Cancer drug waste reduced with use of doctors’ office pharmacies

Over the course of their cancer treatment, a patient’s therapy may change several times. A doctor who prescribes a 15- or 30-day supply of one medication may want to adjust that dosage within one or two weeks if the patient is not tolerating it well.

A second prescription prescribed within that first 30 days, means the unused portion of the first prescription becomes waste. It’s not useful to the original patient, and can’t be given to another patient. If several changes are needed, that creates a lot of opportunity for waste.

How the medication is dispensed can be a factor in how much could be wasted

There are two ways patients can get their prescriptions. They can pick them up directly from the doctor’s office, or the clinic or hospital pharmacy connected to their oncologist’s office; this is called medically integrated dispensing (MID). The MID method improves the coordination of care because the pharmacist has immediate access to the patient’s medical chart, which may prevent an unneeded prescription from being dispensed.^1,2

When patients fill their prescriptions through a non-integrated specialty pharmacy (SP), the doctor sends the prescription electronically; it is processed and may be mailed to the patient, taking several days. More importantly, the SP does not have access to the patient medical record and care isn’t as coordinated as with MID. For example, a  laboratory test or body scan may be needed before deciding if a medication change is required. The MID care team is aware of the testing and can ensure medication dispensed amounts are timed to avoid waste.

Prior analyses have suggested that MIDs are associated with millions of dollars in avoided costs and reduced waste as compared to specialty or mail order pharmacies.^1,3,4

What are the cost savings?

Prime compared medication dose changes delivered through MID and SP for:

• Frequency of medication waste
• Amount of medication wasted
• Potential cost avoidance

Prime and eight Blue Cross and Blue Shield (BCBS) plans implemented oncology practice MID service contracts during 2021 and 2022 for their commercially insured lives. Claims for a list of 27 oral oncolytic medications dispensed through MID or SP channels were analyzed for dose changes.

In the MID analysis, there were 106 dose changes among 84 members, for an average of 1.26 changes per member.  47% of dose changes were associated with waste, with an average of $2,301 wholesale acquisition cost (WAC) medication wasted per dose change.

For the SP analysis, there were 1,037 dose changes among 780 members. This was slightly higher for an average of 1.33 dose changes per member.  55% of dose changes were associated with waste, with an average of $3,333 WAC medication wasted per dose change.

There was an 8 percentage point higher rate of dose changes with waste, and an additional $1,032 in wasted medication cost for each dose change that occurred at SP.

Medication waste frequency and average WAC wasted per dose change

WAC = medication wholesale acquisition cost, MID = medically integrated dispensing, SP = specialty pharmacy dispensing.
* Dose changes were identified among 27 oral oncology medications using the member’s medication claim generic product identifier (GPI) information.
† Waste was defined by a difference between days of therapy dispensed prior to dose change and the number of days that had elapsed, indicating excess supply on hand at the time of dose change.
‡Total WAC of wasted medication divided by the number of dose changes.

Cost comparison of oral oncolytic medication wasted between medically integrated dispensing and specialty pharmacy among commercially insured lives

WAC = wholesale acquisition cost, MID = medically integrated dispensing, SP = specialty pharmacy dispensing.
† Total WAC of wasted medication divided by the number of dose changes
‡ Total WAC of wasted medication divided by the number of waste events
Error bars represent 95% confidence intervals.

This study was sensitive to dose changes; medication discontinued and changes in therapy were not captured or assessed. Only pharmacy spend and waste were analyzed. Medical spend, total cost of care, and indirect costs were not assessed.

MID can reduce both waste and cost

There is significantly less waste from dose changes occurring at medically integrated dispensing (MID) provider practices compared to independent specialty pharmacies (SP). This is due to a combination of fewer waste events and fewer days of medication waste per event. The superior performance of MID offers the potential to save nearly $1.1 million if the 1,037 dose changes for 780 SP utilizers had occurred at MID. These real-world findings are consistent with previous analyses comparing MID and SP waste due to dose changes, and they support the continued efforts to encourage MID use.

Managed care may be able to encourage more MID services through provider incentives.

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References

1. Nubla J, Egerton NJ. Cost avoidance through the medically integrated dispensary for oral chemotherapy: Utilizing the NCODA cost avoidance and waste tracker. J Clin Oncol. 2018 June;36(15). DOI: 10.1200/JCO.2018.36.15_suppl.e18916.
2. Kanter GP, Parikh RB, Fisch MJ, et al. Trends in Medically Integrated Dispensing Among Oncology Practices. JCO Oncology Practice. 2022 July;18(10). DOI: 10.1200/OP.22.00136.
3. Darling JO, Starkey AJ, Nubla JJ, et al. Financial Impact of Medically Integrated Pharmacy Interventions on Oral Oncolytic Prescriptions. JCO Oncology Practice. 2022 May;18(7). DOI: 10.1200/OP.22.00022.
4. Leach JW, Eckwright D, Champaloux SW, et al. Medically integrated dispensing (MID) clinical and cost outcomes compared to specialty pharmacies (SP). J Clin Oncol. 2022;40(16). DOI: 10.1200/JCO.2022.40.16_suppl.e18645.
5. Dillmon MS, Kennedy EB, Reff M. Patient-Centered Medically Integrated Dispensing: ASCO/NCODA Standards Summary. JCO Oncology Practice. 2020;16(6):344-347. DOI: 10.1200/OP.19.00668.