Financial impact from in-office dispensing of oral chemotherapy

2018 ◽  
Vol 25 (7) ◽  
pp. 1570-1575 ◽  
Author(s):  
Anna Howard ◽  
Julia Kerr ◽  
Monica McLain ◽  
Jessie Modlin
Keyword(s):  
Wholesale Price ◽  
Cost Savings ◽  
Oral Chemotherapy ◽  
Third Party ◽  
Financial Impact ◽  
Mail Order ◽  
Total Cost ◽  
Cost Avoidance ◽  
Chemotherapy Agents ◽  
Third Party Payers

Background Oral chemotherapy agents are being prescribed more frequently in many cancer types. In-office dispensing of oral chemotherapy agents has demonstrated clinical benefits and also shown financial benefit to third-party payers. A previous publication estimated over $200,000 in cost savings annually from in-office dispensing solely from medications returned to stock for credit. However, pharmacists in the in-office setting perform many other interventions that may affect financial outcomes. Objective Assess financial impact of oral chemotherapy in-office dispensing by a clinic-based oral chemotherapy program serving five outpatient cancer centers in Southern Idaho. Outcomes include calculated monetary waste and cost avoidance of oral chemotherapy prescriptions from in-office dispensing and mail-order pharmacies. Methods Prescriptions received by the clinic-based oral chemotherapy program for filling through in-office dispensing and mail-order pharmacies were monitored for monetary waste and cost avoidance events from December 2016 through May 2017. Information was collected on the number of returned medications, therapy discontinuations, and dose adjustments. Monetary outcomes were calculated using average wholesale price. Results During the six-month evaluation, prescriptions filled through in-office dispensing had a total cost avoidance of $1,020,193 ( n = 154) and total waste of $154,985 ( n = 36) resulting in an estimated net cost avoidance annually of $1,730,416. Prescriptions filled through mail-order had a total cost avoidance of $20,497 ( n = 4) and a total waste of $80,394 ( n = 15) resulting in an estimated $119,794 net annual waste. Conclusions In-office dispensing of oral chemotherapy provided significant cost savings to third-party payers compared to mail-order pharmacy dispensing. Continued evaluation may help further justify the importance and value of in-office dispensing.

Evaluation of the dosing strategies of biologic agents and the theoretical impact of dose rounding

2016 ◽  
Vol 24 (1) ◽  
pp. 47-55
Author(s):  
Savannah Lindsey ◽  
Laura Beth Parsons ◽  
Lindsay Rosenbeck Figg ◽  
Jill Rhodes
Keyword(s):  
Monoclonal Antibody ◽  
Monoclonal Antibodies ◽  
Medical Center ◽  
Academic Medical Center ◽  
Wholesale Price ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Potential Cost ◽  
Cost Avoidance ◽  
The Cost

Introduction Monoclonal antibodies possess unique pharmacokinetic properties that permit flexible dosing. Increased use and high costs of these medications have led to the development of cost-containing strategies. This study aims to quantify the cost savings and clinical impact associated with dose rounding monoclonal antibodies to the nearest vial size. Methods This study was a single-arm, retrospective chart review assessing all monoclonal antibody doses dispensed at an outpatient community infusion center associated with an academic medical center between August 2014 and August 2015. All monoclonal antibody doses were reviewed to determine the cost of drug wasted using two methods. The waste-cost analysis described the amount of drug disposed of due to the use of partial vials. The theoretical dose savings described potential cost avoidance based on rounding the ordered dose to the nearest vial size. The theoretical rounded dose was compared to the actual ordered dose to explore clinical implications. Results A total of 436 doses were included. Of these, 237 were not rounded to the nearest vial size and included in the analysis. The cost of waste associated with these doses was $108,013.64 using actual wholesale price. The potential cost avoidance associated with the theoretical dose calculation was $83,595.53. Rounding these doses to the nearest vial size resulted in a median 6.7% (range, 1.4–20%) deviation from ordered dose. Conclusions Rounding monoclonal antibodies to the nearest vial size could lead to significant cost and waste savings with minimal deviation from the actual ordered dose.

