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Worksite Pharmacies Can Enhance Overall Drug Management of Patients with Cancer

VBCC - June 2014 Vol 5, No 5 - AVBCC 2014 4th Annual Conference
Wayne Kuznar

Los Angeles, CA—Worksite pharmacies have unique advantages over local pharmacies in caring for employees with cancer.

Bill Raulerson, PharmD, Director, On-site Pharmacy Operations at Walgreens, described the benefits of onsite pharmacies for patients with cancer at the Fourth Annual Conference of the Association for Value-Based Cancer Care.

“We view the role of our pharmacists in the treatment of oncology patients as an opportunity to leverage that patient relationship,” Dr Raulerson said. The advantages are patient access to a trusted clinician, better communication, patient education, and patient advocacy.

Low medication adherence rates are especially common among patients with cancer and may be improved through a worksite pharmacy. “Patients filling prescriptions at worksite pharmacies are about 22% less likely to have a gap in therapy,” he claimed. Onsite pharmacies have a 10% higher rate of adherence than local pharmacies.

When a person with concomitant medical conditions, such as diabetes, hypertension, or chronic obstructive pulmonary disease, is diagnosed with cancer, management of comorbidities is essential to keep patients from costly hospital admissions. “Sometimes these other conditions get overlooked,” said Dr Raulerson. “The role we can play is helping them to continue to manage those conditions, because you don’t want that diabetic to end up in the ER [emergency room] or admitted to the hospital and either delay their cancer therapy or lessen it.”

Worksite pharmacists are able to assist patients with cancer with preventive care and triage, ensuring that high-risk oncology patients receive proper vaccinations. Teaching patients how and when to take their medications increases adherence, resulting in lower morbidity rates.

Onsite pharmacists can help patients deal with adverse events, which are common with cancer drugs, and prevent unnecessary use of healthcare resources.

“The role of the onsite pharmacist is leveraging that patient relationship and helping that patient navigate the complexities of oncology treatment,” Dr Raulerson said.

Florencio Calderon, PharmD, BCPS, Clinical Director, Walgreens, addressed the difficulties employers face in determining how to provide quality cancer treatment for their employees in a cost-effective manner. “I work with our employers in terms of understanding where some of the challenges are, and one of the biggest challenges is oncology,” Dr Calderon said.

According to Dr Calderon, employers must consider the following factors when making employee healthcare decisions:

  • Evidence-based quality care versus avoidable costs can be difficult
  • Transparency of outcomes of employers’ own programs and outcomes available through medical data
  • Site-of-care optimization and medical benefit management: “Site-of-care disparity in terms of cost has a significant impact, not only on the employer, but to the patient, because a lot of the benefit designs have a sharing of the cost”
  • Alignment of incentives and optimizing benefit design
  • Ancillary care access, coordination, and management is critical
  • Create network contracting: “There’s an opportunity to create high-value networks and to have care that exemplifies a best-practice approach.”

Oncology care further complicates employers’ healthcare decisions. In 2013, an estimated 1.6 million new cancer cases were reported in the United States. “When we think about the impact to the workforce, the compelling piece is 10% of healthcare costs are attributed to 1.6% of the impact population,” Dr Calderon said.

The rising incidence of cancer, coupled with an aging workforce population, means that managing this disease will be a growing challenge for employers. “Just as an ability to have benefits to maintain treatment, these employees will remain in the workforce. It becomes important in terms of how we manage these patients,” said Dr Calderon.

Oral oncolytics allow patients to be managed as outpatients. “They give them the flexibility to still have a sense of a ‘normal’ life. I say that in quotes, because these drugs do come with toxicity,” Dr Calderon explained.

Toxicity leads to nonadherence. “If a patient is not adherent, we’re going to have a disastrous outcome in many ways, not just from a patient perspective with their disease, but from a cost perspective as well, because that patient will be hospitalized and will incur higher costs,” Dr Calderon said.

Walgreens Oral Oncology Cycle Management program was created to manage the care of patients taking oral oncolytics. Dr Calderon explained, “This came to fruition because patients are being managed more and more on an outpatient basis, and these drugs have a high toxicity range.” The program was created to enhance patient adherence and to identify opportunities to manage toxicities.

The implementation of this program saved $1374 per patient in reduced waste and hospitalization combined, Dr Calderon said. It also improved the quality of patient care.

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