Oncology: The Gateway to Success in Specialty Pharmacy

June brings the annual American Society of Clinical Oncology meeting in Chicago and our ninth oncology-focused edition of Specialty Pharmacy Times®. The sheer volume of specialty products in the oncology space creates the greatest opportunity for our field. Developments in oncology therapy dominate the number of approvals coming out of the FDA and shadow other disease states. If you want to be a player in specialty pharmacy, oncology is the place to be.

Traditionally, specialty pharmacy has focused on oral or self-injectable oncology products; however, there has been a significant shift as specialty pharmacies become increasingly involved in infused oncology products, which are often administered to patients in the clinic, at home, or in the hospital.

Focusing on Specialty Pharmacy

Given the cost and complexity of oncology products, payers have considered specialty pharmacy as the main channel of dispensing and leverage the drug benefit to better manage the economics. Because of the US system for drug reimbursement, virtually 100% of oncology products are covered by some form of insurance or sponsored coverage. With rare exceptions, all specialty pharmacies touch the payer system through either ownership or contracting.

Because payers control reimbursement, the most significant dollar volume of oncology products flows through payer-owned specialty pharmacies. For accredited specialty pharmacies, the focus is on not just cost but also the optimization of pharmaceutical care outcomes, which are accomplished by ensuring appropriate medication use and maximizing adherence. Economics are important, but if the drug is not managed appropriately, the value created by that therapy can be negatively affected. Patient satisfaction also plays a key role and is measured by specialty pharmacy with a focus on continuous improvement. A close interaction with the patient’s caregivers is critical, because nearly all these products are dose adjusted to tweak their efficacy and minimize adverse effects (AEs). This leads to ongoing communication with the patient to make sure they are doing the right thing with their therapy.

Excellence in Oncology

Adherence

Oncology products by nature are most often cytotoxic and kill off faster-growing tumor cells. However, the human body also has many fast-growing nontumor cells, which are frequently affected by treatment, leading to AEs. Treatment involves an ongoing battle between efficacy and managing these AEs, making adherence to therapy an art in the practice of specialty pharmacy. The complexity of instructions makes patient education paramount. Specialty pharmacies raise the bar on education and reinforcement, using a multifaceted strategy designed to envelop the patient with care. The specialty pharmacy team must be great listeners, probing for issues and providing recommendations that keep patients on therapy to ensure the best outcomes, which correlate highly with adherence. Specialty pharmacies work to empower patients with knowledge about their condition, treatment, and potential AEs. Pharmacists and other specialists supporting the pharmacy counsel patients before the initiation of therapy, reinforcing and complementing the information received from physicians and other caregivers.

Technology
Making sure the patient always has necessary medication on hand requires strategically timed communications so that the patient receives refills before running out of their current supply. A specialty pharmacy employs several techniques to ensure adherence to the dosage regimen and asks questions with each interaction to determine how much of the drug has been consumed. Because most specialty pharmacies deliver medications to the patient’s home, there must be adequate lead time to obtain the approval and secure reimbursement. Technology often comes into play, and several resources can assist in determining the timing of a patient’s next refill. For example, a text message reminder to take their medication is very powerful with some patients. Patients are busy and tend to forget to take their drug, and a text message offers a gentle, minimally intrusive prompt. These texts often request a response to validate they were received and acted on. Some specialty pharmacies use smart vials that remind the patient when to take their medication and have feedback technology to determine if a dose was taken. Some of these devices connect to the internet to provide real-time feedback to the pharmacy. 

Clinical and Call Center Support
The costliest form of care today involves ending up in the emergency department. Having access to trained specialty pharmacy oncology professionals with strong clinical experience may help prevent emergencies caused by AEs and nonadherence. A well-trained specialty pharmacy clinician can often help patients recognize or mitigate AEs that demand medical attention and instruct the patient to seek medical attention, often contacting their oncology team. To achieve the highest level of care, some pharmacies employ staff who have obtained specialized certifications. Having credentialed professionals ensures that patients receive qualified services. One of the better-known programs is by the Board of Pharmacy Specialties, a division of the American Pharmacists Association. Leading specialty pharmacies frequently offer some form of 24/7 clinical support. If a specialty pharmacy has an oncology focus, it is imperative that they employ staff who possess extensive knowledge about oncology products and their AEs. 

Clinical Research
Many specialty pharmacies that work closely with oncologists engage in research by enrolling in clinical studies. By adhering to strict research protocols, providing timely access to specialty products, coordinating dose modifications and patient information, and reporting AEs, specialty pharmacies can play a significant role in advancing the approval of new products and indications. The specialty pharmacy also can contribute to the clinical research process by facilitating the aggregation of data augmented by collecting additional information through patient communication and disease management information.

Arm Patients With Co-pay Assistance Information
Oncology products usually come at a high price and for many patients, co-pays for specialty drugs are prohibitive. Most manufacturers sponsor programs that assist with co-pays or provide financial assistance programs so that high out-of-pocket costs do not prevent patients from accessing therapy. Several foundations around oncology products also offer support but are very complex programs and require a great deal of experience to navigate. Many patients and prescribers are often unaware of these resources and those who are aware are frequently overwhelmed by the applications and enrollment processes.

Specialty pharmacy staff should have solid knowledge about the products they dispense and the programs that can assist patients in accessing these products. For patients to obtain insurance coverage, nearly all available oncology products require a specialty pharmacy to obtain prior authorization. The specialty pharmacy must be adept at obtaining coverage and clearly communicating the status during the process until authorization is received or denied.

Pulling It All Together
A specialty pharmacy’s expertise in supporting oncology patients is among its most essential attributes. Well-trained, compassionate professionals, not just the products dispensed, make a pharmacy special. Specialty pharmacies are also expected to obtain multiple accreditations and provide superior data-driven decision making. Developing partnerships with manufacturers to produce data that are timely, accurate, and comprehensive helps the manufacturer better understand their product’s performance, including how patients respond to therapy.




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