Top Ten Frequently Asked Questions for In-office Dispensing
1.
You can’t make money through in-office dispensing, so why bother?
Realistically, the economics for every practice are very different. Some cities have high costs of labor and some
areas boast expensive office space rental rates. On the other hand, some geographies don’t have these
challenges.
A financial decision around in-office dispensing includes similar metrics, as well as the cost of the drugs, the
pharmacy system, and the reimbursements available. It’s impossible to say you can’t make money without looking
at your specific numbers – just as it’s impossible to say you can.
What you need to do is make the right decision for your practice, and there’s a tool on the Onmark website
designed to allow you to do exactly that. Simply access the In-office
Three Benefits to In-office Dispensing
Dispensing section of the Onmark website for more details.
2.
My state’s regulations probably mean in-office dispensing
is not possible for me
Actually, each state has different rules and regulations for many items,
including in-office dispensing. We understand that you need to make the
right decision for your practice, based on local requirements, as well as
Stark regulations.
What we do know is that most states do allow physician dispensing,
while some even allow practices to create a physician-owned retail
pharmacy. In fact, we’ve encountered only a limited number of locations
where in-office dispensing is completely restricted due to state
regulations. You won’t know what’s best for your setting until you
investigate the details.
3.
None of the payers pay for claims submitted under an inoffice dispensing program
This actually is not the case. Like many high-priced medications, payers
will sometimes require prior authorization requirements to be verified
before they will cover the payment. In others situations, payers may
require a simple explanation and education on in-office dispensing and
how it benefits the patient before approving a claim.
What we discovered when looking at the availability of oral oncolytic and
supportive care medications on a number of national formularies for
well-known pharmacy benefit managers was surprising: the number of
items not covered was quite small.i
4.
Bringing in-office dispensing into your practice is
disruptive and messy
1.
2.
3.
Great for patients – in-office dispensing
provides immediate care and continuity in
an environment patients trust
Patient compliance and adherence –
medication therapy management by the
in-office care team can educate on
potential side effects and mitigate their
magnitude, while an on-site pharmacy
dispensing system can help you
determine which patients need to return
for a refill of their medications
Diversified revenue stream for the
practice – historically, oral chemotherapy
claims were often lost to community
pharmacy
Three Considerations around In-office
Dispensing
1.
2.
3.
State and federal laws – local restrictions
affect physician in-office dispensing,
while Stark regulations should also be
considered
Inventory and technology investments –
while many medications can be provided
on a just-in-time basis, the cost of the
dispensing system and payer contracting
should also factor in your decision
Commitment – as practices have
described to us, it’s easy to do in-office
dispensing well… as long as you have a
committed team executing on a day-today basis
Change can be challenging for any new project and in-office dispensing isn’t any different. The thing to remember
is the oral dispensing process is very similar to what you’re already experiencing with infusion chemotherapy and
can work within the same workflow – therapy is chosen; the patient is counselled; they return to receive their
medications; side effects and compliance are monitored; and the cycle continues.
In fact, customers have openly told us a well-run in-office dispensing program can be implemented using existing
staff and resources. The more important requirement is commitment to make it work, and make it work well.
5.
In-office dispensing is going away
This is unlikely based on the following facts:
• There are more than 50 oral medications used in the treatment of cancerii and the market was estimated
to reach $55 billion by 2009iii
• According to NCCN, about 25% of the near 400 agents currently in the development pipeline are oral
oncolyticsiv
• Several states are moving towards parity for oral and IV oncolytics – some with legislation pending, some
with legislation being drafted - and legislation has been introduced at the federal levelv
• COA (Community Oncology Alliance) also has parity at the top of its agenda when it lobbies on your
behalf in Washingtonvi
• Physicians are expected to provide education and care for patients, yet with payer-specified specialty
pharmacies they may have no influence over whether the patient receives the right dose of medication at
the right time. At the same time, the specialty pharmacy may not be informed of other parenteral
chemotherapy the patient is receiving and is not in a position to monitor the effects of the overall
chemotherapy regimenvii
• As healthcare shifts to a more consumer-driven market, better-educated patients will seek treatment and
advice from those they trust rather than those their insurance may encourage them to patronize. And just
like infusion care, in-office dispensing provides the most effective side effect management and
compliance opportunities for your patientsviii
• In addition, in-office dispensing improves communication for all stakeholders – with providers, patients,
and payers all connecting at the point of careix
6.
