ASCO and the National Community Oncology Dispensing Association (NCODA) have published recommended standards for medically integrated dispensing of oral anticancer therapies and supportive care medications in the oncology clinic.1
Michael Reff, RPh, MBA
“The NCODA created quality standards 6 years ago and recognized the importance of better patient care for patients receiving oral therapies,” said Guideline Co-Chair Michael Reff, RPh, MBA, Executive Director and Founder of the NCODA. “We wanted to create quality standards to help practices support the care of their patients who receive oral oncology medications while improving the continuity of cancer care.”
Medically Integrated Dispensing
Compared with the traditional model of mail-ordering oral anticancer therapies, medically integrated dispensing processes and delivers prescriptions within the oncology clinic. This method may be more convenient for patients and may assist in delivering timely care, particularly if abrupt changes in a treatment regimen are necessary.
The new joint, evidence-based standards set forth by ASCO/NCODA were based on a systematic review of six publications that assessed quality and safety improvement interventions for ambulatory patients receiving oral anticancer drugs. A patient representative, an ASCO staff member, and a multidisciplinary expert panel consisting of individuals with expertise in medical oncology, pharmacy, nursing, and health-care administration took part in the review and creation of the standards.
“As more and more new cancer therapies that are being developed are oral medications, it is important as providers and patients that we recognize the need for protocols similar to those set forward by QOPI® covering infusions,” said Guideline Co-Chair Melissa S. Dillmon, MD, FASCO, of the Harbin Clinic. “It is also important to provide for those practices who chose to take on the responsibility of being a [medically integrated dispensing] pharmacy a way to prove that they are using practices proven to result in higher adherence and therefore longer time on drug with improved safety, all while reducing waste.”
“NCODA is an organization of practices and [medically integrated dispensing] programs that already had put forward internal organizational standards,” Dr. Dillmon continued. “ASCO saw this partnership as a way to build off of the success of this program as well as those standards set forward in the QOPI® program.”
Patient-Centered Quality Standards
The literature review identified several subdomains of patient-centered quality standards for medically integrated dispensing in patients with cancer:
- Patient relationships: Patients should have direct access to the medically integrated dispensing team, particularly by phone.
- Documentation: All clinical encounters should be documented in the patient record.
- Benefits investigation: An investigation of prescription coverage, co-pay determination, and assistance programs should be conducted by the medically integrated dispensing team.
- Medication disposal: Education on proper unused/expired prescription disposals is highly recommended.
- Patient satisfaction: Use of the NCODA patient satisfaction survey may be helpful for soliciting patient feedback and identifying continuous improvement opportunities.
Educating Patients and Improving Prescription Adherence
Patient education was a consistent component in the literature that was associated with improving the quality of medically integrated dispensing in the oncology clinic. According to some studies, an initial education session and subsequent follow-up visits were associated with improved daily adherence to therapy in patients with cancer. Based on these findings, ASCO/NCODA recommend patient education and ongoing follow-up as integral standards for improving the quality of care in populations who receive oral anticancer drugs in the clinic environment.
In addition, the expert panel recommends implementing specific tools and policies in medically integrated dispensing programs for maximizing adherence. Providing patients and providers with calendars that have reminders on refill and medication schedules, monitoring drug toxicities at each follow-up visit, and having discussions on financial aspects that may impact adherence are recommended.
Ensuring Patient Safety
The new standards also highlight several measures medically integrated dispensing personnel can take for ensuring patient safety. They include having a verification system using two patient identifiers (ie, name, date of birth, address) and verifying a toxicity evaluation and management visit with a provider approximately 2 weeks after the patient starts a new oral anticancer therapy.
Future Directions
Under these standards, Mr. Reff said that organizations will be better suited to go to insurance companies and have better collaboration to improve quality and value. “[The standards] provide a management system to support the continuity of care that creates a win-win-win situation for the patient primarily, the practice, and everyone involved in the care of these patients,” he said. “ASCO brings this to scale.”
According to Dr. Dillmon, continual updates to these standards may be necessary. “The expert panel felt the need to look for studies in the future that examine specific protocols or components of interventions that are successful,” she said. Additionally, the panel may look at how different populations can be targeted to address unique demographic challenges, such as minorities and rural populations, patients with limited literacy, and patients whose first language is not English. ■
DISCLOSURE: Mr. Reff owns stock or other ownership interests in Bristol-Myers Squibb, G1 Therapeutics, and Pfizer; has served as a consultant or advisor to BeiGene, Exelixis, Verastem; has participated in a speakers bureau for Boehringer Ingelheim, Incyte, and Pfizer; and has been reimbursed for travel, accommodations, or other expenses by Pfizer. Dr. Dillmon has an immediate family member who owns stock or other ownership interests in Johnson & Johnson and has personally served as a consultant or advisor to Puma Biotechnology.
REFERENCE
1. Dillmon MS, Kennedy EB, Anderson MK, et al: Patient-centered standards for medically integrated dispensing: ASCO/NCODA standards. J Clin Oncol. December 9, 2019 (early release online).
Originally published in ASCO Daily News. © American Society of Clinical Oncology. ASCO Daily News, December 10, 2019. All rights reserved.
