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Smilow's In-House Pharmacy Saved Costs, Beneficial to Patients


Expanding a health system pharmacy’s operations to include specialty drugs, namely oral oncology agents, improved patient care by reducing errors and saving costs.

Expanding a health system pharmacy’s operations to include specialty drugs, namely oral oncology agents, improved patient care by reducing errors and saving costs. The hospital channeled the costs to improve patient education, monitoring, and assistance.

The study, which will be presented at the upcoming American Society of Clinical Oncology’s (ASCO) upcoming Quality Care Symposium, was conducted at the Smilow Cancer Hospital at Yale-New Haven. The cancer center, which has implemented a Quality Oncology Practice Initiative, or QOPI, certification process, identified several drawbacks with their oral oncologic process:

  • Lack of documentation in the electronic health record
  • Involvement of third-party pharmacies for patient refills
  • Incorrect self-administration due to lack of education
  • Delivery delays
  • High co-pays
  • Underuse of patient assistance programs

“Prior to our in-house pharmacy, we had no idea what happened after we sent prescriptions to outside specialty pharmacies,” said lead author Kerin Adelson, MD, assistant professor of medicine and chief quality officer for Smilow Cancer Hospital at Yale New Haven. “Did the patient start treatment later than recommended? Did the patient take the right combination and on a consistent basis? These were all questions that affect quality and outcomes that we were not able to answer before.”

In an attempt to correct these issues, the hospital developed a task force, which in turn created a program that would expedite drug access, standardize consent, and ensure clinical support for patients. A new protocol routed the treatment protocol for oral oncologic agents to a clinical oncology pharmacy and the specialty pharmacy. The orders are verified by the nursing team and the pharmacy team, and pharmacists call on patients at pre-specified intervals to monitor adherence and treatment-related toxicity. The hospital’s Medication Assistance Program provided copay support.

Implementation of the modified protocol resulted in 80% of patients receiving their medication within 72 hours, as opposed to waiting for 2 to 3 weeks, and has, so far, prevented 400 prescription errors. Monitoring is much more stringent and specialty pharmacists at Smilow monitor patients even if they fill their prescriptions at another pharmacy.

The hospital has also witnessed significant cost savings—since its inception in February 2015, the oral chemotherapy program at Smilow has earned $44 million in revenue, with a margin of $9 million. The hospital also provides copay assistance to an average of 140 patients each month.

Highlighting the importance of vigilance, whether patients receive oral agents or intravenous infusions, Howard Cohen BSPharm, MS, FASHP, associate director of Oncology Pharmacy Services at Yale New Haven Hospital, said, “With our protocol, we are able to better address medication adherence and side effects—all of which translates to a higher quality of care for our patients.”

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