NCODA Outlines New Patient-Centered Oncology Distribution Models

During a panel discussion at Asembia’s AXS25 Summit, oncology experts revealed guideline definitions for a more collaborative approach to improve outcomes, streamline access, and reduce costs across the cancer care continuum, highlighting the value of medically integrated care models.¹

Experts champion medically integrated care and oncology optimized distribution models. | image credit: Kanisorn - stock.adobe.com

What Is Medically Integrated Care?

Medically integrated care is a collaborative, patient-centered model that brings together a multidisciplinary team of physicians, pharmacists, pharmacy technicians, social workers, and other providers to deliver coordinated, high-quality care using a shared information system like an electronic health record, explained the panelists. The patient must remain at the center of this model, with all team members aligned around a single source of truth, emphasized Desi Kotis, BSPharm, PharmD, FASHP, chief pharmacy officer, USCF Health.

As cancer therapies become increasingly complex, such as the use of bispecific antibodies, successful treatment requires deep coordination across multiple disciplines, added Kirollos Hanna, BCPS, BCOP, director of pharmacy, Minnesota Oncology. Furthermore, medically integrated care can be described as a way to enhance care delivery while advancing the “quadruple aim”: improving both the patient and clinician experience, achieving better health outcomes, and reducing overall costs, noted session moderator Mike Reff, RPh, MBA, executive director and founder, NCODA.

Current Distribution Definitions

The panel broke down the current definitions of various drug distribution models and their impact on patient access and care coordination. They defined open distribution as allowing any pharmacy to fill a prescription, whereas limited drug distribution channels restrict dispensing to select medically integrated pharmacies (MIPs). Medically integrated dispensing pharmacies are in-house pharmacy models within oncology practices that allow direct medication access. Pharmacy benefit manager (PBM)–owned mail order pharmacies are operated by PBMs and have often been found to fragment care for practices and patients.

The panel also underscored the critical role distribution models play in oncology care, where timely, precise treatment is essential. For instance, MIPs offer a major advantage by having access to electronic health records, lab results, and patient history, allowing pharmacists to make informed, real-time decisions before dispensing medication, which external pharmacies often lack, explained the panelists.

“I think there just goes hand-in-hand and highlights the importance [that] this isn't a cholesterol medication or a blood pressure medication,” said Hanna. “These are life-saving medications that are critical for our patient.”

New Distribution Definitions

NCODA is updating the “Patient-Centered Standards for Medically Integrated Dispensing: ASCO/NCODA Standards,” originally published in 2019,² and hopes the updates will be adopted and utilized by oncologists.

Definitions include¹:

• “Closed distribution: Applies to medications with highly restricted networks, such as those requiring REMS or manufacturer-designed controls. These models typically offer little to no flexibility in dispensing, often excluding MIPs altogether. This includes models with no MIP Access.”
• “Oncology optimized limited distribution: Represents the NCODA preferred model, where PBM-affiliated mail order pharmacies are excluded, and MIPS and non-PBM-affiliated pharmacies can dispense. This model enables coordinated, in-patient care and supports timely, patient-centered treatment. NCODA is committed to continued education and advocacy to expand access to this approach whenever possible.”
• ‘PBM influenced limited distribution: Includes 1 or 2 PBM-affiliated mail order pharmacies. While not preferred, it is important to recognize manufacturers that are attempting to promote MIPs and limit access to PBM owned pharmacies.’
• ‘Open distribution: Are widely available through retail, hospital, and mail order pharmacies without restrictions. Includes Optum, CVS Caremark, and Express Scripts PBM-affiliated mail order pharmacies.’

"Our vision is to be the world leader in oncology by building a patient-centered, medically integrated community whose focus is to innovative the continuity of cancer care, so every patient receives the maximum benefit from their cancer treatment," said Scimeca.

Pharmaceutical companies invest significant time designing these networks to ensure a smooth, positive first experience for patients starting therapy, explained Fitch. They also allow for centralized information and coordinated care, which is especially important for high-risk patients with cancer, noted Kotis.

“Oncology optimized limited distribution was not created in a vacuum, just by NCODA or NCODA staff,” said Reff. “It also incorporated feedback in partnership with our manufacturers and others, so that we knew that we were aligned on how we wanted to ensure that this definition would be consistent across the marketplace, so it represents the NCODA-preferred model where PBM-affiliated mail order pharmacies are excluded, and MIPs and non-PBM mailer pharmacies can dispense.”

References

1. Kotis D, Scimeca F, Reff M, et al. Beyond limits: Rethinking drug distribution to drive patient-centered care. Presented at: AXS25; April 30, 2025; Las Vegas, NV.

2. Dillmon MS, Kennedy EB, Anderson MK, et al. Patient-centered standards for medically integrated dispensing: ASCO/NCODA standards. J Clin Oncol. 2020;38(6):633-644. doi:10.1200/JCO.19.02297