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Brandon R. Shank, PharmD, MPH, BCOP; Phuoc Anh (Anne) Nguyen, PharmD, MS, BCPS; and Emily C. Pherson, PharmD, BCPS
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Pharmacy Team Engagement in Navigating the Revenue Cycle for High-Cost Medications in Patients With Cancer

Brandon R. Shank, PharmD, MPH, BCOP; Phuoc Anh (Anne) Nguyen, PharmD, MS, BCPS; and Emily C. Pherson, PharmD, BCPS
With the clinical and financial implications of high-cost medications, and their impact on health system revenue, it is of utmost importance for all key stakeholders to be engaged in the complex revenue cycle.
5. Timely delivery of medications. 

In certain circumstances, it may be urgent to start cancer treatment. However, we often experience delays with obtaining high-cost novel targeted medications. PAs delay drug procurement in addition to identifying the patient’s preferred pharmacy, which is more often a mail order pharmacy (Figure 2) so that these medications need to be directly shipped to the patient. Providers and support staff spend a large amount of time on the phone with insurance representatives to obtain PA and ensure timely drug delivery, and specialty pharmacies work to ensure prompt delivery of medications as soon as approval is obtained. It is important to communicate with the pharmacy when urgent delivery is needed so the drug can be overnighted to the patient, if necessary. 

Due to drug shortages or restricted use, some medications undergo limited supply distribution. For example, procarbazine, a drug used in combination treatment for lymphoma in the brain, is not carried by all pharmacies. There also have been instances where a patient’s insurance required a specific specialty pharmacy, but that pharmacy was unable to obtain a supply of the drug. These circumstances take a significant amount of time to manage and ensure patient access to the medication.

It can be logistically challenging, especially for patients from out of town, to have their drugs delivered to a hotel or temporary residence. They often need someone to sign for the package, which requires the caregiver to leave the patient’s bedside to obtain medications. Some medications require special handling, such as refrigeration, which adds complexity. Mail order prescriptions may have lower co-pays for chronic medications. If caregivers know medications will be delayed, they can defer the start of cancer treatment until the entire regimen can start at the same time—unless the patient’s clinical situation prevents this. It is often difficult to predict what other medication needs may arise during a course of chemotherapy; therefore, a local community pharmacy is often necessary for obtaining medications to manage symptoms in a timely fashion. In addition, patients often have to rely on caregivers, friends, and relatives to ensure timely delivery of their medications, which may include personally carrying or mailing the medications to the patient’s temporary location.

Conclusion

With the clinical and financial implications of high-cost medications, and their impact on health system revenue, it is of utmost importance for all key stakeholders to be engaged in the complex revenue cycle. Tackling PBMs’ insurance formularies and the reimbursement process can be dynamic and complex. It is crucial for the pharmacy team to collaborate with other providers, hospital financial team members, PBMs, and hospital leadership and leverage their skill sets to manage costs and optimize reimbursement for the health system. Overall, this collaboration will maximize benefits for both institutions and patients, ultimately ensuring the most optimal use of medications. 




AUTHOR INFORMATION

Brandon R. Shank, PharmD, MPH, BCOP, is a clinical pharmacy specialist, Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX.


Phuoc Anh (Anne) Nguyen, PharmD, MS, BCPS, is a clinical pharmacy specialist, Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX.

Emily C. Pherson, PharmD, BCPS, is a clinical pharmacy specialist, Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD. 

ADDRESS FOR CORRESPONDENCE

Brandon R. Shank, PharmD, MPH, BCOP

Clinical Pharmacy Specialist, Division of Pharmacy,
The University of Texas MD Anderson Cancer Center
1515 Holcombe Blvd - Unit 377, Houston, TX 77030. 

E-MAIL BShank@mdanderson.org 
REFERENCES
1. Arends-Marquez A, Knight N, Thomas-Flowers D. ICD-10’s impact reaches far beyond coding: examining the new code sets’ revenue cycle implications. J AHIMA. 2014;85(11):74-76.

2. Loyd LM. Optimizing pharmaceutical reimbursement: one institution’s approach. American journal of health-system pharmacy. Am J Health Syst Pharm. 2006;63(21 suppl 7):S18-S21.

3. Jarrett AT, Patel KR, Babbitt R. Understanding pharmacy department billing and the charge master. American journal of health-system pharmacy. Am J Health Syst Pharm. 2008;65(23):2213-2214. doi: 10.2146/ajhp070675.

4. Blincyto - Coverage and correct coding — revised. CGS website. cgsmedi- care.com/jc/pubs/news/2015/0215/cope28409.html. Updated January 7, 2016. Accessed August 4, 2017.

5. Schumock GT, Li EC, Wiest MD, et al. National trends in prescription drug expenditures and projections for 2017. Am J Health Syst Pharm. 2017;74(15):1158-1173. doi: 10.2146/ajhp170164.

6. Tyler LS, Cole SW, May JR, et al; ASHP Expert Panel on Formulary Manage- ment. ASHP guidelines on the pharmacy and therapeutics committee and the formulary system. Am J Health Syst Pharm. 2008;65(13):1272-1283.

7. Colgan K, Beacher R. Importance of specialty pharmacy to your health sys- tem. Am J Health Syst Pharm. 2015;72(9):753-756. doi: 10.2146/ajhp140796.

8. Anagnostis E, Wordell C, Guharoy R, Beckett R, Price V. A national survey on hospital formulary management processes. J Pharm Pract. 2011;24(4):409-416. doi: 10.1177/0897190011407777.

9. Her QL, Amato MG, Seger DL, Gilmore JF, Fanikos J, Fiskio JM, Bates DW. Review of nonformulary medication approvals in an academic medical center. Jt Comm J Qual Patient Saf. 2017;43(2):89-96. doi: 10.1016/j. jcjq.2016.10.003.

10. Mitchell A, Muluneh B, Patel R, Basch E. Pharmaceutical assistance programs for cancer patients in the era of orally administered chemo- therapeutics [published online January 1, 2017]. J Oncol Pharm Pract. doi: 10.1177/1078155217719585.

11. Rogers J, Pai V, Merandi J, et al. Impact of a pharmacy student-driven medication delivery service at hospital discharge. Am J Health Syst Pharm. 2017;74(5 suppl 1):S24-S29. doi:
10.2146/ajhp150613

12. H.R. 2900 (110th): Food and Drug Administration Amendments Act of 2007. govtrack website. govtrack.us/congress/bills/110/hr2900/text. Published July 16, 2007. Accessed August 16, 2017.

13. Johnson PE, Dahlman G, Eng K, et al; NCCN Oncology Risk Evaluation and Mitigation Strategies (REMS) Work Group. NCCN oncology risk evaluation and mitigation strategies white paper: recommendations for stakeholders. J Natl Compr Canc Netw. 2010;8(suppl 7):S7-S27.

14. Sarpatwari A, Avorn J, Kesselheim AS. Using a drug-safety tool to prevent competition. N Engl J Med. 2014;370(16):1476-1478. doi: 10.1056/ NEJMp1400488.

15. Approved risk evaluation and mitigation strategies (REMS). FDA website. accessdata.fda.gov/scripts/cder/rems/. Accessed August 7, 2017. 
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