Oncology: Staying Ahead of the Pack in the Race to Excellence

JUNE BRINGS THE ANNUAL American Society of Clinical Oncology (ASCO) meeting in Chicago and our sixth oncology-focused edition of Specialty Pharmacy Times. Emerging oncology therapies, often made available to patients through specialty pharmacies, continue to be a key driver and focus of the business. Improving patient outcomes is the ultimate goal of specialty.

That is why specialty pharmacies employ pharmacists and other health care professionals who have disease-specific expertise in oncology. In addition, a specialty pharmacy has a variety of tools it can deploy.

Oncology Products Leading the Pack

Oncology products that are dispensed by specialty include self-injectables, oral oncolytics, parenteral chemotherapy, and biologics. Oncology products continue to be among the most significant core categories dispensed by specialty pharmacies, along with therapies that treat other conditions, such as rheumatology and hepatitis C. Of the oncology medications dispensed by specialty, the clear majority are oral.

Professional Collaboration Drives Specialty Pharmacy Growth

Frequently, the patient diagnosed with some form of cancer is treated by community oncology practices. These practices look to reduce costs while improving quality. They often form partnerships to effectively and efficiently manage critical patient needs with high-touch or high-care multidisciplinary collaborations. The role of the community oncologist is to have primary responsibility for patient care, while that of the specialty pharmacy is to manage clinical complexities, such as educating patients on how to take their medications properly, controlling adverse effects, helping patients deal with late-stage therapies, and managing other intricacies that affect patients.

Many specialty pharmacies employ oncology-certified nurses and board-certified oncology pharmacists who specialize in oncology and have robust disease knowledge. Advances in technology are enhancing the ability to communicate with patients, caregivers, and the oncology practice. This offers a tremendous opportunity for quality patient care, a positive patient experience, and cost containment.

Opportunities for Oncology Certification

Several specialty pharmacies employ pharmacists who have obtained specialized certifications. Having credentialed professionals assures that patients receive qualified services. One of the better-known programs—the Board of Pharmacy Specialties (BPS)—is a division of the American Pharmacists Association and provides post-licensure certification of pharmacists. The BPS Board Certified Oncology Pharmacist program is a credential for pharmacists who meet eligibility requirements that are concentrated on the growing number and complexity of drug therapies for cancer, and on managing cancer- and drug-related adverse events or situations that are not found in treating other conditions.

This program ensures that pharmacists have advanced knowledge and experience for optimizing outcomes for patients with malignant diseases by doing the following:

1. Recommending, designing, implementing, monitoring, and modifying pharmacotherapeutic plans

2. Reducing medication errors

3. Recognizing and responding to adverse physical and emotional issues that may arise during treatment and when providing education and counseling

The American Society of Hospital Pharmacy and the National Association of Specialty Pharmacy (NASP) have certification programs, whereas the Specialty Pharmacy Certification Board developed unique and differentiated certifications for pharmacists that are relevant and meaningful to all specialty pharmacy therapeutic practices, promoting new industry standards with clarity. Many of the topics provided at the upcoming NASP Annual Meeting will have an oncology focus, so keep checking their website (naspnet.org/annual-meeting).

Beyond the Pill, What Is Up With All This “Bagging” and Physician Dispensing?

Community oncology practices have traditionally bought and billed payers for administering infused or injected oncology products. Drug reimbursement is typically equal to the cost of the drug, plus a fixed percentage above the average sales price. We often hear the term “white bagging” or “brown bagging,” both of which effectively take oncology practices out of the business of buying and billing for cancer drugs.

Under white bagging, the payer gets billed by the specialty pharmacy, which then ships them to the practice for administration. Brown bagging differs in that the product is dispensed by the specialty pharmacy, but is shipped directly to the patient, who takes the drug to the practice so a medical professional can administer it to them. Payers have shown a preference for these models in that they can often purchase high-cost products at a lower cost from a specialty pharmacy than from an oncology practice.

This process then shifts the coverage of products from the medical benefit to the pharmacy benefit. Because the patient’s pharmacy benefit of co-pays and coinsurance differ from the medical benefit, the result typically is that the patient assumes a greater portion of the cost burden. Also, the pharmacy drug adjudication process is more efficient than the typical paper-driven medical billing process, which results in greater visibility for the payer as to where their drug spending is going.

Many payers have their own in-house specialty pharmacy and often mandate the use of the white- or brown-bagging channel for some products. Typically, this process sees the oncology practice ordering the product from the preferred specialty pharmacy, which is dictated by the patient’s drug benefit manager or through the designated hub offered by the manufacturer. The prescription order is direct to the preferred pharmacy, and ultimately ends up in the practice.

Many oncology practices are fighting these trends and have developed dispensaries within their own business. Over the last several years, the proliferation of oral cancer drugs has caused many oncology practices to establish in-house pharmacies, using either a board of pharmacy or physician’s medical license. Almost half of US community oncology practices have an in-office dispensing program, and that number continues to grow, according to an August 2016 article in our sister publication OncLive®.

These oncology practices believe this service allows their patients greater convenience and improves their overall health care experience. Because cancer treatment can be exhausting, patients often do not have the time, energy, or mobility to search for and coordinate with a pharmacy that can fill their prescriptions.

Opportunities for Specialty?

Last year, the FDA approved more than 22 new molecular entities, the majority of which were oncology products. Oncology continues to be at the epicenter of new product development. With these rising trends, any stakeholder in pharmacy must take on oncology as a key driver of their practice. A well-trained specialty pharmacy team can offer the patient a holistic portfolio of services for their oncology products and other critical medications and therapies. With these focuses in mind, we are confident you will find this oncology edition highly beneficial to your practice. 

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® is dedicated to the business and profession of specialty pharmacy. We are the source of the most current and complete information in the space. Our Industry Guide can provide the resources you need at SpecialtyPharmacyTimes.com/industryguide.

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About the Author

MR. STEIBER formerly operated a consulting practice and was responsible for commercial operations and trade-supply chain strategy development. Mr. Steiber has served in several senior positions in pharmacy, distribution, and industry over the course of his 40-year career. Mr. Steiber is a licensed pharmacist in Texas, Washington, California, and Pennsylvania. He is affiliated with several professional associations and publications and a frequent speaker on behalf of many professional organizations. Mr. Steiber graduated from Washington State University College of Pharmacy. He has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University and Northwestern University. Mr. Steiber currently resides in Highland Village, Texas.