Oral chemotherapy: A focus on interventions and access.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 44-44 ◽  
Author(s):  
Robert Mancini ◽  
David Wilson ◽  
Jessie Modlin ◽  
Dan Sayam Zuckerman ◽  
Colleen Powell ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Wholesale Price ◽  
Free Drug ◽  
Oral Chemotherapy ◽  
Financial Assistance ◽  
Mail Order ◽  
Self Administration ◽  
Time Period ◽  
Oral Agents ◽  
Number Of Cycles

44 Background: Oral chemotherapies are becoming more predominant with 40% of the currently available oral agents being approved in the last 7 years. Patient self-administration and the costs of these medications raise concerns about monitoring and access. As a result, nonfulfillment rates in the literature have been reported to range from 10-24% with rates directly correlated with cost of the medication. Methods: Patients who utilized the pharmacist-managed oral chemotherapy program were included for evaluation. Patients were excluded if they utilized external mail order pharmacies. Patient charts were audited for documented pharmacist-initiated interventions such as drug-interactions, lab monitoring, and dose adjustments. Patient nonfulfillment rates were evaluated by evaluating percentage of patients referred to number of prescriptions filled. Patients were classified as either filled, mail order, financial assistance or never started. Financial assistance patients were divided into free drug or co-pay assistance. Total amount of free drug obtained was assessed by multiplying the average number of cycles obtained by patients by the average wholesale price (AWP). Results: A total of 702 patients were served by the Oral Chemotherapy program between August 2009 and October 2011. In those patients, 82 drug-drug interactions and 24 patients required dose adjustments up front, mostly due to renal dysfunction. Compared to the 10-24% nonfulfillment rates in the literature, this program was able to keep rates less than 1% for patients who were unable to obtain medication for financial reasons. In this time period, underinsured patients were able to obtain >$1 million in free drug and >$200,000 in co-pay assistance funds thanks to our financial advocates. Conclusions: Collaboration within one health system between oncologists, pharmacists, nurses and social workers/financial advocates was able to ensure better quality of care by helping address medication issues upfront with minimal delays in access. In addition, this program was able to ensure that most patients were able to obtain their medication within a reasonable time period at a reasonable cost, reducing non-fulfillment rates compared to what has previously been reported in the literature.

Clinical and economic impact of pharmacist interventions in an ambulatory hematology–oncology department

2020 ◽  
Vol 26 (5) ◽  
pp. 1172-1179
Author(s):  
Jonathan de Grégori ◽  
Pauline Pistre ◽  
Meredith Boutet ◽  
Laura Porcher ◽  
Madeline Devaux ◽  
...  
Keyword(s):  
Chemotherapy Regimen ◽  
Cost Savings ◽  
Clinical Impact ◽  
Financial Impact ◽  
Drug Event ◽  
Full Time ◽  
Cost Avoidance ◽  
Clinical Pharmacists ◽  
Pharmacist Interventions ◽  
The Cost

Objectives To evaluate clinical and financial impact of pharmacist interventions in an ambulatory adult hematology–oncology department. Methods All cancer patients receiving a first injectable immuno- and/or chemotherapy regimen were included in this prospective study over a one-year period. The clinical impact of pharmacist interventions made by two clinical pharmacists was rated using the Clinical Economic and Organizational tool. Financial impact was calculated through cost savings and cost avoidance. Main results: Five hundred and fifty-eight patients were included. A total of 1970 pharmacist interventions were performed corresponding to a mean number of 3.5 pharmacist interventions/patient. The clinical impact of pharmacist interventions was classified as negative, null, minor, moderate, major and lethal in 0, 84 (4%), 1353 (68%), 385 (20%), 148 (8%) and 0 cases, respectively. The overall cost savings were €175,563. One hundred and nine (6%) of all pharmacist interventions concerned immuno- or chemotherapy regimen for cost savings of €148,032 (84% of the total amount of cost savings). The cost avoidance was €390,480. Cost avoidance results were robust to sensitivity analyses with cost of preventable adverse drug event as main driver of the model. When the cost of employing a pharmacist was subtracted from the average yearly cost savings plus cost avoidance per pharmacist, this yielded a net benefit of €223,021. The cost–benefit ratio of the clinical pharmacist was €3.7 for every €1 invested. Principal conclusions: To have two full-time clinical pharmacists in a 55-bed ambulatory adult hematology–oncology department is both clinically and financially beneficial.

