Limiting the Distribution of Oncology Drugs

Oncology is already among the top therapeutic classes in specialty pharmacy.1 Experts say that drugs to fight cancer will continue to dominate the next wave of FDA approvals and enter the market at a rapid pace. Yet specifically how these medications are delivered to patients is also expected to evolve over time. This is especially true as manufacturers look to partner with specialty pharmacies that possess highly specific expertise in supporting patients with cancer and their complex treatment regimens.

Approximately 80% of manufacturers are already managing their products, many of which are oncology drugs, through a limited distribution model.2 A limited distribution network is a carefully vetted group of specialty pharmacies selected by a drug manufacturer to dispense a particular drug. Pharmacists and support staff at these network pharmacies are typically trained by the drug’s manufacturer to support patients receiving this specific therapy. Within the oncology space, manufacturers typically limit access to their drugs to anywhere from 1 to 3 specialty pharmacies of the approximately 60,000 traditional and specialty pharmacy options available to them.3

By their very nature, oncology medications distributed through specialty pharmacies are already somewhat limited in distribution. This model aligns with the unique capabilities of specialty pharmacies themselves. Specialty pharmacies typically employ highly trained experts in specific disease states—such as cancer—who can provide high-touch support to patients, ranging from adherence strategies to patient education and data-driven clinical recommendations.

This ongoing outreach ensures that all patients are receiving the greatest benefit from their therapy while minimizing adverse events. At the same time, these pharmacists are often skilled in care coordination, collaborating with the patient’s prescriber, serving as an important member of the individual’s care team, and acting as an advocate for the patient in communicating with insurance companies.


There are a few types of limited networks in place to support patients with cancer today. The smallest models in this spectrum are the exclusive, ultralimited networks, which may include just a single pharmacy. These avenues are frequently used to distribute orphan drugs—medications that treat rare health conditions. This is a direct result of the willingness of payers to extend access to a single pharmacy for such a small group of patients. Limited small networks, in the middle of this spectrum, typically expand this reach to 2 to 5 pharmacies. These are often a mix of independent pharmacies and those owned by payers or pharmacy benefit managers. That's important because independent pharmacies don't limit in-office dispensing of medications, which is critical in the oncology space. Finally, limited large networks feature a larger range of pharmacies, anywhere from 6 to 15. They include the broadest mix of pharmacy types, both large and small, nationwide.

Results from research show that some drug manufacturers are now starting to move toward the more limited end of this spectrum within oncology. Although limited distribution networks for these drugs used to commonly include upward of 25 to 30 pharmacies, they currently comprise 1 to 3 on average.4


Drug manufactures must consider a host of issues when deciding on a network distribution strategy. However, there are 3 key factors that play the most significant role in the size of the specialty drug network itself. These are:


This includes the nature of the drug, its indication, the complexity of administration, and other clinical issues. To align with these requirements, manufacturers will carefully vet specialty pharmacies to make sure they have the expertise, experience, and capabilities to support patients on a particular treatment. For oncology drugs, this requires that a pharmacy’s staff not only has the knowledge needed to answer questions and provide guidance to these patients but also understands how to provide compassionate support that accounts for the patient’s holistic needs—including physical and emotional factors such as social support.

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