Making the Case for Medically Integrated Dispensing

Barry Fortner, PhD
Published: Friday, Nov 23, 2018
Barry Fortner, PhD

Barry Fortner, PhD
Today, 35% of oncology drugs in the pipeline are oral, according to a recent report by the Community Oncology Alliance (COA). With the rise of oral oncolytic prescribing and development, more oncology practices are implementing in-office dispensing programs to provide a seamless treatment experience for patients. The terminology for this practice is now commonly referred to as medically integrated dispensing, which more accurately reflects the level of clinically coordinated care that patients can expect from their community physicians.

While medically integrated dispensing has many benefits for community practices, challenges do exist.


Keeping prescriptions within the practice can be an uphill battle. Pharmacy benefit manager (PBM) formularies and preferred network frameworks often prohibit or limit dispensing by oncology practices. This can interfere with the start of therapy and its continuity. An oncology practice’s familiarity with patient medical histories and preauthorization needs can help accelerate access to medication.

Direct and indirect remuneration (DIR) fees are what a dispenser pays to a Medicare Part D sponsor or its PBM, and these can add up to an impediment to the success of an in-office dispensing program. DIR fees were initially established to account for all costs associated with prescription medications, including manufacturer rebates and other price concessions. Today, however, DIR fees can include “clawback” fees, which are assessed well after the point of sale and can hit a community practice’s bottom line hard. This constitutes another hurdle for community practices trying to establish in-office dispensing programs. With current DIR fees, oncologists may not know if they’ll be fairly paid for the therapies they dispense. Such financial risk can hold practices back from developing medically integrated dispensing programs. Much work still needs to be done, particularly on Capitol Hill, in communicating how these fees ultimately affect the patients.


Oncologists should consider evaluating a variety of partners, from technology companies and consultants to group purchasing organizations, to determine who can connect them with the resources they need for successful in-practice dispensing. With advanced analytics that leverage electronic medical records and patient portal data, community oncologists will have the information they need to gauge practice performance and optimize patient care. These data can be packaged to show manufacturers and payers the benefit of including dispensing practices as a channel for product access.
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