scholarly journals Cost Avoidance from Automated Dose Rounding of Biological and Cytotoxic Anticancer Drugs in an Integrated Delivery Network

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 10-11
Author(s):  
Amit Sanyal ◽  
Susan K Woelich ◽  
Matthew Mattila ◽  
Stephanie McCleary ◽  
James Thomas ◽  
...  
Keyword(s):  
Medication Errors ◽  
Cost Savings ◽  
Position Statement ◽  
Total Cost ◽  
Cost Avoidance ◽  
Medicines Use ◽  
The Us ◽  
Calculated Dose ◽  
Integrated Delivery ◽  
The Cost

Background: Projected costs of cancer care are expected to reach $172.8 billion dollars by 2020[1]. Cost of oncology drugs have outpaced other areas[2] with novel drugs priced at a median of $115,981/year between 2009 and 2013[3], making cost control an important priority. Rounding drug doses to the nearest vial size, as long as the difference is smaller than an accepted percentage, has been shown to reduce the cost of care[4]. This also allows workflow efficiency by simplifying compounding and decreasing waste documentation[5] and reduces the potential for medication errors[6]. Dose rounding has been recommended by the Hematology/Oncology Pharmacy Association (HOPA)[5] and the HOPA position paper was endorsed by NCCN[7]. Methods In accordance with HOPA position statement, an integrated community-based healthcare system comprised of 13 providers across 8 infusion centers implemented dose rounding to the nearest vial if within 10% based on actual calculated dose for biological and cytotoxic agents. Performed manually by oncology pharmacists at the time of initial introduction in January 2020, this was transitioned to automated dose rounding by the oncology chemotherapy software (Epic Beacon, Epic Systems, Verona, WI) in June 2020. To facilitate provider adoption and maximize cost-savings, we compiled a list of 31 biological and chemotherapy agents that provided the greatest therapeutic margin and potential for cost savings. Dose rounding parameters for each agent was developed to standardize and facilitate automated dose rounding. Lower and upper bounds were set so that the vial size was within 10% of the actual calculated dose (e.g. doses between 91 mg and 111 mg to a 100 mg vial, Table 1). Cost avoidance was calculated based on the acquisition price of the lowest vial size available and necessary to make the pre-rounded dose. Results Total cost avoidance between January 2020 and July 2020 by dose rounding 31 different chemotherapy and biological agents was $679,780.02. Automated dose rounding drugs introduced in June 2020 high value drugs resulted in cost savings of $ 112,994.12 over a seven week period. Dose rounding of biological drugs accounted for 89.4% of the total cost savings. Rounding of cytotoxic drugs resulted in a cost saving of $71,588.35. Trastuzumab dose rounding was associated with the greatest amount of cost avoidance of $147,194.44, accounting for 21.65% of total cost avoidance. Dose rounding up to the nearest vial ranged between 0.13%-9.75% (median 3.52%). Dose rounding down to the nearest vial ranged between -0.10% -9.93% (median -3.36%). Conclusions: We demonstrate feasibility of implementing an automated EHR based dose rounding protocol in an integrated delivery network, widespread adoption across multiple centers and significant cost avoidance accrued from the intervention. Similar dose rounding protocols should prioritize biologics agents due to their high utilization and costs. References: 1. Mariotto A B, K.Y.R., Shao Y, Feuer E J, Brown M L, Projections of the Cost of Cancer Care in the United States: 2010-2020. Journal of the National Cancer Institute, 2011. 103(2): p. 117-128. W2. Medicines Use and Spending in the US: a Review of 2016 and Outlook to 2021.https://www.iqvia.com/institute/reports/medicines-use-and-spending-in-the-us-a-review-of-2016. 2016, IQVIA. W3. Mailankody S, P.V., Five Years of Cancer Drug Approvals: Innovation, Efficacy, and Costs. JAMA Oncology, 2015. 15(4): p. 539-540. W4. Vandyke TH, A.P., Ballmer CM, Kintzel PE., Cost avoidance from dose rounding biologic and cytotoxic antineoplastics. Journal of oncology pharmacy practice, 2017. 23(5): p. 379-383. W5. Fahrenbruch, R., Kintzel, P., Bott, A. M., Gilmore, S., Markham, R, Dose Rounding of Biologic and Cytotoxic Anticancer Agents: A Position Statement of the Hematology/Oncology Pharmacy Association. Journal of oncology practice, 2018. 14(3): p. e130-e136. W6. Goldspiel, B., Hoffman, J. M., Griffith, N. L., Goodin, S., DeChristoforo, R., Montello, C. M., Chase, J. L., Bartel, S., Patel, J. T, ASHP guidelines on preventing medication errors with chemotherapy and biotherapy. American journal of health-system pharmacy, 2015. 72(8): p. e6-e35. W7. National Comprehensive Cancer Network. NCCN Chemotherapy Order Templates (NCCN Templates®). https://www.nccn.org/professionals/OrderTemplates/PDF/HOPA.pdf. Accessed July 30, 2020. 2020, NCCN: Plymouth Meeting, PA 19462. Disclosures No relevant conflicts of interest to declare.

