete handwritten prescriptions. Time and money can also be saved by utilizing technology for both new and renewed prescriptions. According to data from the Agency for Healthcare Research and Quality, computerized medication order entry systems (eg, e-prescribing) could prevent up to 84% of dose, frequency, and route errors in medication use.2
Patient safety is clearly of top importance, but financial benefits are a wonderful side effect of e-prescribing. Medical errors cost insurers money; therefore, it stands to reason that if society is able to lessen the number of medical errors, health care–related costs may go down. A study in Health Affairs found that the estimated total cost of measurable medical errors in the United States is $17.1 billion annually.3
Of this total pie of medical errors, the biggest slice is accounted for by adverse events associated with medications. In fact, for every dollar spent on health care in the United States, as much as 45 cents is related to a medical mistake.4
OPTIMAL ONCOLOGY OUTCOMES
Specialty pharmacies—particularly those specializing in oncology care—are best positioned to provide the patient with an optimal treatment outcome. Oncology treatments work best when a patient, the treating physician’s team, and a specialty pharmacy work together to overcome treatment challenges. These challenges are significant in oncology care and include:
After the first shock of diagnosis wears off and the patient learns of their oncology treatment plan from the physician, the next big stumbling block to the healing process is a full understanding of the cost of therapy. There are many questions that need to be answered for the patient, and only a specialty pharmacy that works with this challenge daily can quickly and efficiently gather the information needed to assess available resources. Specialty pharmacies are experts at benefit verification, assessing patient out-of-pocket costs, and securing financial assistance if necessary.
The patient will have a steep learning curve, even before the treatment itself starts. Those with cancer will need to receive information about lifestyle changes, medication administration, adherence education, anticipated side effects, and how to manage those side effects, just to name a few of the training hurdles that patients face. The specialty pharmacy serves as a key educator in helping the patient and the patient’s caregivers adjust to the new vocabulary that has been thrust upon them with a cancer diagnosis.
3. Drug Therapy Management
The work is far from over after a treatment plan is in place. The treating doctor needs to know that the plan is being followed by the patient, that the patient is monitored and managed for adverse effects, and that potential drug–drug interactions are monitored and avoided. This can only occur with intensive monitoring for safety and efficacy by a specialized oncology clinical pharmacist.
The care model at BioPlus is set up as a therapy pod with all business disciplines present and is ideally suited to help the patient tackle treatment costs, training, and drug therapy management. Unlike the mail order or retailer model, BioPlus’ oncology treatment teams work together to manage each patient. The treatment teams develop personal relationships with both the patient and prescribing doctor. One advantage to this team approach is that when a BioPlus team member is unavailable, there are other team members who are already familiar with the patient and can step in to provide seamless care.
ADHERENCE IS KEY TO ONCOLOGY TREATMENT SUCCESS
The main concern with complex therapies is compliance. On average, patients become noncompliant with their treatment within the first 30 days of starting therapy.5
Mail-order pharmacies typically deliver a 90-day supply of therapy to patients and do not speak with the patients until it’s time for their next 90-day supply refill. At that point in the process, many patients may have stopped their treatment due to unmanaged side effects.
Noncompliance is far from a small issue. Similar to medical errors, noncompliance costs the US health care system billions every year. Putting the money issue aside, poor medication adherence leads to unnecessary progression of diseases, complications, impaired quality of life, and even premature death. The World Health Organization estimates that only about 50% of patients take their medications as prescribed—with the problem cutting across gender, age, income, and education. 6
It sounds surprising at first glance: why would someone with a health problem as serious as cancer not complete their treatment exactly to the prescribing physician’s orders? There are actually a lot of barriers that get in the way of taking all medications prescribed at the right time and in the right amount.
COMMON TREATMENT BARRIERS
The patient doesn’t understand the instructions of how to take or use the medication.
The authorization process through health care plans can be confusing and overwhelming.
The medication might cause side effects that are uncomfortable.
The patient is worried that side effects could occur and avoids the medication due to that concern.
The treatment costs are too high for the patient to pay.
The patient forgets to take the medication.
The patient forgets to get a refill.
“By working with patients to set realistic expectations about side effects and offering tools to minimize side effects, as well as providing assistance navigating the financial aspect of getting medications, following up on refills, and offering 24/7 access to doctors of pharmacy, we’ve found that most patients who would have fallen into the ‘noncompliant’ category instead complete their treatment so they can end up with the best possible treatment outcomes,” reported Dr. Montanez.
BioPlus provides best-in-class specialty pharmacy services to manage a patient’s therapy experience. This holistic approach and attention to the management of each stage in the oncology therapy continuum is what may account for an oncology compliance rate of more than 96% for BioPlus patients. SPT
1. Jha AK, Classen DC. Getting moving on patient safety: Harnessing electronic data for safer care. N Engl J Med
November 10, 2011;365:1756-8.
2. Agency for Healthcare Research and Quality. "Reducing and preventing adverse drug events to decrease hospital costs." 2001. www.ahrq.gov/qual/aderia/aderia.htm.
3. van Den Bos J, Rustag K, Gray T, et al. The $17.1 billion problem: The annual cost of measurable medical errors. Health Aff
4. Goodman JC, Villarreal P, Jones B. The social cost of adverse medical events, and what we can do about it. Health Aff
5. Thinking Outside the Pillbox A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease A NEHI Research Brief – August 2009.
6. World Health Organization (2003) (PDF). Adherence to Long-Term Therapies: Evidence for Action
. Geneva: World Health Organisation. ISBN 92-4-154599-2. http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf.
7. BioPlus Data on File, 2012.
About the Author
Nick Maroulis, PharmD, is the director of pharmacy for BioPlus Specialty Pharmacy, where he manages the specialty pharmacy, including the key area of oncology, as well as being involved in research and clinical drug trials. He has extensive professional experience in specialized nutrition support, oncology, pediatrics, and home infusion pharmacy.