ORAL ONCOLOGY MEDICATIONS offer tremendous new cancer treatment options. However, in many cases, it is a significant logistical challenge to get these medications to patients in a timely manner. Prior authorization (PA) requirements, cost, and other factors can lead to turnaround times of up to 3 weeks,1 delaying the start of therapy and creating substantial anxiety for patients.

Providers from Summa Health, an integrated health system based in Ohio, note both the emotional and the physical implications of a cancer diagnosis.

“We know our patients with cancer face a lot of emotional and physical challenges,” said Sameer Mahesh, MD, who leads the hematology-oncology team at Summa Health. “The emotional baggage associated with a cancer diagnosis is very high.”

Megan Johnson, PharmD, RPh, who works alongside Mahesh and other providers as the clinical pharmacist in Summa Health’s Cancer Center, noted that the complexities of treating cancer add to the importance of rapid turnaround times.

“Cancer is an extremely unique condition. There is a lot of uncertainty for patients in terms of their disease progression and life expectancy,” she said. “When we look at medication turnaround times for these patients, sometimes it can mean the difference between life and worsening of their disease state or death.”

Patient worries are compounded by a lack of familiarity with the complexities of specialty medication access. Johnson said that when she meets with patients initially, most think they can just go to their local drugstore, pick up their medications, and begin taking them immediately. This disconnect often leads to frustration.

“In reality, of course, patients encounter many obstacles, such as [PAs] and high out-of-pocket expenses, when working with external specialty pharmacies,” Johnson said.

Mahesh said that by the time providers see these patients, they have already done a significant amount of waiting from symptom onset to diagnosis. Therefore, reducing medication turnaround times has the potential to both enhance clinical outcomes and improve the patient experience.

Impact on Oral Oncolytic Access, Turnaround Times, and Clinician Satisfaction
Summa Health partnered with Trellis Rx to launch clinic-based specialty pharmacy services in April 2019. Before implementation, patients were referred to external specialty pharmacies, which often had limited communication with the patient’s care team at Summa Health. Now, patients are referred to the Summa Health Specialty Pharmacy, which embeds pharmacists and liaisons directly into clinics to work seamlessly with other care team members. To assess the effect of the services on oral oncolytic access, turnaround times, and clinician satisfaction, Summa Health and Trellis Rx conducted surveys before and after the Summa Health Specialty Pharmacy launched in the health system’s cancer center.

Before launch, when using external specialty pharmacies, 76.19% of survey respondents replied either “somewhat agree” or “strongly agree” to the statement, “Access to specialty medications is often problematic for my patients.”2

The question, “How long after prescribing a specialty medication does it take (on average) for your patients to receive their first fill?” garnered these responses before launch:
  • 0.00% Less than 2 days
  • 42.86% Between 2-7 days
  • 47.62% Between 7-14 days
  • 4.76% Longer than 14 days
  • 4.76% I do not know when my patients receive their medications.

Through a separate survey of surrounding external specialty pharmacies, Summa Health and Trellis Rx found that turnaround times for patients using the external specialty pharmacies averaged 9.7 days for oral oncolytics.1 In contrast, the average medication turnaround time is dramatically lower at 1.3 days1 for patients using the Summa Health Specialty Pharmacy.

“A few years ago we didn’t have in-clinic specialty pharmacy services, but we recognized how the approach would address a vital aspect of care delivery,” Mahesh said. “So, we cross-trained some of our nurses in specialty pharmacy. As a result of that training, our medication wait times already were below national averages. Now, though, with the integrated Summa Health Specialty Pharmacy in place, our averages have been reduced significantly more.”

Post-launch survey results also indicate that physicians are more satisfied with their experience with the health system specialty pharmacy compared with their previous experiences with external specialty pharmacies. The overall Net Promoter Score (NPS) for specialty pharmacy services across all clinics rose from -20 to 94 six months after the launch of the Summa Health Specialty Pharmacy. Furthermore, 91.30% of post-implementation survey respondents indicated they “strongly agree” with the statement: “The Summa Health Specialty Pharmacy has made it easier for my patients to access specialty medications.”