scholarly journals Financial impact of oral chemotherapy wastage on society and the patient

2018 ◽  
Vol 25 (4) ◽  
pp. 824-830 ◽  
Author(s):  
Varun Monga ◽  
Chenise Meyer ◽  
Brandon Vakiner ◽  
Gerald Clamon
Keyword(s):  
Cancer Progression ◽  
Financial Burden ◽  
Wholesale Price ◽  
Oral Chemotherapy ◽  
Financial Impact ◽  
Insurance Companies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Time Period ◽  
Oral Agents

Background Targeted oral agents are now increasingly being utilized in cancer treatment, but are expensive. Changing the dose of these medications due to toxicity or discontinuation secondary to disease progression or death causes waste from unused medication. Limiting waste is an important goal, as waste has a substantial financial impact on patients and insurance companies. Methods Patients started on oral targeted agents' sunitinib, everolimus, axitinib, or vemurafenib between January 2012 and February 2015 who obtained their medications at Holden Comprehensive Cancer Center specialty pharmacy were included in the analysis. We acquired dispensing data retrospectively for each of the agents and reviewed patient charts. Wasted tablets/capsules were calculated from their last fill to the dates of stoppage or dose adjustment. The amount associated with the wastage was calculated using the average wholesale price. Repository drug usage data during the same time period was obtained. Results Eighty-eight patients had their prescriptions filled at Holden Comprehensive Cancer Center during the study time period. Waste occurred in 41% of all patients with primary reasons attributed to cancer progression in 25 patients, death in five patients, toxicity in five patients and increase in dosage of targeted therapy in two patients. A total of 1179 tablets or capsules were wasted from all causes, priced at a total of $248,595.69. Conclusion Oral chemotherapy medications are associated with wastage, which is a significant financial burden to society. Progression of disease emerged as the single most important factor accounting for wastage. Novel ideas are needed to prevent wastage, thereby reducing healthcare costs.

scholarly journals PCV67 PROJECTED COST SAVINGS TO THIRD PARTY PAYERS FOR THE YEAR FOLLOWING GENERIC SIMVASTATIN AVAILABILITY IN USA

2006 ◽  
Vol 9 (6) ◽  
pp. A357-A358
Author(s):  
PK Gandhi ◽  
WF McGhan ◽  
JJ Spooner ◽  
AM Peterson
Keyword(s):  
Cost Savings ◽  
Third Party ◽  
Third Party Payers

Financial Impact If Payers Use Medicare Rates

2000 ◽  
Vol 93 (3) ◽  
pp. 852-857 ◽  
Author(s):  
Robert E. Johnstone ◽  
Carrie Hosaflook
Keyword(s):  
West Virginia ◽  
Third Parties ◽  
Third Party ◽  
Financial Impact ◽  
West Virginia University ◽  
The West ◽  
University Department ◽  
Third Party Payers

