Medically Integrated Dispensing Helps Prevent Oncology Care Fragmentation: Katherine Tobon, PharmD, BCOP

Medically integrated dispensing (MID) helps prevent care fragmentation that can lead to poor patient outcomes, Katherine Tobon, PharmD, BCOP, of Moffitt Cancer Center, told The American Journal of Managed Care® last month at an Institute for Value-Based Medicine® event in Tampa, Florida. Tobon served as a panelist during the discussion, “Pharmacy at the Helm: Medically Integrated Dispensing in Oncology.”

Watch part 1 to learn more about MID, including its advantages and drawbacks.

This transcript was lightly edited; captions were auto-generated.

Transcript

What are the key operational components of a successful MID program? What challenges most commonly arise during implementation, and what is required for long-term sustainability?

I feel really strongly that a really strong, embedded clinical pharmacy team is imperative for this model. It allows an additional layer of monitoring as well as education for the patients. Now, in addition, there are other staff who are needed. We need a good, robust specialty pharmacy, as well as, a lot of times, specialized nurses to help follow up on these, and potentially financial experts, as well.

A well-built EMR [electronic medical record] is really imperative, one, for documentation, as well as following the patients, as well as in the payer models, in terms of finances, making sure that things are able to get approved. Then, there are a lot of specifics around the regulatory standpoint. The specialty pharmacies need to get additional accreditation, like URAC accreditation, as well as other complex regulatory monitoring.

The challenges that can typically arise with integrating and really starting up these MIDs, or medically integrated dispensing, are when we know it's a high cost upfront. So, it's a high cost to get the pharmacy going, and it’s a high cost to get the staff implemented and trained. It's also a high cost for the specific accreditation, especially URAC accreditation.

Now, for long-term sustainability, you need to make sure you have strong staff to keep the patients, as well as have a good payer model, and just think ahead of how you can continue to build your teams.

Is MID well-positioned to support value-based oncology care models today? Why or why not?

Yes, absolutely. So, these medically integrated dispensing are very well positioned to support our value-based oncology care models. It's allowing for closer follow-up and monitoring of our patients. The provider is able to send the prescription and have that conversation with the clinical pharmacist as well as the nurse, and we're able to follow up on it in real time, as well as ensure that we are overcoming any payer hurdles and making sure the patient has access to the medication, as well as ensuring long-term follow-up. We do know that fragmentation of care leads to poor outcomes, so the MIDs really prevent that from happening.

Looking ahead, as cancer care becomes increasingly outpatient and personalized, how do you see the role of oncology pharmacy evolving?

I truly believe that the complexity of care for oncology patients is going to continue to grow. The regimens will be more complex, the patients will be more complex, as well as the treatments: the combinations of oral and IV [intravenous], or a combination of multiple oral medications.

Really, what we need is the clinical pharmacist to continue to be involved from the beginning, to be able to provide the education, to be able to help tease out the best treatment regimen with the providers, and to help prevent any delays in access. I see oncology pharmacists continuing to have more involvement in toxicity management for these patients long-term, as well, to make sure that we are able to keep these patients on these life-saving medications.