Realizing cost savings through medically integrated dispensing
By Christie Smith, PharmD, MBA
Can a medically integrated dispensing model help reduce drug waste and decrease the total cost of care?
Like many aspects of the oncology journey, the issue of how pharmacy waste1 occurs is layered—especially when the physician and the pharmacist are not able to work in tandem.
Imagine, for example, that an oncology patient has just started a new course of treatment. Maybe the treatment causes side effects, and the patient needs to shift to a lower dosage. Or perhaps the course of treatment needs to be adjusted altogether. But what happens when a prescription has been filled and sits unused? What if the prescribing pharmacy doesn’t realize that treatment has shifted, and continues to fill a prescription that’s no longer needed?
Scenarios like this can lead to pharmacy waste: drug overages that go unused and that can occur at a cost to practices and patients alike. But when patients have reliable access to oral oncolytic therapies—and when pharmacists can review real-time updates about that patients’ course of treatment—practices can see a decrease in pharmaceutical waste and an increase in patient adherence. 2,3,4,5 That’s where Prime Therapeutics’ IntegratedRx™-Oncology comes in.
What is IntegratedRx?
AmerisourceBergen began offering Prime Therapeutics’ IntegratedRx-Oncology to qualified medically integrated dispensing (MID) practices and health system pharmacies through its pharmacy services administrative organizations (PSAOs) in late 2021. This groundbreaking clinically integrated program allowed patients to experience a more holistic approach to cancer care by receiving their prescribed oral oncolytics—and other medications—in a clinical setting.
A medically integrated oncolytic dispensing program like IntegratedRx-Oncology also gives the practice’s dispensing pharmacist real-time access to their patients’ medical records, allowing them to adjust prescriptions or dosages on the spot. Because of this, providers have found that filling oncolytic prescriptions in the clinic can lead to a significant reduction in pharmaceutical waste.6 It can support better patient outcomes by creating more accessible means for patients to start (and stick to) their prescribed course of care.7
How is IntegratedRx-Oncology working with pharmacies to reduce waste?
In addition to real-time data sharing across its robust network, Prime Therapeutics came up with a way to partner with participating pharmacies to offer a greater level of accountability and support. At the start of 2023, Prime Therapeutics launched its oral oncology waste reduction program. The goal of this program is to optimize waste reduction opportunities across MID and health system pharmacies participating in the IntegratedRx-Oncology program.
Running through August 2023, this program focuses on:
- Proactively assessing pharmacy member refills
- Ensuring proper dispensing and billing frequency
- Improving coordination between drug refills and efficacy and toxicity assessments
- Providing best practices to help achieve pharmacy waste reduction
Participating providers will also receive an incentive for meeting the target waste ratio: Prime Therapeutics will remove the 2024 escalator for participating providers, so high performers will be reimbursed at the same rate in 2024 as they are in 2023.
But participants in the waste reduction program may uncover other benefits, too. For example, a previous pilot program conducted by Prime Therapeutics led to some compelling results for practices that assessed pharmacy waste after utilizing the IntegratedRx-Oncology clinically integrated dispensing model. When the company analyzed its data to assess drug waste differences between oral cancer therapies dispensed through a clinically integrated model with that of a central specialty pharmacy, they saw “a potential average savings opportunity of $1,800 per medication dose change at a MID pharmacy compared to a central fill specialty pharmacy.”8
To realize potentially significant cost savings through reducing pharmacy waste then becomes beneficial for both the practice and the patient, leading to a decrease in the overall cost of care.9,10
How IntegratedRx-Oncology delivers value
Prime Therapeutics understands that delivering value to the clinicians and pharmacists that partner with their program goes beyond an assessment of cost. Helping the practice save time on administrative tasks so they can keep their focus on their patients matters, too. To that end, Prime Therapeutics is exploring how to best streamline their prior authorization process.
When a prescription requires a prior authorization from the insurance company, patients may have to wait to start treatment until the appropriate paperwork is filled out and filed. As Prime Therapeutics considers how to enhance their patient-first approach, facilitating faster starts for patients getting on new prescriptions is key. Reducing wait times by enabling faster starts for patients needing to begin a course of medication could make a difference in patient outcomes by alleviating the stress of waiting for care and offering the peace of mind that treatment can begin quickly.11,12 So, we’ll keep an eye out for potential developments like this from Prime Therapeutics in our continued IntegratedRx-Oncology partnership.
Learn more about IntegratedRx™-Oncology
This model is currently available to AmerisourceBergen’s partnering community oncology physicians and health systems participating in Blue Cross plans; participating practices must have an accreditation within a year. If your practice is interested in participating in this new medically integrated dispensing model now or in the future, contact your pharmacy services team at email@example.com.