Transcript Document

The In-Practice Pharmacy Value Proposition & Need for a National
Ricky Newton, CPA
Orlando, Florida
April 24, 2015
Lumi Question #1
▪ Do you have one of the following within your practice currently?
• Retail Pharmacy
• In-house dispensing (only allowed to dispenses drugs that your
physicians prescribe within the practice)
• We do not currently dispense oral drugs within our practice
© 2015 Community Oncology Alliance
Lumi Question #2
▪ For those that do not dispense drugs in their clinics
• We are very interested in setting up an in-house or retail pharmacy
within our clinic
• We do not have the physical space to set up in-house dispensing but
if we did we would be interested
• Our state laws do not allow our practice to dispense oral drugs
within our clinic
• We have no interest of dispensing oral drugs from within our clinic
© 2015 Community Oncology Alliance
Why a National Pharmacy Organization?
▪ Community oncology practices expressed interest based on
current existing pharmacy facilities (dispensing or retail
pharmacy) or on planned facilities
• 59 practices (from CAN) originally expressed interest
• 72 practices currently part of COPA
• 82 practices weighed in on priorities for COPA
▪ Pharmacy issues becoming more important
• USP chapters 797 and 800
• Oral cancer drugs an increasing percentage of pharma pipelines
▪ Need for standards and information sharing on “best practices”
▪ Threat of specialty pharmacy disjointing
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70 Oncology Oral Drugs
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Oral Drugs Classified by Indication
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© 2015 Community Oncology Alliance
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COPA Mission
▪ Foster oral cancer therapy tightly integrated into cancer patient
treatment at the site of care. Specifically, COPA will:
• Help practices enhance outcomes of cancer patients treated with oral
▸ Focus on quality, efficiency, and financial viability
• Establish quality standards, best practice benchmarks, operating
procedures, and other clinical/operating processes
Provide a forum for practices to share best practices and information,
especially relating to state pharmacy issues
Develop the quality/value proposition of “integrated oral cancer
treatment” for payers (Medicare, private, self insured)
Educate pharmaceutical companies on the clinical/value proposition of
“integrated oral cancer treatment”
© 2015 Community Oncology Alliance
Lumi Question #3
▪ Please rank the following five items in order of importance to
you (1 being the most important and 5 being the least)
• Guides, tips and templates for contracting with insurance companies
• White paper that tells the story of why payers should choose
practices dispensing oral drugs to their patients verses specialty
• Library of patient assistance programs for all oral chemo and
supportive care drugs
• Develop and benchmark quality measures and standards for
operating a dispensing pharmacy in a practice
• Patient & Payer focused educational material highlighting a
practice’s dispensing program
© 2015 Community Oncology Alliance
Comments from COPA Survey from Practices
▪ Most important hurdle that we have is insurance companies allowing physician dispensing. Please work
on getting major commercial insurances to allow us to dispense.
▪ I think the biggest issue we face is competition from specialty pharmacy. Community oncology
dispensing/pharmacy programs needs to find a way to be recognized by the pharmacy benefit manager's
as a "specialty dispenser/pharmacy". I think that oral adherence & toxicity management, having the ability
to dispense all oral oncolytics, and having dialogue on what is happening in the oral oncolytic market
space with the high price increases (6 to 10% increases) are important topics as well.
▪ Information on how to combat insurance carriers who will not let you dispense or only let you do first fill
▪ How to battle with payers requiring orals be dispensed only by their selected specialty pharmacies
▪ Any assistance with helping contract and combating insurance and specialty pharmacies would be a
great help.
▪ A major concern is dealing with payers who require oral drugs to be ordered thru PBMs, and how this
would influences the viability of an oral chemo and support drug dispensing program.
▪ I feel the most important tool is one that will document compliance, quality and safety measures so that
we can utilize that to show payers the importance of maintaining physician dispensing. If there was a
way for us to track the over fill, delays in dispensing and other issues for Rx's issues with specialty
pharmacies, we can provide comparative information that indicates in office dispensing is better for
patients and payers.
▪ Contracting for orals, period - with payers - perhaps as a group?!
© 2015 Community Oncology Alliance
Immediate Priorities
▪ Create standard national quality measures
▪ Establish a way to measure quality in a tangible way
• Similar to the oncology medical home initiative
▪ Publish an independent report/analysis documenting
patient experience of receiving oral cancer drugs in
practice versus specialty pharmacy
▪ Develop the COPA website
▪ Create information sharing on the closed COPA list serve
© 2015 Community Oncology Alliance
Web Site Content for Patients
▪ Library of patient assistant programs for all oral chemotherapy
and supportive care drugs
▪ Library of patient focused educational materials on each oral
▪ Patient focused educational material highlighting a practice’s
dispensing program
▪ Blog for patients to be able to ask questions of other patients
on oral drugs or the ability to write their stories and
experiences to share with other
Lumi Question #4
▪ Does your pharmacy satisfy the requirements for
• USP 797
• USP 800 (Which means you also qualify for USP 797)
• Neither of the above
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Website Content on State Pharmacy Laws and USP
797 & 800
▪ Link to all state laws for in-house and retail pharmacies
▪ Listing of what each state allows in regards to in-house and
retail pharmacies
▪ Resources and project plan to assist in complying with USP 797
& USP 800
© 2015 Community Oncology Alliance
Website Content on Pharmaceutical, GPO & Pharmacy
Software Vendors
▪ Links to pharmaceutical & GPO contracts on oral drugs
▪ Links to pharmaceutical patient assistance programs
▪ Listing of each drug and indication along with the links to each
pharmaceutical company websites for each drug
▪ Links to companies that provide in-house/retail pharmacy
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Tool Box for Managing Pharmacies Website
▪ Policies and procedures for operating in-house and retail
▪ Historical information from the list serve on all questions and
▪ Benchmarking and other financial data
▪ Infrastructure needs for setting up and maintaining
pharmacies inside a practice
▪ Quality Measures
▪ Staffing Models
▪ Resources to assist in state pharmacy board audits
▪ Stories of Success and Failures
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Website Content on Payers
▪ Non Participating payers by state
▪ Medicare Part D
▪ Medicaid programs
▪ Payer focused educational material
▪ Guides, tips and templates for contracting with payers
© 2015 Community Oncology Alliance
COPA Board
▪ Josh Cox, Pharm.D., BCPS, Chairperson
• Dayton Physicians Network
▪ Tommy Harwood, CPT, Chairperson
▪ Steve D’Amato, BS Pharm, BCOP
• New England Cancer Specialists
▪ John Clagg, RPh
• The Center for Cancer and Blood Disorders
▪ Bob Phelan
• Cancer Specialists of North Florida
▪ Maryann Roefaro, M.S., FACMPE
• Hematology-Oncology Associates of CNY
▪ Stacey McCullough, PharmD
• Tennessee Oncology
▪ Michelle Moore, RPh
• Michiana Hematology Oncology
© 2015 Community Oncology Alliance
COPA Listserv and Involvement
▪ COPA List Serve
• [email protected]
▪ COPA Registration
▪ Questions
• Ricky Newton (757-639-4855 or rn[email protected])
© 2015 Community Oncology Alliance