(420) The value of medical and pharmacy integration in managing oral oncologic medications

Background: : Medically integrated pharmacies, also known as medically integrated dispensing (MID) care models, are dispensing pharmacies that use a patient-centered and multidisciplinary team approach to provide medications, often in oncology practices. The integration of prescriptions through an onsite physician dispensing practice allows the dispensing team to have a comprehensive understanding of the patient's health record, which facilitates follow-up care. MID systems have demonstrated the potential to transform oncology practices by creating a more comprehensive care model, reducing waste, saving costs, and improving clinical outcomes.

Objective: : To expand on previous analysis by measuring adherence to orally administered oncolytic medications in two cancer types at multiple oncology practices.

Methods: : This was a retrospective study of adult patients treated with Xtandi® (enzalutamide) for prostate cancer and Imbruvica® (ibrutinib) for chronic lymphocytic leukemia from July 1, 2016 – July 30, 2022. Oncology care model pharmacy claims data were obtained from three US-based practice sites and merged with Medicare oral dispensing data. The study groups were MID, comprising patients who filled all their prescriptions at MID pharmacies, and non-MID, consisting of patients who filled prescriptions on- and off-site. Therapy adherence for each medication was measured by calculating the medication possession ratio (MPR) for patients in the MID and non-MID groups who had >1 prescription. The numerator was capped at the number of days in the follow up period, since MPR is overinflated if patients obtain early refills. The standardized mean difference (SMD) of the adjusted MPR was used to quantify the difference between the groups. A value ≥20% was considered meaningful.

Results: : A total of 133 patients were included; the number of MID and non-MID patients for each medication were enzalutamide (36:10) and ibrutinib (58:15). The mean age (SD) for enzalutamide patients was 76 (8) years and 77 (9) years for ibrutinib patients. For the MID subgroups, the MPR for patients receiving enzalutamide was 0.83 and 0.75 for patients receiving ibrutinib. The SMD between the MID and non-MID subgroups (n=119) was 48.1% for enzalutamide and 40.3% for ibrutinib.

Conclusions: : Oral oncolytic therapy adherence was meaningfully higher in the MID group vs the non-MID for the two medications. These findings support the potential benefits of MID care models in oncology; further analysis of impact of MID on total cost of care is ongoing.

Sponsorship:: Cencora