Staff members found that patients are getting their medications quicker and starting treatment more efficiently without lapses in their treatment.

Clinic-Based Care Model: Benefits for Providers and Patients
The survey results paint a good picture, but they do not describe how to address specialty medication barriers and increase satisfaction.

John Feucht, MBA, RPh, system director of pharmacy services at Summa Health, credits the results to the clinic-based care model, which embedded local pharmacists and pharmacy liaisons directly into care teams.

“This medically integrated approach ensures patients receive coordinated, personalized care and reduces the administrative burden specialty medications often create for other providers,” he said.

The pharmacy is able to streamline patient identification and management through integrated clinical workflows supported by a specialty pharmacy technology platform, which uses electronic health records (EHRs) to notify pharmacists and pharmacy liaisons about patients who would benefit from their services.

As soon as a new patient is identified, pharmacy liaisons immediately begin a benefits investigation, PA, and financial assistance. Upon approval, the team fills the prescription at the on-site pharmacy and a clinical pharmacist provides medication  education to the patient. Throughout the process, providers can communicate directly with the specialty pharmacy team in-person and through their EHR, which allows patients to receive ongoing support for issues such as refills and adverse effects from a pharmacy liaison they personally know.

It is a proactive approach that enhances therapy experiences, improves medication access and adherence, increases clinic efficiency, and strengthens relationships:
  • Clinical efficiency. Clinic-based pharmacy liaisons are an integral part of the care team and can easily communicate with other providers either in person or through the EHR. “Even if we don’t fill for a patient, I still follow them clinically throughout their entire journey,” Johnson said.
  • Drug access. Many drug manufacturers are beginning to recognize the value of a medically integrated specialty pharmacy model. For instance, the manufacturer of one oncology drug closely examined the Summa Health Specialty Pharmacy to ensure it was a true integrated delivery, network-based model before approving access to its medication—now the drug is commonly prescribed by Summa Health providers.
  • Appeals and PA. Clinic-based pharmacy liaisons remove the burden of appeals and PA processes from physicians and nurses. “Just today, one of our providers prescribed an oral oncolytic for a patient, and I was able to get [PA] before he left. Within 2 hours, the pharmacy had it ready,” Johnson said.
  • Financial assistance. Clinic-based pharmacy liaisons also work to navigate insurance and secure financial assistance from drug manufacturers, nonprofit associations and other organizations so that patients can start therapy sooner and stay on it longer. Johnson tells the story of a patient who received his medications through a mail-order pharmacy, but upon trying to refill the prescription was told he had a $700 co-pay, which nearly accounted for an entire paycheck for the single father of 4. Johnson quickly discovered his insurance had changed and took care of authorizations and assistance. By the next day, his prescription was filled and delivered with a $0 co-pay.

“So many specialty pharmacy interactions are over the phone. But face-to-face conversations build stronger relationships and add another layer of support,” Mahesh said. “It boosts patients’ morale to know they have more than just their physician on their team, fighting the fight for them.”

Lift Burdens for More Supportive Care Cancer occupies a distinctive niche among complex disease states. Long medication turnaround times and the resulting treatment delays only add to patients’ frustration and intensifies their fear about the future of their disease. We must recognize that medication turnaround time is so much more than just a metric. When a disease state is so fragile that we measure life expectancy in weeks or months, every day is valuable. It is imperative, therefore, that the medication- access process moves as smoothly and swiftly as possible. A clinic-based health system specialty pharmacy service gives patients a trusted resource to help lift medication burdens and speed medication access.
 
Stuart Deal, PharmD, RPh, is the vice president and general manager, Summa Health Specialty Pharmacy at Trellis Rx in Akron, Ohio.

REFERENCES
  1. Trellis Rx. Oral Oncology Medication Turnaround Times Outcomes Reporthttps://www.trellisrx.com/trellis-rx-outcomes-report-oral-oncology-medication-turnaround-times. Accessed November 27, 2019.
  2. Trellis Rx Summa Health Provider Satisfaction Survey results