The 5-year relative survival rate for patients diagnosed with cancer (all sites) in 1984-1986 was 54%. The survival rate increased to 68% for patients diagnosed from 1999 – 2006, a 12% increase. During the latter period, female breast cancer patients had a remarkable 90% 5-year survival rate, up from 79%. 5-year survival rates for leukemia patients increased from 42% to 55% and for prostate cancer from 76% to 100%.
Increased survival rates can be attributed to earlier diagnosis, advanced screening tools, and more sophisticated treatments. Technological advances have introduced specialty drugs that offer millions of patients hope when they receive a cancer diagnosis. For many of you, oncology nursing today hardly resembles what it did 10 years ago due to the advent of specialty drugs for your patients.
Specialty drugs are generally defined as high-cost injectable, infused, oral or inhaled drugs that require close supervision and monitoring. 2 These unique characteristics, unlike drugs for acute, routine conditions such as antibiotics, directly affect you and your office practice in a variety of ways. You must be alert to patients’ potential inability to afford the specialty drug prescribed. Some benefit plans pay for specialty drugs under medical benefits while others under pharmacy benefits, e.g. more forms. Payors require prior authorization before a specialty pharmacy can dispense a patient’s first dose of medication. How many of your practice staff members have spent hours on the telephone to satisfy your patients’ pharmacy benefit manager (PBM) requirements to obtain a prior authorization?
The good news for current cancer patients and for those who will be diagnosed with cancer is the number of drugs in development to treat cancers for nearly every site. According to recent reports from the Pharmaceutical Research and Manufacturers of America (PhRMA), pharmaceutical research and biotechnology companies have over 900 drugs in development to treat several types of cancers.3
With the potential FDA approval of hundreds of oncolytic agents, your choice of a specialty pharmacy will have a direct impact not only on your patients but on you as well. The selection of a specialty pharmacy affects all stakeholders and has long-term implication. The decision should be based on its capacity to address each specialty drug’s unique requirements, to provide comprehensive, quality clinical services to patients, and support your needs.
I. Access to Limited Distribution Drugs
A specialty pharmacy’s positive, ongoing relationship with pharmaceutical manufacturers is extremely valuable as it may determine the pharmacy’s access to certain specialty drugs. Manufacturers often elect to limit the number of specialty pharmacies that can dispense their drugs to maintain close control over inventory. Their specialty drugs may require unique clinical management and not all pharmacies have the expertise or infrastructure to adhere to those controls. It is critical that you and your patients have access to the limited distribution oral oncolytics necessary to reach optimal health outcomes.
II. Specialty Medication Therapy Management
Adherence to all drug regimens is critical. Adherence to specialty drug regimens is often more difficult to patients due to the drug’s side effects, its complex instructions, a patient’s family or social support, and in some cases, a patient’s outlook for their future. A patient who is prescribed an anti-hypertensive does not experience the degree of emotional stress or physical consequences of your oncology patients. These variables correlate highly with adherence. Therefore, it is imperative for your specialty pharmacy to offer multi-tiered Specialty Medication Therapy Management.
a. Specialty Pharmacist Counsel
Patients who are empowered about their condition, treatment, and potential side effects are more likely to be compliant.4 Specialty pharmacists should counsel patients before the initiation of therapy, reinforcing and complementing the information received from physicians.
b. Strategically Timed Communications
A specialty pharmacy should offer strategically timed communications with patients to ensure that the patient receives their refills before running out. This service is particularly crucial for patients being treated with a REMS prescribed oncolytic drug such as Revlimid.® Specialty pharmacies must contact patients with sufficient time to ensure patients have complied with the guidelines outlined by the FDA. Revlimid’s manufacturer Celgene publishes quarterly scorecards that demonstrate a specialty pharmacy’s turn-a-round time for new prescriptions and refills for Revlimid. These scorecards are indicators of a specialty pharmacy’s commitment to its role in supporting patient care and adherence.
c. Technological Tools
Adherence tools are not “one size fits all” solutions. For many patients, an interactive or dose-related adherence tool is more compelling. A text message as a reminder to take their drugs is very powerful to some patients. If they are busy and tend to forget to take their drug, a text message is a gentle, minimally intrusive tool that prompts them. The bi-directional text messaging program includes:
A more interactive technological tool to promote adherence is GlowCap,™ an innovative electronic drug reminder. The GlowCap is placed on the prescription bottle and a wireless reminder light plugs into a kitchen or bathroom outlet. The cap pulses and glows orange at a predetermined time. It is a subtle reminder for a patient to take their drug. If disregarded for two hours, the reminder escalates to a telephone call with the message, “It’s time to take the pill in your green GlowCap.”
III. Customer Service
Patients with cancer face challenges that are unimaginable to individuals taking traditional drugs. Every patient deserves the highest possible level of customer service. However, your patients require more educated specialty pharmacy service providers.
a. 24/7 Clinical Support
Patients’ access to clinical pharmacists during their oncolytic drug regimen may prevent an emergency room visit due to a side effect and likely non-adherence in the future. A pharmacist can often provide a solution for patients to mitigate side effects when confronted with a side effect. In other situations, the clinical pharmacist may recognize a side effect that demands medical attention, may instruct the patient to seek medical attention, and then contact the patient’s physician. Around-the-clock access to clinical pharmacists offers patients peace
of mind.
b. Specialty-trained Call Center Staff
Too often, patients who contact a call center speak with someone with general call center skills. Patients undergoing cancer treatment should not have to educate their call center contact. A specialty pharmacy whose sole business is specialty pharmacy recognizes that their call center staff must possess extensive knowledge about oncolytic drugs and their side effects. These specialty pharmacies appreciate the value of consistency for patients, e.g. speaking with the same call center staff member. Their call center staff members are intuitive to recognize nuances in their patients that may represent depression or side effect and they have the skills to navigate through every patient’s benefits structure.
c. Financial Assistance/Copay Assistance for Patients
For many patients, copays for specialty drugs are prohibitive. Patient adherence and persistence may suffer due to the cost of their drugs.5 Many pharmaceutical manufacturers offer copay assistance and/or financial assistance programs to ensure that high out-of-pocket costs do not prohibit patients from accessing their drugs. There are also several nonprofit organizations that offer financial aid to patients who cannot afford their copays. Patients are often unaware of these resources and are frequently overwhelmed by the applications and enrollment processes. A specialty pharmacy must have in depth knowledge of these programs and routinely inform patients of their availability and initiate the process, thus assuring access for patients to obtain their drugs.
d. Prior Authorization Services
Your oncology practice should focus its efforts on direct patient care and limiting its administrative expenses. A specialty pharmacy should provide a knowledgeable prior authorization team to assist you, your physicians, and your patients. Your specialty pharmacy should facilitate the prior authorization approval and should communicate with you, the patient and physician at all times during the process until approval is received or denied.
e. Regional Account Management
Account managers are a specialty pharmacy’s on-the-ground facilitators. Account managers should regularly visit your practice and meet with you, your physicians and your staff to update you on new drugs to the market, to offer educational opportunities for your staff and/or your patients and to learn about your and your patients’ challenges related to specialty pharmacy. By better understanding the unique needs the practice, your account managers can better serve you and your patients.
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