Background In 1992, Medicare changed its method for calculating physician payments. The resulting fee schedules have contained low payments for anesthesiologists. Now, other third-party (insurance) payers are using these schedules. The financial impact on anesthesiologists if all payers pay Medicare rates is unknown. Methods Payments from Medicare were compared with payments from other third parties in each clinical procedural terminology (CPT) grouping used by the West Virginia University Department of Anesthesiology during 1998. Changes in total Department of Anesthesiology receipts were determined if non-Medicare third-party payers paid Medicare rates. Then, the effect of adding payments at Medicare rates from patients without insurance was determined. Finally, potential changes in receipts of the Departments of Anesthesiology, Radiology, Surgery, and Medicine were compared by considering only patients with insurance and recalculating total payments to the departments using Medicare rates. Results Medicare paid less than other third-party payers in every clinical procedural terminology group. Total Department of Anesthesiology payments would decrease by 31% if all non-Medicare third-parties paid Medicare rates. Adding payments at Medicare rates from patients without insurance still leads to a 21% decrease in total Department of Anesthesiology receipts. Considering only patients with third-party coverage, Medicare-rate payments would decrease total Department of Anesthesiology payments by 37%, whereas radiology, surgery, and medicine payments would decrease by 26, 22, and 13% respectively. Conclusions Universal payments at Medicare rates would substantially reduce revenue to anesthesiologists, proportionally more than to radiologists, surgeons, or internists.

Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program

2000 ◽  
Vol 35 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Robert A. Quercia ◽  
Ronald Abrahams ◽  
C. Michael White ◽  
John D'Avella ◽  
Mary Campbell
Keyword(s):  
Cost Savings ◽  
Cost Effective ◽  
Hemodialysis Patients ◽  
Cost Avoidance ◽  
Number Of Patients ◽  
Epoetin Alpha ◽  
Clinical Benefits ◽  
Unit Dose ◽  
One Year ◽  
Alpha Therapy

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was $83,560 and $91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was $191,159 and $203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at $1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.

Supply Chain Coordination for E-Commerce: Risk Penalty vs. Flat Rate

2021 ◽  
Author(s):  
Ju Myung Song ◽  
Yao Zhao
Keyword(s):  
Supply Chain ◽  
Information Asymmetry ◽  
Risk Sharing ◽  
Supply Chain Coordination ◽  
Wholesale Price ◽  
Problem Definition ◽  
Third Party ◽  
Common Belief ◽  
Shipping Industry ◽  
Flat Rate

Problem definition: We study the coordination of an E-commerce supply chain between online sellers and third party shippers to meet random demand surges, induced by, for instance, online shopping holidays. Academic/practical relevance: Motivated by the challenge of meeting the unpredictable demand surges in E-commerce, we study shipping contracts and supply chain coordination between online sellers and third party shippers in a novel model taking into account the unique features of the shipping industry. Methodology: We compare two shipping contracts: the risk penalty (proposed by UPS) and the flat rate (used by FedEx), and analyze their impact on the seller, the shipper, and the supply chain. Results: Under information symmetry, the sophisticated risk penalty contract is no better than the simple flat rate contract for the shipper, against common belief. Although both the risk penalty and the flat rate can coordinate the supply chain, the risk penalty does so only if the shipper makes zero profit, but the flat rate can provide a positive profit for both. These results represent a new form of double marginalization and risk-sharing, in sharp contrast to the well-known literature on the classic supplier-retailer supply chain, where risk-sharing contracts (similar to the risk penalty) can bring benefits to all parties, but the single wholesale price contract (similar to the flat rate) can achieve supply chain coordination only when the supplier makes zero profit. We also find that only the online seller, but not the shipper, has the motivation to vertically integrate the seller-shipper supply chain. Under information asymmetry, however, the risk penalty brings more benefit to the shipper than the flat rate, but hurts the seller and the supply chain. Managerial implications: Our results imply that information plays an important role in the shipper’s choices of shipping contracts. Under information symmetry, the risk penalty is unnecessarily complex because the simple flat rate is as good as the risk penalty for the shipper; moreover, it is better for the seller-shipper coordination. However, under information asymmetry, the shipper faces additional shipping risk that can be offset by the extra flexibility of the risk penalty. Our study also explains and supports the recent practice of online sellers (e.g., Amazon.com and JD.com), but not shippers, to vertically integrate the supply chain by consistently expanding their shipping capabilities.

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