Medically Integrated Pharmacies, Oral Oncolytic Agents Grow in Importance During COVID-19

Despite efforts to diminish the effects of COVID-19 on care of patients with cancer, the pandemic still poses challenges to oncology care delivery. However, as practices have gained experience in this new environment, health care professionals have found innovative ways to work around many of the obstacles COVID-19 presents.

Last year’s lockdowns and restrictions dramatically affected in-office care, initially halting screenings and new patient consults while changing the way care could be delivered to existing patients. Eventually, practices identified and adopted strategies that reduced immunocompromised patients’ potential exposure to the virus. Ultimately, changes were made that brought medically integrated dispensing (MID) pharmacies and oral oncolytic agents to the forefront of patient treatment, along with technologies facilitating continuity of care.

Oral Therapies and MIDs Support Ongoing Care

Although care for new patients was basically on hold for several months, practices largely were able to continue caring for existing patients. As the pandemic progressed, oncologists altered treatment of patients undergoing therapy, selecting oral agents when possible in place of intravenous options, to minimize patient time in the clinic.

In May 2020, a survey of community practices throughout the United States was conducted by Healthcare Research & Analytics, the results of which showed that over half of the oncologists/hematologists had shifted at least 10% of their patients from infusions to oral oncolytic agents.¹ Because the survey was taken just a few months into the pandemic, it is reasonable to assume the percentage is probably much higher now.

Although oral oncolytic agents do not require administration in the clinic like infusion therapy does, patients still must be closely monitored, and this is where MIDs played a key role. These in-office pharmacists took on increased responsibility in the care management paradigm as use of oral oncolytic agents increased drastically.

When this shift toward oral oncolytic agents occurred, MIDs stepped forward to perform vital functions such as comprehensively evaluating patient comorbid conditions, determining dosing schedules, managing toxicity and adverse effects (AEs), clearing insurance hurdles, and educating patients and the care team about new oncolytic agents. Vigilance concerning any changes in these patient factors was required, and that responsibility fell more onto MIDs.

MIDs were highly successful in their expanded role, especially in driving adherence. With all the turmoil and changes the pandemic caused, a decline in adherence might be expected. However, based on data from community practices supported by McKesson, patients had a higher adherence rate during that time frame than in the prior year.

This uptick in adherence demonstrated the value MIDs provide in effective patient treatment. It also revealed that there may have been increased patient awareness as to the importance of adherence, resulting in patients taking greater control and ownership of their treatment.

Restriction Reductions Provided New Delivery Options

In response to the pandemic, the nation’s largest pharmacy benefit managers (PBMs) lifted certain delivery restrictions. This enabled a different approach to care, allowing practices to customize how medications reach each patient. For practices within the US Oncology Network (the Network), an assessment was done to determine how each practice could best serve patients, which supported the development of new delivery models to minimize patient time in the clinic.

New delivery options based on the assessment results included the following:

• In-person pickup from the practice—The patient continued to pick up medications at the practice, and the MID used various approaches to minimize patient time in the facility, including advance fulfillment, coordinating a pickup date to coincide with an appointment, or having the patient wait outside while the prescription was prepared.
• Curbside pickup—MID staff delivered the prescription to the patient’s vehicle to complete point of sale and patient treatment activities.
• Courier or delivery service—The MID staff sent the prescription to the patient’s home via a local courier.
• Biologics specialty pharmacy home delivery— Express delivery through Biologics by McKesson was also available. Biologics was fully staffed to perform benefit investigations, obtain prior authorizations, secure patient funding, and offer medication counseling.

Telemedicine Empowered Continuity of Care

Another factor played a key role in providing ongoing care during the pandemic: telemedicine. Three federal stimulus packages addressing COVID-19 were enacted in March 2020 that expanded coverage of Medicare telemedicine services, resulting in the rapid adoption of telemedicine across the health care landscape.²

The Centers for Medicare & Medicaid Services (CMS) previously required telemedicine recipients to have a prior established relationship with a provider; however, at the start of the pandemic, CMS allowed patients to be cared for remotely by new physicians, opening the door to new patient consultations, meeting a critical need in cancer care.²

CMS also expanded telemedicine coverage to include many additional services, enabling virtual patient/oncologist consultations and follow-ups.2 These reimbursement regulations are quite complex and remain very fluid.

Telemedicine in oncology care is not new but its use was very limited before the pandemic. According to the Healthcare Research & Analytics survey, 8% of oncologists/hematologists used telemedicine services prior to the pandemic, but by May 2020 when the survey was taken, that total jumped to 88%.¹

During COVID-19, telemedicine took on an expanded role as it enabled social distancing, providing the mechanism for continuity of care. Although physicians could not see their patients in person, they could see them on video calls, allowing assessments to be conducted. Additionally, from an oral perspective, MIDs were able to use telemedicine to monitor patients and be proactive in managing toxicities and AEs, which enabled a high adherence rate among patients.¹

All practices in the Network utilized telemedicine platforms to provide safe care during the pandemic, and the usage rate continues to be around 10% to 15%. From March 2020 through February 2021, more than 436,000 visits were performed virtually by providers in the Network.¹ These included medical and radiation oncology, multiple surgical specialties, and other visit types such as genetics, palliative care, hospice, nutrition, AE management, and prechemotherapy counseling.¹

Although patients can now visit clinics in person, there is a strong likelihood telemedicine will remain available to patients. In fact, the Healthcare Research & Analytics survey reported that 90% of the oncologist/ hematologist respondents indicated they will continue to utilize telemedicine in their practices.¹

Takeaways From the Pandemic

Much was learned over the past year about how to provide care to patients with cancer in the new COVID-19 environment. One important thing that came to the forefront was that MIDs are part of a robust system able to successfully treat existing cancer patients during the pandemic. Employing oral therapies, MIDs kept adherence high and supported quality care in multiple ways. The value of MIDs and oral therapies was clearly demonstrated throughout this period.

From the pandemic also emerged a new appreciation and role for telemedicine, which became the mechanism driving continuity of care. This innovative tool enabled patients with cancer to connect with their integrated health care teams to receive uninterrupted quality care safely in their homes. Post COVID-19, telemedicine will likely be more heavily utilized than before the pandemic, playing a key role in routine checkups and light reviews.

Finally, stakeholders that often contend with one another about site of care, pricing, or access took action that created a unique health care industry team effort—whether intentional or not—to keep quality care accessible to patients with cancer. From government and PBMs lifting restrictions to oncology practices being more flexible, all entities moved in the same direction to do what was necessary to ensure patients could still receive their treatments.

Not only did these efforts create a united front for meeting patient needs during the pandemic, they also provided a blueprint for how to meet future emergencies that may arise. Hopefully, COVID-19 will soon be in the rearview mirror, but either way, oncology stakeholders have identified new strategies to successfully serve patients during times of crisis.

Mark Alwardt is vice president of medically integrated dispensing for McKesson.

Shereen Stutz, RPh, is senior director of medically integrated dispensing for McKesson.

REFERENCES

1. Heckard D. How oncologists are coping with COVID-19. PharmExec.com. July 15, 2020. Accessed August 27, 2021. https://www.pharmexec.com/view/ how-oncologists-are-coping-covid-19-0

2. Royce TJ, Sanoff HK, Rewari A. Telemedicine for cancer care in the time of COVID-19. JAMA Oncol. 2020;6(11):1698-1699. doi:10.1001/jamaoncol.2020.2684