Royce Burrus, MBA, RPh, FASCP

SPECIALTY PHARMACIES ARE improving health and creating value in the oncology space. Study results have demonstrated that pharmacists are effective partners in improving care, reducing cost, and avoiding drug complications for patients with cancer.

Yet what does excellence in oncology pharmacy look like? For any specialty pharmacy program to reach excellence, it must be patient centric, outcomes focused, collaborative, and future oriented. 

This year, an estimated 1,806,590 individuals will receive a cancer diagnosis in the United States.

 By 2030, worldwide cancer incidence is expected to reach 3.6 million new cases per year.

 As incidence increases, so, too, does the need for medical professionals experienced in cancer treatment. The annual growth rate for medical oncologists is 5%, though a rate of 40% is needed to meet the rising number of cancer cases.

 A strong specialty pharmacy partnership can help medical oncologists spread resources while providing effective, high-level care. 

In addition to rising incidence rates, the past decade has seen a record number of new cancer treatments. Over the next several years, 65% of new drug approvals will be for specialty medications targeting cancer or rare disease.

 Specialty pharmacies are experienced in the management of complex, high-dollar medications. As new and innovative cancer treatments are approved, specialty pharmacies will continue to play an important role in medication distribution and support services. 

The site of care for cancer treatment is changing. Up to 80% of patients with cancer now receive care in the outpatient setting.

 The emergence of coronavirus disease 2019 (COVID-19) will influence this trend for the foreseeable future. The pandemic will result in an ongoing push for more home-based treatment options, furthering the need for oncology-focused specialty pharmacy services. Pharmacists play an important role in helping to manage and monitor treatment in outpatient and home environments. Research shows both patient and treatment center benefit from a strong specialty pharmacy partnership.

The cost of cancer treatment is trending upward. In 2001, $57 billion was spent on treating cancer in the United States. Estimates from the National Cancer Institute predict that cost will rise to $173 billion this year.

 Specialty pharmacies drive down the cost of care in a variety of ways, by promoting adherence to therapy, identifying utilization or dosing mistakes, and helping to avoid unnecessary hospitalizations, for example. Research has proved that specialty pharmacies can reduce costs and improve patient satisfaction.

Cancer is a devastating diagnosis for patients and their families and other loved ones. A strong relationship between patient and health care provider can positively affect the patient’s ability to cope.

 Patients value working with pharmacists to help manage their treatment. Research conducted at an outpatient clinic in Texas demonstrated that 86% of patients felt it important to discuss their cancer treatment with a pharmacist. Seventy-six percent requested a pharmacy follow-up at their future visit.

One of the primary pillars of an excellent specialty pharmacy program is patient-centric care. In a large study, patients who perceived their health care providers as “knowing them as a person” had higher rates of treatment adherence, more positive beliefs about the effectiveness of their therapy, fewer missed doctor appointments, and a higher quality of life.

 Every patient with cancer faces unique challenges that affect their day-to-day treatment, from psychosocial to financial issues. Pharmacists who earn the trust and get to know the individual needs, challenges, and preferences of their patients are better able to support, educate, and empower those they serve. 

From timely access to medication and support services to interventions promoting safety and adherence, outcomes-focused services make oncology specialty pharmacies the best they can be. Patients with cancer typically have 3 additional comorbid conditions and take an average of 9 different medications.

 Preexisting conditions, polypharmacy, and the complexity and toxicity of cancer treatment contribute to significant drug-related challenges that pharmacists can help patients avoid. In one study, investigators analyzed more than 4000 oncology prescriptions. Pharmacists found drug-related problems in more than 1% of the prescriptions. Subsequent interventions led to treatment discontinuation, dosing adjustments, alternate administration routes, and other modifications.

Specialty pharmacies affect outcomes through highly coordinated medication therapy management (MTM) programs. Strong MTM programs improve adherence and quality of life.

 MTM programs incorporate validated, diagnosis-specific clinical assessments, patient-reported outcomes, and quality-of-life measures. MTM allows the pharmacy to deploy targeted, data-driven interventions, identify drug-related challenges, and promote individual health goals. 

Study results show that when continuity of care is high, patient outcomes improve.

 Achieving continuity requires a high level of collaboration across health care disciplines. Patients can easily feel lost or confused when coordinating care across a complex health care environment, especially when dealing with a diagnosis such as cancer. Specialty pharmacies can ease that burden by fostering collaboration among patients, health care providers, payers, pharmaceutical manufacturers, community-based organizations, and peer-to-peer support networks. Highly coordinated, collaborative care positively affects the patient journey by promoting the development of a multidisciplinary support system and providing ongoing resources throughout the patient’s course of therapy and recovery. 

By working with a range of health care stakeholders, specialty pharmacies can affect more than just the individual patient journey. Analyzing pharmacy data and sharing appropriate information can help identify trends, areas for improvement, cost savings, and other opportunities to promote safer, more effective care. Manufacturer partnerships and limited distribution drug programs provide specialty medication and support for patients with extremely rare or complicated conditions. Clinical trial and research programs help advance research, leading to new and improved therapies, and 340B partnerships extend care to uninsured and underinsured populations while providing additional revenue to eligible treatment centers. Support for community-based 501(c)(3) organizations promotes research, peer-to-peer support, and the availability of emergency financial assistance for patients in times of need. 

