The American Cancer Society released its annual report on cancer statistics, showing that we have made clear and significant progress in treating numerous forms of cancer. The overall rate of death has declined steadily since 1991, translating to over 3 million lives saved.
Despite this progress, I still see room for improvement in a care model where patients too often slip through the cracks.
The National Cancer Institute identified that cancer care in the U.S. accounted for over $20 billion in health care spending in 2019, including more than $16 billion in patient out-of-pocket costs. As a specialty pharmacist, I am acutely aware of the rising cost of oral cancer medications, which more than doubled in cost between 2013 and 2017 and can make access to those medications prohibitive for many.
Patients who receive a cancer diagnosis also inherit a burden of responsibility that includes managing their appointments, prescriptions, and a mountain of paperwork. Without the proper support system, patients can pay unnecessary out-of-pocket fees or fall behind in their treatment, which can result in disease progression and hospitalizations. By addressing gaps in medication access, patient safety, and long-term follow-up, we can lower the exorbitant cost of cancer care and achieve more consistently positive outcomes.
Prior authorization requests from insurers have become a major hurdle for specialty patients. The American Hospital Association found prior authorizations can delay therapy and drive up the cost of care in a recent report. Included in this report, a 2021 American Medical Association survey of more than 1,000 physicians and their staff identified that prior authorization hassles led to patient abandonment of treatment in 82 percent of respondents.
The cost of cancer therapy can also prove prohibitive for some patients, with out-of-pocket costs for oral cancer medications exceeding hundreds or even thousands of dollars per month. While additional funding may be available for some, navigating the vast financial assistance landscape can be especially challenging. Even for patients who can afford their medication, the use of an insurance-mandated mail-order specialty pharmacy rather than a local retail pharmacy can be a foreign concept to patients and can present its own obstacles related to medication dispensing and delivery.
An integrated cancer care model that incorporates dedicated personnel like pharmacy technicians, patient support advocates, and/or medication access specialists into the process can help eliminate such hurdles and streamline access to specialty medications. In this model, a highly structured support team is trained to acquire the medications needed and is adept at navigating prior authorization, appeals, financial assistance, pharmacy dispensing, and drug delivery. When this care team is positioned within the health system itself, there may be access to additional financial assistance options. Internal funding through social work or charity care and programs, such as the 340B drug pricing program, help health systems to re-invest in community care and improve patient access to treatment.
Due to the potential delay in access to self-administered oncology agents, the prescriber may not always know exactly when their patients start treatment. Patients taking oral cancer medications at home often have limited oversight, and the care team can lose visibility into medication adherence and toxicity.
In addition, cancer therapy can be very complex. While some treatment regimens consist of multiple anti-cancer medications taken simultaneously, patients are also often on a variety of supportive medications to lessen the toxicity of their treatment (e.g., anti-nausea medications) and may be taking various other medications to directly manage symptoms from their cancer (e.g., pain medications). Each of those medications has unique start and stop dates for treatment cycles, and multiple physicians may need to consult on the course of treatment along the way. Some patients may take up to 20 pills per day and may need to administer injectable therapies at home. Integrated cancer care teams can support these patients by enhancing patient education, adherence counseling, side effect management, and patient advocacy.
Having direct access to an integrated health system specialty pharmacy pharmacist or nurse with routine check-ins throughout treatment can minimize the risk for non-adherence, optimize tolerability of the regimen, support complicated at-home regimens and ensure appropriate monitoring throughout. Health system specialty pharmacies also have increasingly achieved dual accreditation status from the Accreditation Commission for Health Care (ACHC) and URAC. Those credentials have long been considered the gold standard in pharmacy accreditation and a testament to the high safety standards that health system specialty pharmacies uphold.
Long term follow-up
Even after the initial phase of their treatment, cancer patients generally return to clinic for follow-up appointments every three to six months for three years or more. These checkups may include bloodwork, physical assessment, and other tests and procedures that evaluate disease status and monitor for toxicity from treatment. They are also a time to check-in on the patient’s mental and emotional state as a cancer diagnosis and treatment can have significant implications.
By uniting all aspects of the patient’s clinical care in an integrated and coordinated model, the health system builds a supportive environment around the patient that can mitigate the risks of missed medication doses or appointments. As the time between clinic visits lengthens, patients who remain on treatment still have regular touchpoints with the specialty pharmacy in an integrated cancer care model. The pharmacy team connects with patients monthly for refills and at that time can ensure adherence to treatment, lab monitoring, and follow-up appointments. In addition to confirming adequate follow-up is in place, the clinical pharmacy team bridges the gap between visits to assess the patient’s overall health and well-being and may help connect patients to other support resources as needed.
The integrated specialty pharmacy
Health system specialty pharmacies are proven to help mitigate the access, safety, and follow-up issues that can lead to diminished health outcomes for cancer patients. These pharmacies have a unique combination of expertise and resources designed to provide holistic support for all aspects of the patient journey. The integrated care model is proven to provide patients with the support they need to navigate their treatment.
Health systems can close the remaining loopholes in cancer treatment and improve patient outcomes through a commitment to integrated care.
Chelsey Lindner is a clinical pharmacist.
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