Medically integrated dispensing (MID) clinical and cost outcomes compared to specialty pharmacies (SP).

Abstract

e18645 Background: Oral oncolytics MID offers potential care and cost advantages compared to a centralized SP model. A pharmacy benefit manger and 3 health plans created a pilot program to enable and encourage oncology practice MID with the goal of improving care, enhancing the provider and patient experience, and reducing drug waste. This study assesses clinical outcomes and drug waste differences between MID and central SP dispensing using real-world pharmacy claims data. Methods: The MID pilot program was implemented early 2021 within 3 oncology practices across 3 plans commercially insured lives. Members were required to have continuous enrollment for the adherence and discontinuation (d/c) measures. Adherence was measured using the CMS industry standard proportion of days covered with a > / = 80% cut point. D/c was measured in new initiators defined as no claim evidence of the drug in the previous 90 days with discontinuation defined as having a > / = 45-day therapy gap within the first 180 days. Dose changes were defined as a new unit strength being dispensed for a previously filled drug. Each measure used a unique drug list: 3 CDK4/6i for adherence; 10 highly utilized oral brand and generic oncolytics for d/c; and 26 oral oncology brand drugs having multiple strengths and labeled dose change directions for dose change waste. The adherence and waste measures assessment end date was Dec 31, 2021 and for d/c was Jan 28, 2022. Statistical testing: adherence- Fischer’s exact test; d/c- chi-square; and waste– t-test. Results: For adherence, individuals were followed for an average of 243 days, range 21-333 days, without a statistical difference between MID and SP follow-up. CDK4/6i adherence was 82% (9 of 11) for MID and 73% (421 of 574) for SP, p = 0.74. D/C was 29% (15 of 52) for MID and 48% (360 of 753) for SP, p = 0.01. Waste occurred in 29% (6 of 21) of MID dose changes and 50% (315 of 627) of SP dose changes, p = 0.05; resulting in an average cost of $937 and $2,733 per dose change at the MID and SP, respectively, for an SP average dose change additional cost of $1,796. Conclusions: MID demonstrated numerically higher adherence, significantly lower d/c rate with MID having a number need to treat of 5 to prevent one less d/c event, and significantly lower waste expense with an estimated savings of $1.1 million, if all 627 individuals with a dose change at SP had used a MID. These real-world findings have resulted in a national PBM network to encourage MID use.