Oral oncology medications have become more common in recent years with half of cancer drugs approved in 2017 being oral oncolytics. As a result, physicians now prescribe oral cancer medications to many patients with advanced solid tissue tumors in addition to or instead of intravenous chemotherapy.1
While oral oncology medications have many benefits, they have also created new challenges for patients and their providers. Enabling patients to access and start these therapies in a timely manner remains a significant issue. Affordability, prior authorization, and other factors often delay initiation of therapy, leading to turnaround times* of two to three weeks.2
In addition to causing anxiety and stress for patients and their families, delays in therapy initiation have been associated with increased mortality for certain cancers, especially in their early stages. Thus, addressing these challenges has the potential to both improve the patient experience and enhance clinical outcomes.
Clinic-based health system specialty pharmacies significantly reduce turnaround times compared to external specialty pharmacies
Recently, three of our health system partners compared the average turnaround times of oral oncology medications dispensed by their clinic-based specialty pharmacies to the average turnaround times of oral oncology medications dispensed by external specialty pharmacies.
To obtain turnaround times from external specialty pharmacies, the health system specialty pharmacies contacted independent and PBM-owned specialty pharmacies that filled oral oncology medications from a health system prescriber.
Each health system found that the average turnaround time for patients using their clinic-based specialty pharmacy was significantly shorter than the average turnaround times for patients using external specialty pharmacies:
Health System A**
-Health system specialty pharmacy: 2.5 day average turnaround time
-External specialty pharmacies: 23 day average turnaround time
Health System B
-Health system specialty pharmacy: 2.4 day average turnaround time
-External specialty pharmacies: 14 day average turnaround time
Health System C
-Health system specialty pharmacy: 1.3 day average turnaround time
-External specialty pharmacies: 9.7 day average turnaround time
Health system specialty pharmacies address barriers to specialty medication accessibility, enabling patients to start therapy sooner
When specialty pharmacy services are integrated into outpatient clinics, health systems can provide the high-touch, personalized care patients prescribed specialty medications require. Compared to external specialty pharmacies with remote or reactive patient engagement, health system are uniquely positioned to reduce turnaround times by proactively addressing barriers that delay patients from starting therapy:
1. Prior Authorization and Appeals: In a recent American Medical Association survey, 90 percent of physicians said the prior authorization process delays patient access to care. A health system specialty pharmacy accelerates this process by providing skilled pharmacy liaisons to manage it proactively. Compared to external specialty pharmacies, clinic-based pharmacy liaisons can easily communicate with other providers allowing them to quickly collect and submit required information. This removes the burden of prior authorization from doctors and nurses, who often have limited capacity and time to complete required paperwork. Liaisons in the clinic setting develop personal relationships with patients providing an added motivation to remove administrative burdens and gain health plan approval. And health systems incentivize liaisons to achieve specific prior authorization approval times.
2. High Out-of-Pocket Expenses: Even after cancer patients receive prior authorization, many struggle to access their prescriptions due to the high out-of-pocket expenses related to these therapies. One study found that the average per-claim out-of-pocket costs among 21 oral oncolytics ranged from $15 to $500. Health system specialty pharmacies address this barrier by securing financial assistance from drug manufacturers, nonprofit associations, and other organizations for patients. This support leads to patients starting therapy sooner and staying on it longer.
3. Pharmacy Processing: Finally, health system specialty pharmacies can process and dispense prescriptions quickly. Instead of sending prescriptions to an external specialty pharmacy over the internet or phone, doctors send prescriptions directly to their clinic-based specialty pharmacy team via the health system’s EHR. Pharmacy liaisons then efficiently manage benefits investigation, prior authorization, and financial assistance. Upon health plan approval, the specialty pharmacy team immediately fills the prescription in the on-site pharmacy, and the clinical pharmacist personally gives the medication to the patient when providing drug counseling.
The results of this clinical outcomes study demonstrate the impact health system specialty pharmacies have on important clinical and performance measures like turnaround times. Our partner health systems are currently completing additional studies to evaluate how a clinic-based specialty pharmacy model impacts other clinical and performance measures, such as medication adherence.
Read a clinical outcomes study from Southern Ohio Medical Center or learn about other benefits of a health system specialty pharmacy or contact us to discuss building or expanding a clinic-based specialty pharmacy at your health system.
1. Given B, Given C, Sikorskii A, Vachon E, Banik A. Medication Burden of Treatment Using Oral Cancer Medications. J Oncol Nurs. 2017 Oct-Dec; 4(4): 275–282.
2. Trellis Rx partner health system specialty pharmacy data
*Turnaround time is defined as how long it takes for a patient to take first dose after the prescription is written
**Health system only evaluated turnaround times for Pfizer oral oncolytics
This post is related to:Specialty Pharmacy