Specialty Oncology Pharmacy Practices

A SORx CCS Program is the touchstone for all other SORx operations, and for clients, it is the face of the pharmacy. An efficient, personalized CCS staffed by highly motivated, registered pharmacy technicians results in very satisfied clients.

The specialty oncology pharmacy (SORx) market has become increasingly challenging, and this trend is forecasted to continue into the foreseeable future. Successful SORxs have dynamic strategic and operational plans and programs, which result in them being best-in-class in the provision of patient-centric care and payer satisfaction while generating at least adequate profitability.

Critical to most SORxs’ provision of patient-centric care is centralized customer service (CCS), which provides comprehensive customer support 24 hours a day, 7 days a week. It is safe to say that CCS representatives (CCSRs) usually are the “face” of the SORx since they are the primary point of contact for patients and other clients. CCSRs provide clients with their first, and often lasting, impression of the SORx. To leave the best impression on clients, it is important that clients believe that their needs are understood and addressed in a timely manner. SORxs often accomplish this by employing well-trained and experienced pharmacy technicians as CCSRs.

Typically, these technicians are registered with the board of pharmacy of the state in which the SORx resides and is permitted as a pharmacy. Many of the technicians are also certified pharmacy technicians by the pharmacy technician certification board. Technicians will have completed a structured, thorough initial job orientation to the SORx practice. Their skills are reassessed at least annually with on-the-job retraining done as needed, including policy and procedure reviews, patient and patient data privacy (Health Insurance and Portability Act of 1996, protected health information, and HIPAA HITECH Act), and prevention of Medicare Fraud, Waste and Abuse, to mention a few critical touch points. Any orientation/retraining program must be designed and communicated by management to ensure work-related behavior that is consistently characterized as professional.

Usually the first SORx employee to receive and start processing a new prescription is the CCSR. Because the typical CCSR is, at a minimum, a registered pharmacy technician, the CCSR can readily recognize a complete versus incomplete prescription. They are quick to obtain missing information that they are allowed by law and regulation to obtain, for example, demographic data, and they know when to engage the pharmacist to obtain all other missing prescription data. The CCSR will quickly enter prescriptions into the SORx’s computer system and will develop and begin executing a patient and health plan specific plan for payment of the prescription. This will include but is not be limited to:

• Determine health plan benefits
• File for and receive a payable claim
• Inform the patient of any copay or coinsurance
• Determine if financial/copay assistance is needed
• If financial assistance is needed, then lead the patient through the process of obtaining assistance from an adequately funded patient assistance program or appropriate foundation
• Determine any prescription-related constraints
• Initiate a start-of-care assessment tool, collecting key data for review/revisions by the pharmacist
• Communicate their findings and actions with the pharmacist and the fulfillment operation
• Have the pharmacist verify the accuracy, completeness, and appropriateness of the prescription as it has been entered in the pharmacy computer system
• Send the verified prescription to the fulfillment operation for dispensing and shipment
• Frequently provide certain dispensing and clinical information to physicians’ offices, typically in the form of faxes of documents prepared by the pharmacists, eg, medication lists as part of the SORx’s role in medication reconciliation to improve medication safety

Although robotic outbound calling is efficient and has less human resource expense associated with it, such communication systems do not address patients’ psychosocial need to interact with human caregivers. As research has demonstrated, having each patient speak to a CCSR or other pharmacy representative, even for initial fulfillment and refills, contributes to improved medication therapy adherence and persistency. For this reason, the more successful SORxs maximize the use of human-to-human communication processes, particularly for patients at high risk for nonadherence.

An SORx’s CCS program is the touchstone for all other SORx operations, and for clients, it is the face of the pharmacy. An efficient, personalized CCS staffed by highly motivated, registered pharmacy technicians results in very satisfied clients.

About the Authors

Royce A. Burruss, RPh, MBA, FASCP, has been engaged in the practice of pharmacy in a variety of settings, having concentrated on specialty pharmacy for the past 14 years in clinical and senior management roles. He is the director of specialty pharmacy, clinical services, Cardinal Health | Specialty Pharmacy | OncoSource Rx. Prior to this, he practiced clinical and administrative pharmacy in managed care, home infusion, retail, and hospital settings. He has 11 active pharmacist licenses (VA, MD, KY, TN, AZ, LA, NE, OR, AR, MS, and NC). He has led practices to successful JACHO and URAC accreditation. Since 1999, he has been an assistant clinical professor of the University of Maryland, School of Pharmacy. He has published in peer-reviewed journals and taught university-level courses on various topics. He graduated from Virginia Commonwealth University, Medical College of Virginia, School of Pharmacy with a bachelor of science in pharmacy and received an MBA from the University of Richmond.Fawad Malik, PharmD, serves as a senior project manager with 6 years of specialty pharmacy experience and provides clinical and operational support for the specialty pharmacy. Prior to this, he had lead roles in the implementation of disease-specific programs with a leading specialty pharmacy within the industry. In his current role, he led his practice in achieving a successful URAC accreditation. He is also involved in implementing and maintaining manufacture- and REMS-specific program guidelines. He received his PharmD from Ernest Mario School of Pharmacy, Rutgers University.Ted Traurig has held upper management business operations positions in specialty pharmacy, home infusion, and managed care pharmacy for the last 17 years. He is well versed in all aspects of pharmacy operations, strategic thought, and process building for JCAHO- and URAC-accredited alternate site pharmacy models. Ted is a registered pharmacy technician in the state of Maryland and holds a bachelor’s of business administration from the University of Phoenix.Jennifer Benevicz, RPT, is currently the manager of operations for a URAC-accredited specialty pharmacy which provides service throughout the United States. She has held leadership positions on clinical teams and in business operations management in specialty pharmacy and home infusion for 13 years. She is well versed in all aspects of pharmacy operations and has played leadership roles in obtaining and maintaining JCAHO and URAC accreditation of alternate site pharmacy models. She is a registered pharmacy technician in the state of Maryland.