Presenter: Angie Wood, PharmD, BCPS, BCOP, CSP, Clinical Oncology Pharmacist, Trellis Rx–North Memorial Health, Robbinsdale, MN
Co-Authors: Brian O’Keefe, PharmD, BCOP, Clinical Oncology Pharmacist, Trellis Rx, Parkview Health, Fort Wayne, IN; Jessica Mourani, PharmD, Director, Clinical Outcomes Research, Trellis Rx
BACKGROUND: The time from ordering an oral oncolytic to the patient’s receipt of the drug can be a source of angst for patients and prescribers who are hoping to avoid delays in treatment. Previous studies report a median time to the access of oral oncolytic agents ranging from 4 to 12 days.1-4 The factors that contribute to the lag between the prescription being written and patient access include prior authorizations, financial toxicity, pharmacy review, and delivery time. Health system specialty pharmacies (HSSPs) are uniquely positioned to overcome these barriers. Parkview Health established an integrated specialty pharmacy model to streamline and improve the process for patients in need of oral oncolytics.
OBJECTIVE: To compare the time to access oral oncolytic treatments before and after specialty pharmacy integration.
METHOD: This retrospective, comparative time-series analysis measures the access time to oral oncolytic drugs for patients before and after the integration of an HSSP at a genitourinary oncology clinic. Access time was defined as the difference in business days between a new order and a patient’s receipt of the ordered drug. The integrated specialty pharmacy completed prior authorizations, addressed financial barriers, completed chemotherapy education, and dispensed the therapy or triaged it to the in-network specialty pharmacy. A secondary end point compared the access time of patients filling an oral oncolytic drug prescription at the HSSP versus at an outside pharmacy.
RESULTS: A total of 80 patients were identified who had started an oral oncolytic drug before the HSSP integration. The median access time was 7 business days. In all, 82 patients were identified who had started therapy after the HSSP integration. The median access time was 6 business days, resulting in a 15% reduction in the time to therapy after the HSSP integration. The median access time when dispensing through the HSSP was 5 business days versus 9 business days for outside specialty pharmacies, resulting in a 43% reduction in the time to therapy after the HSSP integration.
CONCLUSION: The integration of an HSSP resulted in a 15% reduction in patient access time, demonstrating the enormous impact that an HSSP can play in avoiding delays to therapy. Furthermore, this study demonstrates the importance of filling a prescription with the integrated HSSP, as demonstrated by the 43% reduction in access time in patients filling their prescription internally.
- Wyatt H, Peter M, Zuckerman A, et al. Assessing the impact of limited distribution drug networks based on time to accessing oral oncolytic agents at an integrated specialty pharmacy. J Hematol Oncol Pharm. 2020;10(4):198-205.
- O’Neil D, Accordino MK, Wright JD, et al. Delay in receipt of newly prescribed oral anticancer drugs. J Clin Oncol. 2019;37(15 suppl):6541.
- Wang AA, Tapia C, Bhanji Y, et al. Barriers to receipt of novel oral oncolytics: a single-institution quality improvement investigation. J Oncol Pharm Pract. 2020;26:279-285.
- Niccolai JL, Roman DL, Julius JM, Nadour RW. Potential obstacles in the acquisition of oral anticancer medications. J Oncol Pract. 2017;13:e29-e36. Epub 2016 Dec 6.
- Geynisman DM, Meeker CR, Doyle JL, et al. Provider and patient burdens of obtaining oral anticancer medications. Am J Manag Care. 2018;24:e128-e133.