The growth of the oncology drug pipeline has fueled the emergence of new oral therapies. While these therapies make treatment more convenient, when compared with traditional infused chemotherapy regimens, they also present new challenges, particularly in the area of adherence.
The growth of the oncology drug pipeline has fueled the emergence of new oral therapies. While these therapies make treatment more convenient, when compared with traditional infused chemotherapy regimens, they also present new challenges, particularly in the area of adherence. According to some studies, adherence rates for oral oncolytics dip as low as 20%.1
When oncology medications are taken in a home setting and there are fewer face-to-face interactions with the prescriber, patients can find it challenging to manage side effects and adhere to complex dosing regimens. Additionally, the evolution of oncology therapies over the past decade is mirrored by a rise in treatment costs that can play a role in a patient’s decision to begin treatment or stop using the medication. Given the access, challenges, and increased responsibilities on patients taking these therapies and the continued use of value-based reimbursement models by payers, it is critical to design patient-centric programs for oral oncolytics that improve patient adherence through stakeholder collaboration. Healthcare providers, such as oncologists, oncology nurses, and specialty pharmacists, must leverage their collective resources and expertise to enable each patient to realize the best possible outcome.
NAVIGATING THE FINANCIAL BARRIERS
Oncology patients often face high out-of-pocket costs associated with their treatment regimens. While in-office treatments and diagnostics are often covered under the medical benefit, oral oncolytics are likely managed under the patient’s pharmacy benefit. Normally, patients pay between 20% and 30%2out-of-pocket for the treatment, which can translate to about $24,000 to $36,000 over a year, without factoring in health insurance premiums. Patient assistance programs and private foundations exist to help patients who face affordability challenges, and specialty pharmacies, working collaboratively with physicians, play a key role in connecting patients to these resources. For example, physicians in the ION Solutions network will refer the patient to US Bioservices, Amerisource Bergen’s national specialty pharmacy, which helps expedite the patient’s start of therapy at the lowest out-of-pocket cost to the patient. The ION physician network includes non-dispensing practices and dispensing practices that lack access to a specific specialty product. Even after insurance authorizations are secured, financial assistance options can be difficult for a patient to navigate. Pharmacy specialists provide continued guidance related to manufacturer copay assistance program enrollment and foundation assistance temporary and long-term approvals. Ultimately, when specialty pharmacies and physicians work together to ensure patients’ access to therapy, financial barriers are overcome and speed-to-therapy is accelerated.
PATIENT EDUCATION AND COMMUNICATION
Patient and caregiver education and communication is essential, not only as a patient begins therapy but also throughout treatment, when a patient may experience side effects that require dose or therapy adjustments. During infused oncology regimens for which patients travel to a care site, oncologists can educate patients about their specific therapy, manage their expectations, closely monitor the progression of their health status, and mitigate potential side effects. When a patient self-administers an oral therapy at home, an integrated approach is needed to monitor treatment, identify the barriers a patient may face and connect them to available resources and support. Specialty pharmacies can increase patient touchpoints and fill in gaps between patient-practice interactions, adding a layer of therapy-specific support and education provided by pharmacy clinicians. Through clinical assessments, specialty pharmacies gain frequent, actionable information about the patient’s progress and work in partnership with healthcare providers to help patients overcome challenges and adhere to therapy. For example, US Bioservices specialty pharmacy partnered with oncology practices that are members of the ION Solutions group purchasing organization to establish nursing outreach programs that proactively manage patients at key milestones in their therapies. The specialty pharmacy monitors data, including information pulled from clinical trials, to determine when a patient is likely to experience side effects and then works with oncologists to develop appropriately timed communication and escalation protocols.
Additionally, resources like US Bioservices’ MyPathpoint prescriber portal improve the connectivity between a physician’s office and the pharmacy, allowing these stakeholders to deliver more clinically integrated care to the patient. Prescribers gain real-time access to pharmacy care team notes and detailed information about patient interactions along with the status of a prescription from receipt to delivery. Prescribers can also use the portal to easily provide information back to the pharmacy, such as clinical documentation, refill approvals, and new prescriptions. With transparent information sharing, not only can the prescriber more closely monitor the patient, but also the pharmacy and the prescriber can offer more seamless and consistent patient communication, which promotes adherence.
EVOLVING DISPENSING SYSTEMS
Just as models for patient communication continue to evolve so do dispensing models. These models range from pharmacy benefit management controlled models to independent specialty pharmacies to oncology practices that offer in-office dispensing services. Regardless of the model, every member of a care team provides better patient support when they have transparency in regard to the factors that influence access, adherence and outcomes. Increased collaboration between oncologists, nurses, and pharmacists not only improves the patient experience but also helps to manage costs and resourcesand ensures appropriate clinical management.
With the changing healthcare landscape and the continued introduction of new therapies, providers will continue to face challenges associated with maximizing clinical outcomes, particularly as the growing use of oral oncolytics shifts the site of treatment from a physician’s office to a patient’s home. However, oncologists and specialty pharmacists, collectively, have the resources and expertise needed to help patients navigate the challenges faced throughout treatment, including adherence, so each patient can realize the full benefit of therapy.