CVS Reverses Decision on Physician Dispensing of Oncology Drugs

Pharmacy benefit managers (PBMs) play a very significant role in healthcare management, with health insurers using PBM expertise in supervising prescription drug benefits. However, a recent announcement by CVS Caremark to render all cancer clinics that dispense oral cancer agents as out-of-network come January 1, 2017, created a furor in the community oncology realm. A major opponent of this decision, the Community Oncology Alliance (COA), has said that CVS Health has now decided to lift this restriction.

A report released in August this year, which was commissioned by COA, discussed the impact that the CVS decision would have had on patient care. Physician dispensing on site creates a much tighter continuity of care and allows patient monitoring by the treating oncologist. Shifting the dispensing to mail-order or PBM-owned specialty pharmacies can create a significant gap in oncology care delivery, the report claimed.

In addition to the significant consolidation among PBMs, which creates narrower networks and a monopoly, major PBMs like Express Scripts, OptumRx, and CVS Caremark have launched their own specialty pharmacies that can capture a significant market share of specialty drugs.

Maintaining a single site of care—for consultation, drug dispensing, and drug administration—is what an integrated care delivery system should look like. It reduces the likelihood of errors and can significantly improve adherence in the case of oral anticancer agents. In the long term, this will improve clinical outcomes and avoid unnecessary care.

CVS attorneys have now released the following statement: “Oncologists who dispense medications will remain in our Medicare Part D networks pending future dialogue with CMS. We are in the process of communicating this information to affected dispensers and beneficiaries.”

Ted Okon, MBA, executive director of COA, said in an e-mail, “This was a serious patient crisis that was narrowly averted. We are relieved that CVS reversed course but still have concerns about their motivations and communications that their decision is ‘pending future dialogue with CMS.’ That is simply leaving undue uncertainty for cancer patients and their providers. COA will not rest until we are certain that cancer patients’ stress-free and affordable access to their oral medications is secure.”

The CVS decision has, at least for the time being, averted unnecessary stress for patients. The CVS statement has, however, left the window of opportunity open for the PBM to make changes to its drug dispensing coverage policy in the future.