Drug Topics - February 2009 - (Page 30)

SPECIAL REPORT ONCOLYTIC AGENTS such as trastuzumab (Herceptin; Genentech), costing $70,000, patients hit the Medicare Part D “donut hole” almost immediately. Others are turning to their pharmacists for help with patient assistance programs. Safety, access Pharmacy stakeholders are struggling to keep up. “The problems include patient safety as well as timely access to these medications through community and specialty pharmacies,” said Saul N. Weingart, MD, PhD, director of the Center for Patient Safety, Dana-Farber Cancer Institute, Boston. “Unfortunately, I don’t yet see much nationally in the way of systematic adoption of improvements.” Throwing another issue into the mix, Weingart added that there is a view emerging that these drugs require patients’ written, informed consent, whereas only a few pharmaceutical companies have developed materials to support adherence. “Our center is deploying an enhanced prescribing module for oral chemotherapy,” he said. Unique competencies, business needs “I think pharmacy will step up and deﬁne what unique business needs and competencies are required,” said Zweigenhaft. “You will see models emerge that build the capability into [coordinated management between the] pharmacy and physicians.” Associations have not yet responded to members’ need for more information to help them dispense the oral oncolytics. “We do try and help our members better navigate the challenges of dealing with these drugs,” said John Norton, spokesman for the National Community Pharmacists Association (NCPA). NCPA does sponsor continuing education programs on Medicare billing procedures, for example. Meanwhile, the American Pharmacists’ Association responded to Drug Topics’ inquiries by stating it “could not ﬁnd a staff member who could speak to the issue.” Chain pharmacies are beginning to develop strategies to streamline dispensing of oral cancer drugs. The oral oncology market is the fastest-growing sector of CVS Caremark’s specialty pharmacy business, with revenue growth of 20 percent in 2008, according to public relations director Christine K. Cramer. The chain uses pharmacist-led teams to support patients taking oral oncology drugs. Team members are educated about oncology medications, the conditions each drug treats, and how they ﬁt into treatment protocols. “By centralizing the management of cancer patients in a single team, our oral oncology program is designed to help patients better understand their treatment and manage side effects so they can stay adherent to therapy,” Cramer said. Kerr Drug, a regional chain with 102 stores in North and South Carolina, is in the early stages of tackling the challenges of ﬁlling oral oncology prescriptions, according to Mark Gregory, vice president of pharmacy and government relations. Re- quests for such prescriptions at Kerr are growing. “We have barely scratched the surface, but it’s certainly on our radar screen,” he said. “Every one of these medications potentially presents a unique situation for each individual patient,” said Gregory. He cited a recent case of a patient at a South Carolina Kerr pharmacy who attempted to ﬁll an oral oncology prescription for a medication that the pharmacy did not have on hand. “We discovered it required prior authorization from the patient’s health plan to be covered, and acquiring the product itself was kind of a challenge,” he said. Eventually the pharmacy was able to procure the drug, although not from the chain’s regular distributor. “We’re just beginning to develop centralized resources to help patients with situations like that, to procure the drug and clear them for coverage,” Gregory said. Much of the responsibility for helping patients navigate the complexities of obtaining and using oral oncology medications will probably fall to KDI Health Solutions, Kerr’s clinical services arm. “The model isn’t fully developed yet, but we certainly see KDI playing a role in providing those services,” he said. Walgreen Company ﬁlls about 1.2 million oncology prescriptions, although the company doesn’t distinguish between prescriptions for infusion and oral medications, said media relations specialist Robert Elﬁnger. Walgreen pharmacies stock anastazole (Arimidex; AstraZeneca), exemestane (Aromasin; Pﬁzer), tamoxifen, letrozole (Femara; Novartis), capecitabine (Xeloda; Roche), and imatinib (Gleevec; Novartis). Not all pharmacies stock every one of the medications, but they can almost always get them from another store in 24 hours or less, Elﬁnger said. The process of ﬁlling the prescriptions is time-consuming, says Elfinger. Typically, the pharmacist must verify that the patient is covered for the medication and that the prescribing physician has met all the safety requirements. “Each of these [steps] can take up to half an hour on the phone,” Elﬁnger said. “Then there’s additional time explaining to the patient how to take these drugs and their possible side effects.” Incorporating specialty techniques Prior authorizations, proper billing and reimbursement, coordinating concomitant therapies with the oncologist, and getting to the bottom of denied authorizations and claims so the patient with cancer receives the medication in a timely fashion are some of the hurdles pharmacists face. Specialty pharmacies such as the retail portion of the Huntsman Cancer Hospital Pharmacy, Salt Lake City, are somewhat better equipped to handle the difﬁculties surrounding oral oncolytic dispensing. “What is unique is that I hire pharmacy technicians who have prior-authorization and patient-assistance [experience],” said Scott B. Silverstein, RPh, MS, director of the pharmacy. “Our concern is to get the patient W W W.D R U GTO P I C S .C O M 30 DRUG TOPICS Februar y 2009 http://WWW.DRUGTOPICS.COM

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Drug Topics - February 2009 Contents Health-System Edition Group Attempts to Resurrect Pain Care Act HSE Business Management HSE Clinical Letters Up Front Up Front in Depth Community Practice Niche Pharmacies Serve Special Populations Special Report Oral Oncology Drugs New Drugs Update 2008 Approvals OTC New Products Viewpoint

Drug Topics - February 2009

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