Integrated Health-System Specialty Pharmacy Care Model Associated With Lower Oncology Medical Expenses

Research presented at the 2021 American Society of Health-System Pharmacists (ASHP) Specialty Pharmacy Conference suggests overall medical expenses for oncology patients were significantly improved by using an integrated health-system specialty pharmacy (HSSP) care model. This model was associated with a $911 mean per member per month (PMPM, P<.05) decrease in total medical expense. According to the investigators, this is due to reduced hospital outpatient visits, free standing physician office visits, and emergency department (ED) visits.

To conduct the study, the investigators used a national health insurer de-identified database of 13.8 million Medicare Advantage members to identify those filling self-administered specialty oncology medications between 2018-2019. The HSSP group was composed of members enrolled in the oncology care model who filled at the participating HSSP group pharmacies with prescribers who were integrated into the care model.

This group was then compared to network members who used pharmacies in the same geographic area. A total of 129 HSSP group members and 2937 network members were identified, with both cohorts including members with continuous insurance coverage. The primary outcome for the study was PMPM expenses, with the secondary outcome of mean health care use per member per year (PMPY).

According to the results of the study, although there were no statistically significant differences between cohorts in 2018, the 2019 follow up showed a $911 PMPM improvement in total medical expenses for the HSSP group compared to the network members (HSSP group $3738 compared to network $4649; P=.01). PMPY was considerably lower among the HSSP group compared to the network cohort, including hospital outpatient (6.6 vs 9.1), ED (0.2 vs 0.4), and physician office (14.3 vs 17.5) visits.

Although the overall costs for the HSSP group were lower, total pharmacy expense was $299 PMPM greater for the HSSP group than the network ($2587 vs. $2288, respectively; P=.89) However, according to the study authors, this increase was not statistically significant. They said it may be possible to attribute this difference to improved persistency observed in integrated HSSP members.

REFERENCE

Dale Fasching, Jennifer L. Donnovan, Kate Smullen, Kristen Ditch, Brian S. Smith. Improved oncology total medical expense associated with the use of integrated health system specialty pharmacy care model. Poster presented at: 2021 ASHP Specialty Pharmacy Conference; virtual. Accessed July 15, 2021.