Richard Harris, MD
The use of specialty pharmacy in oncology practice has grown, becoming a mainstay for many practices. Historically, that has not been the case for urology practices, but that trend is changing as more urologists see the potential of managing their prostate cancer patients with oral oncolytics, rather than referring them immediately to medical oncologists. There are many processes for a urology practice to consider when partnering with a specialty pharmacy, including time and capital investments. Challenges include prior authorization, storage of medications, adherence, and benefits investigations.
“I think it’s a newer trend in actually a number of clinical specialties and urology would certainly be one of them,” said Richard Demers, RPh, MS, assistant executive hospital director for pharmacy services at the University of Pennsylvania. “The term specialty pharmacy defines a market space of products that have a significant per dose or per month expense associated with them. They also often require prior authorization from payers in order to be covered.”
Eric Sredzinski, PharmD, concurs. “I would say urology and specialty pharmacy are at a crossroads at this point.” With the approvals of medications for advanced prostate cancer, such as abiraterone acetate (Zytiga) or enzalutamide (Xtandi) “we are starting to see more urology practices working with specialty pharmacy,” said Sredzinski, an executive vice president of Clinical Affairs and Quality Assurance for Avella Specialty Pharmacy.
The trend is growing for a number of reasons, including the need for increased patient support from a prior authorization perspective or a narrow distribution network for particular agents. Although abiraterone and enzalutamide have limited distributed, “some agents have closed distribution channels so there are very few people who can purchase those products,” said Demers.
Eric Sredzinski, PharmD
Additionally, “manufacturers have implemented processes to direct these prescriptions through a centralized hub,” said Sredzinski. “In our case, we have a specific team dedicated to urology. We have streamlined the process so that we can work with the office conducting the benefits investigation to determine where the coverage lies for that prescription.”First Steps
When a practice is considering seeking a relationship with a specialty pharmacy, the first step is to understand how the practice is currently configured. Sredzinski says the practice needs to ask how it currently manages their patients and who is involved. Who are the main points of contact within the organization? What outcomes do they want to achieve, and what kind of communication do they want from the specialty pharmacy?
Once those questions are answered, his company “seeks to provide an overlay on what the practice is currently providing and create enhanced services.” The practice manager should understand what the specialty pharmacy is doing during different time points—how the specialty pharmacy is providing counseling, how the information is being provided to patients, and if any issues need to be escalated and addressed by the urologist. Any data or feedback should be provided back to the practice manager, who can then use it to improve patient outcomes.Level of Complexity
Specialty pharmacy also adds a level of complexity to patient care, usually to the patient’s benefit. Specialty pharmacies are particularly adept at dealing with financial issues, exploration and explanation of member benefits, and providing patient support. Also, many specialty pharmacy medications require special storage facilities and processes. Specialty pharmacies can ensure the integrity of the agent through the distribution process, from the manufacturer, to storage, and to final delivery to the patient.
These requirements might be new to the urology practice staffers and the set of activities to handle specialty pharmacy medications could be beyond the scope of the staff’s experience.
“Because of the added activity that needs to occur around these therapies, as far as control and access and patient teaching, finding a good partner on the specialty side is probably very valuable to a urology practice,” said Demers.