Multidisciplinary Approach to Managing Oral Oncolytics

Michael Reff, RPh, MBA: This is a good stepping point to talk about NCODA [National Community Oncology Dispensing Association], the organization that I founded. We have 280 practices around the country that are members of this organization. We have quality standards that talk about adherence, which you’re mentioning now. The quality standards are really the backbone, or are sort of the recipe on how to truly be a medically integrated service primarily and solely for the patients, but they also add value back to the practice and other stakeholders in this space, like payers and state boards of pharmacies and other stakeholders. They provide value by looking at the oral therapy model, emphasizing the benefits of having a team who is focused on that. The ultimate goal is to delight the patient who is receiving this oral therapy as much as possible.

Joyce O’Shaughnessy, MD: Right. It really is all about giving the patient the best care, of course. You’ve got the option where the specialty pharmacy can fill the prescription or the practice can fill the prescription, right? What’s been happening with that over the last few years or so? And then let’s discuss the integrated medical pharmacy. How is that going to possibly improve the situation?

Michael Reff, RPh, MBA: Having a medically integrated pharmacy team helps the practice be able to go to payers who may dictate the distribution model for a prescription as to whether it can be filled at the practice or whether it has to go outside to a specialty pharmacy.

If a practice can demonstrate the quality and value that I know a medically integrated pharmacy team can, then that payer may be obligated or encouraged to allow that practice to go beyond the first fill. What I mean by that is most times, when you prescribe a CDK4/6 inhibitor, your pharmacy may be able to fill the first fill. Then all subsequent fills need to go out to a specialty pharmacy that is dictated by the payer. What 8 NCODA practices have done across the country is work regionally with payers to demonstrate to them the quality and value. By showing quality and value, we see better adherence, right? We look at the medication possession ratios. There are fewer adverse effects. We see better management of financial toxicities, because we know that these compounds are very expensive. So by wrapping our team around the 4 quality standards of NCODA, we have provided opportunities that are unprecedented—to be able to go beyond the first fill with 11 regional payers and employer groups at these 8 separate practices that are in different states in the country.

Joyce O’Shaughnessy, MD: Yes. That makes so much sense.