Panel Discussion: Orals Adherence & Challenges Friday, April 28 th, 2017
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1 Panel Discussion: Orals Adherence & Challenges Friday, April 28 th, Community Oncology Alliance
2 Panel Discussion: Orals Adherence & Challenges Ray Bailey, RPh, Director of Pharmacy Florida Cancer Specialists Stacey McCullough, PharmD, Senior Vice President Pharmacy Tennessee Oncology Todd Murphree, PharmD, Ambulatory Pharmacy Manager, Clearview Cancer Center 2017 Community Oncology Alliance
3 Ray Bailey, RPh Director of Pharmacy 2017 Co mmunity Oncology Alliance 3
4 RX to GO Centralized Specialty Oncology Pharmacy Florida Cancer Specialists Centralized Call Center providing HUB services for all oral oncology drugs. Including Financial Assistance and Prior Authorizations. State of the Art Specialty Pharmacy with automation technologies. Licensed in over 40 States. Dual Specialty Pharmacy Accreditation including Oncology Distinction Proprietary oral adherence IT platform called ORCA with pharmacy and practice designed oral chemotherapy care plans. Access to over 99% of all oral oncology drugs on the market Practice based model with access to EMR giving Pharmacist real time access to patients medical records
5 Oncology Resource Compliance Application
6 Scheduler Layout
7 Pharmacist Layout Cabozantinib Rph Follow up
8 Patient Profile Palbociclib Oral Capsule 125mg PO Palbociclib Oral Capsule 125mg PO Imatinib Oral Tablet 100 MG 20 mg PO 12 Time a Week
9 HIPAA Verification
10 Initial Tech Form- New To Medication
11 RPH Initial Counseling
12 Drug Characteristics Palbociclib Palbociclib Palbociclib Palbociclib Palbociclib Palbociclib Palbociclib
13 Refill Assessment Form
14 Discharge Summary
15 Medication Weekly Follow Up Form Cabozantinib Cabozantinib Cabozantinib Cabozantinib
16 Labs Follow Up Form
17 RPH Intervention Follow Up Form
18 Stacey McCullough, PharmD Senior Vice President Pharmacy 2017 Co mmunity Oncology Alliance 18
19 Centralized comprehensive pharmacy services for 30 sites of care URAC and ACHC Specialty Pharmacy Accredited Utilize Commercially available MTM program PharmD scheduled new patient teachings 2 FTE (Certified Pharmacy Techs) for MTM follow-up and refill calls 2017 Community Oncology Alliance
20 New Patient Care Plan 2017 Community Oncology Alliance
21 New Patient Teaching Primarily Telephonic Interactions Patient Assessment Self-sufficient vs care taker Medication Reconciliation Non-adherence risks Medication Prescribed Dosing Complexity (daily routine) Food Requirements Drug Interactions Side Effects: expectation, preparedness and management 2017 Community Oncology Alliance
22 Teaching Resources Manufacturer Starter Kits Patient Education Sheets 2017 Co mmunity Oncology Alliance 22
23 Adherence Activity and Tracking
24 Adherence Activity and Tracking 2017 Community Oncology Alliance
25 Adherence Activity Coordinate call with scheduled MD visit per EMR (OCM opportunity also) General Assessment of tolerability Specific Pill count Schedule Refill Delivery 2017 Co mmunity Oncology Alliance 25
26 Coordination of Care Initial medication teaching points documented in EMR Medication delivery date notated in EMR Patient Triage for intolerability /side effect management Lost to follow up and non-adherence communication 2017 Co mmunity Oncology Alliance 26
27 Todd Murphree, PharmD Ambulatory Pharmacy Manager 2017 Co mmunity Oncology Alliance 27
28 CCI PHARMACY v Licensed retail pharmacy inside community oncology clinic 13 physicians, 3 locations serving oncology patients in North Alabama 150 Rx s/day 20% specialty prescriptions v Staff Pharmacy Manager One full time staff pharmacist - shares time between IV pharmacy and dispensing pharmacy (27 hours) o Recently added 10 pharmacist budget hours 2 PRN pharmacists (1-2 shifts per month) 3 full time technicians 3 cross-trained technicians 7 Social Workers 1.5 oral PA coordinators 2 PAP program coordinators 2017 Co mmunity Oncology Alliance 28
29 Adherence Workflow v New Rx received v Rx reviewed Weight, BSA, labs, etc. Dosing v Benefit verification v PA v Copay assistance v Pharmacist Counseling v Patient added to TherigySTM Interface with PioneerRx Document new start counseling Mark complete and refill assessment scheduled 2017 Co mmunity O ncology Alliance 29
30 Adherence workflow cont d v Pharmacist works refill assessments assigned daily v Review all pertinent information in EMR: Labs Physician visit notes Nurse calls Social work notes Hospital admissions Scheduler v Contacts patient if due for refill Adverse event monitoring Adherence assessment v Schedules refill around appointment date if appropriate v Coordinates with clinical staff if adherence or adverse effect follow up needed Lenalidomide Lenalidomide Lenalidomide 2017 Co mmunity Oncology Alliance 30
31 Challenges to Adherence Program vlack of interfacing between systems (EMR, dispensing software, adherence platform) leads to: Fragmented workflow Increased burden on pharmacy staff Decreased efficiency of communication among clinical staff vdecreased access to our patients Non-profit foundations closing PBM mandates to fill at PBM-owned specialty pharmacies 2017 Co mmunity Oncology Alliance 31
32 Challenges to Adherence Program (cont d) vpatient dependent factors Voluntary non-adherence Adverse effects Don t want to take medication Don t think drug is working v Involuntary non-adherence Forgetting to take dose Cost issues Complex regimens o IV/oral combination regimens o Complex schedules lenalidomide, palbociclib, trifluridine/tipiracil, sunitinib malate Albrecht PharmD, MSLIS, S. (n.d.). The Pharmacist s Role in Medication Adherence. US Pharm. 2011;36(5): Retrieved March 23, 2017, from Co mmunity Oncology Alliance 32
33 QUESTIONS
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