Pharmacy dispensing systems are tough to use. It’s not as easy as it sounds
The McKesson Pharmaserv dispensing system is actually very easy to use. It was originally designed for small,
independent pharmacies – those without a large team working behind the counter, and where multi-tasking is a
common occurrence. Pharmaserv runs on Windows and is intuitive and easy to use. In our experience, most
practices are up-and-running and adjudicating claims within the first day of training.
7.
In-office dispensing means a whole new set of payers to call and a new level of administration to
deal with
Actually, in-office dispensing does not mean you will have to deal with a new group of payers, but it does mean
that new pharmacy benefit contracts will need to be executed with the same payers you usually call. Fortunately,
McKesson’s AccessHealth can facilitate this process with minimal additional administration. Through its
experience with small, independent retail pharmacies, AccessHealth is able to provide you access to aggressive
rates with over 9,000 pharmacy benefit plans under a single AccessHealth contract. In addition, AccessHealth
consolidates the reimbursements from each of their plans into a single payment.
8.
It’s very expensive – just look at all the pharmacy hardware you’ll get!
That’s partially true, you do get hardware. But it’s not extraordinarily expensive. The combined monthly costs to
lease a Pharmaserv dispensing system and have AccessHealth consolidate reimbursements for you are a little
over $650. In addition, each adjudicated script costs $0.055. When you consider the opportunity for increased
patient care and a diversified revenue stream, it’s likely the expenses aren’t as high as perceived.
9.
Between the pharmacy system and cabinets for drugs, in-office dispensing takes up a lot of space
Many may think so, but let’s look at the details. You’ve probably already got a workstation in your chemotherapy
mixing area, and the Pharmaserv system can be housed in your existing server room. In addition, you’ll order
your oral oncolytics and supportive medications on an as-needed basis – just like your infusion products. You’ll be
surprised by the limited amount of space you’ll need for an in-office dispensing program. In fact, the additional
inventory may fit in your existing Lynx cabinet!
10.
McKesson’s not interested in growing your practice, just selling you drugs
Actually, McKesson sees in-office dispensing as another opportunity to strengthen your business as well as its
partnerships with its Onmark customers. In fact, each piece of the solution – the Pharmaserv dispensing system,
the AccessHealth payer contracting, the medication therapy management tools and patient education materials,
etc – all come from a McKesson business.
We feel we are demonstrating our breadth of service and commitment to community oncology by providing you
with the tools for a successful in-office dispensing program.
Based on the above, we challenge you to think about in-office dispensing in a different light. We don’t think you
should be asking yourself “can we do in-office dispensing?” but instead “why aren’t we already doing inoffice dispensing?” or perhaps even “how do we start?”
i
Based on a March 2010 analysis of ten commonly-prescribed oral oncolytics and supportive medications and their availability using online formulary tools
provided by Cigna, Medco, Wellpoint, Highmark, Express Scripts Tricare, and Emblem Health.
ii
Kruczynski, Mary. “Community Oncology Alliance: Oral Oncolytics and the In-House Pharmacy.” Presented at the Onmark Leadership Summit, March 5, 2010.
iii
Moseley, Warran. “Dispensing oral medications: why now and how?” Community Oncology, August 2009,
http://www.communityoncology.net/journal/articles/0608358.pdf
iv
Campbell, Maude; et al. “Oral oncology drugs.” Modern Medicine. February 1, 2009.
http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Oral-oncologydrugs/
ArticleStandard/Article/detail/578180?contextCategoryId=40143
v
Barnes, Lauren; et al. “Oral Oncolytics / Addressing the Barriers to Access and Identifying Areas for Engagement.” Avalere, February, 2010.
vi
Kruczynski, Mary. “Community Oncology Alliance: Oral Oncolytics and the In-House Pharmacy.” Presented at the Onmark Leadership Summit, March 5, 2010.
vii
Rough, Steve. “Implications of the Specialty Drug Marketplace for Health-system Pharmacy: A Roundtable Discussion.” American Journal of Health-System
Pharmacy. 2007;64(22):2364-2372.
viii
Barefoot, Jeanette; et al. “Keeping Pace with Oral Chemotherapy.” Oncology Issues, May/June, 2009.
ix
Kruczynski, Mary. “Community Oncology Alliance: Oral Oncolytics and the In-House Pharmacy.” Presented at the Onmark Leadership Summit, March 5, 2010.