New Frontiers in Specialty Pharmacy Oncology Management

Specialty Pharmacy Times, June 2012, Volume 3, Issue 3

As industry invests billions into self-administered oncolytics, specialty pharmacy steps in. This special issue focuses on the cutting-edge, real-world practices and successes of specialty pharmacy in oncology.

As industry invests billions into self-administered oncolytics, specialty pharmacy steps in. This special issue focuses on the cutting-edge, real-world practices and successes of specialty pharmacy in oncology.

Oncology drug discovery continues to be the epicenter of the growth of specialty pharmacy. What is the most common thread that links optimal specialty pharmacy care? In a word, data, data, data, and more data. If we did not say it enough—it’s data.

This month we focus on oncology practice in specialty pharmacy. As we invited our authors to express their views and insights around best practices, the theme kept coming back to their intelligent use of data. At Specialty Pharmacy Times, we clearly see the evolution and importance of specialty pharmacy tied to patterns of patient behavior. It is these patterns that drive the practice to optimal patient care in oncology.

The cornerstone of specialty oncology practice is oral oncolytics. Oral oncolytics are becoming more common across the industry, and many managed care organizations are implementing protocols to manage this therapeutic class. For various reasons primarily tied to reimbursement we see some infused products flowing through specialty, but industry is investing billions in the development of oral and self-administered oncolytics.

Payers are asking specialty pharmacies to support their patients in at least 3 areas:

(1) Maximize adherence to therapy

(2) Educate patients about medication tolerance and adverse effects

(3) Actively monitor regimen adherence, persistency, and length of therapy

Health plans realize that specialty drug spend growth will reach 40% of total plan drug spend by 2020. Traditional health plan management of oncology drug spend had little success in identifying efficient quality of care and effectively addressing savings due to the following challenges:

  • Lack of physician alignment around evidence-based treatments
  • Increased variances for oncology treatment
  • Financial incentives in coverage rules resulting in more expensive regimens
  • Limited quality programs for medical and pharmacy drug management
  • Decrease in number of communitybased oncologists

This is where specialty pharmacy steps in through the intelligent use of data. Databases are designed to leverage information that includes member eligibility, open refill, and prescription fill history that establish a patient health record and patient history and conduct utilization reviews. Today’s state-of- the-art specialty pharmacy management systems are utilized to determine the patient’s date of next required fill as well as allow the scheduling team an opportunity to coordinate patient education and medication delivery and focused communications strategies using multiple health care disciplines.

Objectives in specialty pharmacy continue to improve around the creation of collaborative reimbursement models, promotion of active physician participation in guideline development, reducing treatment variability, reducing lines of therapy, promoting appropriate use of biologics, reducing emergency department and hospital visits, transition of therapy, support for end-of-life decisions, appropriate transition to oral oncology drugs from alternative therapies, minimizing prior authorizations to evidence-based treatment protocols, and streamlining the administration of medical claims.

Our credo with Specialty Pharmacy Times continues to focus on the value given to the patient, their family, and coordination of care among health care providers. Patient adherence is a key factor to optimize therapeutic outcomes, particularly in oncology where increasing responsibility now falls on the patient. We learn the value of a multidisciplinary approach as the oncology landscape continues to evolve where pharmacists, technicians, nurses, and other aligned caregivers work together with a patient-centric vision to optimize patients’ therapeutic experience and clinical outcomes.

With this second annual edition focused on oncology, we continue our mission: Specialty Pharmacy Times is THE journal fully committed to setting the publication standard through peer-written and -reviewed articles focused on the “real world” of specialty pharmacy practice.

We invite you to enjoy this issue and pass it on!

Dan Steiber, RPh

Dan Steiber, RPh, is a principal of D2 Pharma Consulting LLC (d2rx. com) and is responsible for commercial operations, trade-supply chain strategy development including 3PL selection, regulatory oversight, and “operationalizing” organizations. Mr. Steiber has served in several senior positions in pharmacy, distribution, and industry over the course of his 35-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 Plano, Texas.