Can a medically integrated oncology pharmacy decrease waste and avoidance?

Abstract

e23207 Background: Oral oncolytic medications cost thousands of dollars each month to the cancer patient. The median cost of waste from dose reduction, discontinuation due to progressive disease, and medication being held due to side effects is estimated to be an average waste of $4290 per patient (Lam et al., 2023). Additionally, The National Institutes of Health reported in 2012 that $418 billion is wasted due to suboptimal use of medications in the US (Alhomoud, 2020). On average, the monthly cost of one oral oncolytic prescription is $10,000-$25,000. This financial distress can be devastating to cancer patients emotionally and physically, significantly affecting their quality of life. Financial toxicity may cause cancer patients not to fill necessary oncolytic prescriptions, skip medication doses, or take less medication than the prescribed amount. AON Pharmacy sought to measure the value of oncology-trained nurses in a medically integrated pharmacy to continue the cancer care continuum, maximize cost avoidance, and reduce the waste of oral oncolytic medication. Methods: This study evaluated whether having oncology-trained nurses review electronic medical records before a refill of an oral oncolytic medication would decrease waste and increase cost avoidance to patients and payors. During a chart review done by an oncology nurse, if a discrepancy were found with the patient’s EMR, such as laboratory abnormalities, scans showing progressive disease, or unmanaged side effects, the nurse would triage the doctor's office via the EMR before medication was dispensed. If the doctor ordered the medication to be placed on hold or discontinued, waste and cost avoidance were tracked using the National Community Oncology Dispensing Association waste tracker. Results: Data was collected from February 2023 to December 2023. Data points included 157 nursing interventions. These interventions included six interventions for progressive disease, eight interventions for therapy change, 134 interventions for treatment held, three for dose change, five for deceased patients, and one for others. Commercial insurance payors had 17 interventions, Medicaid had eight interventions, Medicare had 129, and Patient Assistance Programs had three interventions. This resulted in $1,994,629.88 saved in waste and cost avoidance to patients receiving oral oncolytic medications for 2023. Conclusions: Using oncology-trained nurses to help patients through the cancer care continuum, improve clinical outcomes, and promote cost avoidance and waste reduction of oral oncology medications proved to be highly effective in avoiding waste and decreasing the daily financial toxicity cancer patients feel. AON Pharmacy is committed to using oncology nurses to review EMRs in 2024 to decrease waste and avoidance. 2024’s goal is to reduce waste and avoidance by over 2 million.