Impact of medically integrated pharmacies on oral anticancer medication prescription abandonment.

Abstract

66 Background: Due to the high cost of oral anticancer medications, financial toxicity may limit patient access to treatment. Abandonment occurs when a patient does not fill a prescription. Higher out of pocket costs have been associated with higher rates of prescription abandonment of treatment across cancers with national abandonment rates typically reported as 18%. An integrated patient assistance process within the care team as occurs in a medically integrated pharmacy is postulated to lower abandonment rates. We measured prescription abandonment rates in the Texas Oncology (TXO) medically integrated pharmacy (MIP). Methods: We reviewed prescription data from the electronic health record (EHR) and our pharmacy dispensing system, for all new oral anticancer medications prescribed from January 2022 to December 2022. Prescriptions that were sent electronically from the EHR but did not have a corresponding dispense in the pharmacy dispensing software were classified as having a barrier to fill. Among the prescriptions that had a barrier to fill, we randomly selected cases for further detailed review to identify cause of barrier. By reviewing the EHR, we also examined whether patients filled any alternate oral or injectable anticancer agent within 60 days due to a formulary block, patient choice or physician choice. Abandonment was defined when patients did not receive their treatment or appropriate alternative treatment within 60 days of the written prescription date. Results: 17,442 prescriptions for oral anticancer medications were prescribed by Texas Oncology physicians. Of those 8460 were filled by the TXO MIP without extensive barriers. 8982 of prescriptions were not filled at our TXO MIP and of those 2895 (32%) prescriptions were further reviewed to determine cause of barrier to fill. 1435 (49.5%) prescriptions had a pharmacy benefit manager (PBM) design that routed the prescription to an external pharmacy and out of the continuity of care of the MIP. 827 (29%) of patients experienced financial toxicity and received free drug assistance with the help of the MIP patient assistance team. 72 (1.3 %) of patients were started on an appropriate alternative therapy with input from the medically integrated care team. 15 patients did not start their oral anticancer treatment which resulted in an abandonment rate of less than 1%. Conclusions: National abandonment is reported as high as 18% largely due to high out of pocket costs. The Texas Oncology MIP has a dedicated patient assistance team. Within the MIP, although 29% of patients had a financial barrier to fill, the prescription abandonment rate was <1%. Oral anticancer medications filled in the MIP led to decreased prescription abandonment due to the integrated patient assistance, pharmacy, and clinical teams. A medically integrated pharmacy should be the preferred approach for specialty cancer medications.