To best serve patients, specialty pharmacies need to be future oriented. Health care lags behind other industries in digital maturity.

 Patient expectations regarding the digital capabilities of their health care providers have increased significantly.

 In addition to patient expectations, COVID-19 is accelerating the requirement for specialty pharmacies to leverage technology in new ways. Future-facing specialty pharmacies are prepared to meet these requirements and use digital tools to engage patients, promote adherence, encourage healthy behaviors, and monitor health. 

Accreditation from leading health agencies is another important component for specialty pharmacies to remain forward facing. To maintain accreditation, health care organizations must meet rigorous standards while implementing continuous process improvement plans. Accreditation establishes a culture focused on excellence and ongoing organizational growth. 

The number of cancer survivors in the United States is increasing. The 5-year relative survival rate for cancer has reached 67.4%.

 By 2026, a predicted 0.3 million cancer survivors will be living in the United States.

 Thousands of dedicated health care professionals are working hard every day to help patients manage, treat, and eventually cure cancer. Specialty pharmacies and the staff they employ are among them. 

New treatments, expanding site-of-care options, rising costs, and the need for oncology-focused medical professionals will increase demand for strong specialty pharmacy partnerships. Specialty pharmacies providing patient-centric, outcomes-focused, collaborative, and future-oriented care will emerge as powerful allies throughout the patient journey—helping to ease burden, slow progression, and speed recovery for those facing cancer. 

, is marketing director and senior regional care coordinator at BioMatrix Specialty Pharmacy; 

, is director of pharmacy services at BioMatrix Specialty Pharmacy. 

Alexander M, Gabre E, Gatwood K, Gatwood J. Impact of clinical pharmacists in outpatient oncology practices: a review. 

. 2017;74(19):1549-1557. doi:10.2146/ajhp160475

Cancer stat facts: cancer of any site. National Cancer Institute Surveillance, Epidemiology, and End Results Program. Accessed July 17, 2020. 

https://seer.cancer.gov/statfacts/html/all.html

Cancer statistics. National Cancer Institute. Updated April 27, 2018. Accessed July 17, 2020. 

https://www.cancer.gov/about-cancer/understanding/statistics

Jenerette C, Mayer D. Patient-provider communication: the rise of patient engagement. 

 2016;32(2):134-143. doi:10.1016/j.soncn.2016.02.007

Raper A. The rise of specialty medications: hope for patients, hurdle for health care. CoverMyMeds. March 14, 2019. Accessed July 17, 2020. 

https://www.covermymeds.com/main/insights/articles/the-rise-of-specialty-medications/

Cancer care migrates to outpatient setting. 

http://www.jhconline.com/cancer-care-migrates-to-outpatient-setting-2.html

Park J, Look KA. Health care expenditure burden of cancer care in the United States. 

Joo EH, Rha SY, Ahn JB, Kang HY. Economic and patient-reported outcomes of outpatient home-based versus inpatient hospital-based chemotherapy for patients with colorectal cancer. 

Prip A, Møller KA, Nielsen DL, Jarden M, Olsen MH, Danielsen AK. The patient-healthcare professional relationship and communication in the oncology outpatient setting: a systematic review. 

Mckee M, Frei BL, Garcia A, Fike D, Soefje SA. Impact of clinical pharmacy services in an outpatient chemotherapy academic clinic. 

. 2011;17(4):387-394. doi:10.1177/1078155210389217

Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? 

 2006;21(6):661-665. doi:10.1111/j.1525-1497.2006.00399.x

Hwang J, Holmes HM, Kallen MA, et al. Accuracy of reporting current medications by cancer patients presenting to an emergency center. 

. 2010;18(10):1347-1354. doi:10.1007/s00520-009-0760-x 

Delpeuch A, Levque D, Gourieux B, Herbrech R. Impact of clinical pharmacy services in a hematology/oncology inpatient setting. 

Burruss R, Bhusal B, Oleru K, Arikian V, Jaster R, Stranz M. Adherence to oral oncolytic and neurologic specialty medications by a specialty pharmacy. Poster presented at: National Association of Specialty Pharmacy Annual Meeting & Expo 2019; September 9-11, 2019; Washington, DC. Accessed July 22, 2020. 

https://naspnet.org/wp-content/uploads/2019/09/09-2019-NASP-Annual-Meeting-Poster.pdf

van Walraven C, Oake N, Jennings A, Forster AJ. The association between continuity of care and outcomes: a systematic and critical review. 

Landi H. Study: healthcare lags other industries in digital transformation, customer engagement tech. Healthcare Innovation. March 30, 2018. Accessed July 17, 2020. 

https://www.hcinnovationgroup.com/population-health-management/news/13030021/study-healthcare-lags-other-industries-in-digital-transformation-customer-engagement-tech

NTT Data study finds nearly two-thirds of consumers expect their healthcare digital experience to be more like retail. News release. NTT Data Services. March 5, 2020. Accessed July 17, 2020. 

https://www.businesswire.com/news/home/20180305005288/en/NTT-DATA-Study-Finds-Two-Thirds-Consumers-Expect

Articles

Study results have demonstrated that pharmacists are effective partners in improving care, reducing cost, and avoiding drug complications for patients with cancer.