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Medically Integrated Dispensing: An Alternative to How Oral Drugs Get Dispensed
March 14, 2019

Medically Integrated Dispensing: An Alternative to How Oral Drugs Get Dispensed

The National Community Oncology Dispensing Association, Inc. (NCODA) is a grassroots, not-for-profit organization, founded to strengthen oncology organizations with medically integrated dispensing (MID) services. NCODA is addressing the growing need for MID cancer clinics to improve operations at the pharmacy level in order to deliver quality and sustainable value to all stakeholders involved in the care of cancer patients receiving oral therapy. NCODA brings value to practices through adoption of quality standards, sharing of best practices and improving financial viability. Through NCODA, dispensing organizations will be in a position to further demonstrate their high quality and patient-centered focus. With NCODA’s value proposition, oncology organizations will be able to convey to all stakeholders why it is vitally important for a patient’s treatment to remain with their oncologist to go beyond the first fill.
This article is authored by NCODA Patient Contributor Bill Wimbiscus, a Chicago-area journalist with more than 35 years experience. He has written and edited for numerous newspapers and magazines.

While oral chemotherapy has dramatically changed the face of cancer treatment, how the drugs are dispensed can be nearly as important as the drugs themselves.

“It’s one thing to prescribe an oral medicine for a patient,” said Guri Doshi, MD, a urinary and prostate cancer specialist with Texas Oncology, the state’s largest cancer care provider. “It’s another to get it into their hands.”

The decision on how a drug gets dispensed is dictated solely by the patient’s insurance plan. At present, most plans require oral oncolytics to be distributed via mail order through specialty pharmacies.

These state-licensed facilities provide specialty medications to patients with serious health conditions through large healthcare networks. Because of their high patient volume, they’re able to negotiate bulk discounts from drug manufacturers and pass the savings on to insurers.

However, a growing number of plans have begun offering a second alternative: at practices with their own pharmacies, patients are now given the option of picking up prescriptions directly from the clinic. Proponents of this method, known as Medically Integrated Dispensing (MID), believe it provides better patient outcomes and is substantially more cost-effective.

“It really helps improve patient care based on the shorter time it takes to have the patient obtain medication,” Doshi said.

The briefer time frame becomes apparent as soon as the doctor writes the prescription. First fill prescriptions are sent electronically to the pharmacy, which must then wait for insurance authorization before it can fill it.

“The difference is that with MID, there is an immediate verification, so it’s received and worked on immediately,” Doshi explained. “While with specialty pharmacies there can be a delay in getting the drugs to the patient. It can take up to a couple of weeks. It’s a huge problem and most significant when we’re just getting the patient started on their cancer treatment. A delay of 2 weeks or more can really make a significant impact on a patient’s health.”

The difference between the 2 systems becomes even more apparent after the first fill is completed.

With MID, the doctor continues to manage the prescription directly through an in-house pharmacist. The patient simply picks it up from the pharmacist once it’s filled.

With specialty pharmacies, however, the responsibility of managing subsequent fills falls solely on the patient. It’s their job to contact the pharmacy and schedule delivery times.

“After the first fill, the onus is on the patient,” Doshi explained. “They have to be the one to continue to communicate with the pharmacy. Even if the doctor does it for them, it’s still external to the doctor-patient relationship, a third party.”

Intergrated Access
Jan Merriman, director of clinical and pharmacy services for Minnesota Oncology and a longtime advocate of MID, understands the need for integrated access. She and her team work closely with approximately 100 physicians, nurse practitioners and physician assistants across 12 sites.

“The specialty pharmacy doesn’t have access to the patient’s medical list and they can’t see patient’s labs,” Merriman explained. “It’s like trying to coordinate another outside entity that isn’t under our control and one that’s difficult to communicate with. It’s not like they’re really a partner in the patient’s care.”

That’s because once the prescription leaves the clinic, providers are in the dark regarding its status.

“When we send scripts off to CVS and the larger corporations, we never know when they're mailed, when they're received, etc., unless we call,” said Kirollos S. Hanna, a hematology/oncology clinical pharmacist at the Mayo Clinic. “And unfortunately, we do not have the time to do so for each patient. Unless the patient is an excellent historian (and most are not), this issue is a big problem when assessing adherence.”

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