The NCCN Task Force on Specialty Pharmacy Issues Preliminary Report

May 2010, Vol 1, No 1 - NCCN Conference

Hollywood, FL—As specialty pharmacy (SP) expands rapidly into oncology, there is a need to better define its role. This was the aim of the National Comprehensive Cancer Network (NCCN) Task Force on Specialty Pharmacy, whose chair presented the group’s preliminary report at the 15th Annual NCCN Conference.

“There is a vibrant specialty pharmacy industry, and the impact in cancer care is expanding,” said Rowena N. Schwartz, PharmD, of Johns Hopkins Hospital in Baltimore, Maryland.

Much of the interest in SP comes from the evolving role of oral antineoplastic agents. Of the 400 new antineoplastic agents in the pipeline, 25% are planned as oral drugs, and already spending on oral agents has more than doubled since 2002 (Weingart SN, et al. J Natl Compr Canc Netw. 2008;6[suppl 3]:S1-14). Specialty pharmacists may prove to be a valuable source of information

on using these new medications safely, effectively, and economically, according to Dr Schwartz.

The Task Force explored aspects of SP that are unique to oncology and presented recommendations for joining SP and oncology. In particular, the Task Force addressed the mechanisms and potential benefits of SP as a distribution channel for oncology therapeutics. It identified opportunities as well for disease state management, cost of care, clinical research, and safety.

“The Task Force wanted to demonstrate there are opportunities to optimize cancer care by partnering with specialty pharmacy,” she said. “We wanted to show how specialty pharmacy is cost saving and offers value to third-party payers.”

Defining Specialty Pharmacy

The Task Force defined SP as a pharmacy service model designed to fill the perceived gaps in pharmaceutical care associated with traditional community pharmacy practices. In oncology, the scope of the practice includes the oral antineoplastic agents and supportive care medications, such as erythropoiesis-stimulating agents. Health maintenance and management of comorbidities is also part of SP.

The current operational models include limited-distribution medications, infusion services, mail order, and distribution of medication via the community pharmacy network.

SP serves as a “hub” between prescribers, the drug manufacturer, and the patient, Dr Schwartz explained. Within this “hub” is a patient/provider registry, verification of insurance coverage, and monitoring of treatment adherence and side effects. SP can also be involved in outcomes assessment, which is a growing need in the current environment.

Advances in Patient Care

“Patients are increasingly expected to share more of the cost burden of the oral antineoplastics,” she observed. There are high copays, tiered coverage, and the infamous “doughnut hole,” as well as hidden costs, such as changes in medication that lead to medication wastage. “Specialty pharmacy offers cost-friendly strategies to reduce costs to the patient,” according to Dr Schwartz.

SP also enhances medication safety by increasing product familiarity, availability, and access, and providing individualized monitoring, data tracking, and hazardous waste disposal. Additionally, patients in clinical trials can have timely drug access, coordination of care (ie, dose modification), and coordination of information through SP, the Task Force pointed out. 

But coordination of cancer care is perhaps the most important concern of SP. “We need to find out how specialty pharmacy can impact positively on cancer care,” Dr Schwartz said, “and not fragment care or confuse patients about the care they receive.”

Optimal care coordination will include not only authorization and drug distribution but also patient education, treatment monitoring, and disease management. This expanded responsibility for pharmacy highlights the need for team collaboration and a change in mindset about the role of pharmacy. The specialty pharmacist’s unique training can be an asset to patients and oncologists alike, she pointed out.

“One of the great things about specialty pharmacy is you are often working with pharmacists who are very knowledgeable about the products they are dealing with and therefore have a lot of information for patients and their families,” Dr Schwartz explained.

One area left unaddressed by the Task Force, however, included drug costs and economic concerns. The group maintains that these issues are too broad and complex to be considered

under its mission. However, the group did recommend that an alternative financial model for pharmacy reimbursement be designed—one that will “get away from selling a product to providing services of value,” Dr Schwartz explained, and that inefficiencies associated with increased cost be identified and eliminated.

Preliminary Recommendations by the NCCN Task Force on Specialty Pharmacy

  • Specialty pharmacy personnel should be “trained” in oncology. Optimal coordination of care for patients and their families should be the priority.
  • Communication among all members of the oncology team involved in drug therapy decision-making should be standardized, using a common language.
  • Strategies should be created to assure coordination of care for patients treated in multiple healthcare settings.
  • Health information technology systems (ie, electronic health records) should be developed and used to foster collaborative care.
  • Shared-data needs (ie, for integration of case management, insurance coverage, clinical information and outcomes) should be identified and national standards established.
  • Standards and requirements for care coordination and medication safety should be developed.
  • Operational processes that support frequent changes of treatment should be established (eg, allowing dispensing of smaller amounts of medication at one time).
  • Regulations should be implemented for dispensing and handling of oral chemotherapy.
  • The use of “brown bagging” (ie, purchases made at one place but administered in another) for chemotherapy, antineoplastic agents, and supportive care medications should be eliminated.