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Oncology Pharmacy

As oncology engages in value-based reimbursement, new payment models, and precision medicine, oncology pharmacists and pharmacy staff are integral to successful delivery of quality, cost-effective patient care.

The challenges are ongoing: increasing complexity of treatment regimens, new drug approvals and indications, the expansion of biosimilars in oncology, rapid advances in immunotherapy, the high cost of cancer treatment, and continual regulatory and reimbursement changes. 

The ACCC Oncology Pharmacy Education Network (OPEN) brings together education, resources, and peer-to-peer networking to help pharmacy professionals surmount the challenges and succeed.  OPEN offers the knowledge and know-how to navigate the accelerating course of change in oncology—clinically, operationally, fiscally, and programmatically. From USP <800> to integration of biosimilars, from preauthorizations to strategic planning—OPEN addresses real-world oncology pharmacy management issues such as reimbursement, distribution, inventory management, and effective integration of oral oncolytics, biosimilars, and immunotherapies for cancer.


Podcast

  • [PODCAST] Episode 7: The Evolution of Oncology Pharmacy
    Oct 29, 2019
    Learn more about the role that oncology pharmacists play in cancer care and how that role is changing in the face of new therapies and the advent of value-based health. Discover how UNC Hospital's Department of Pharmacy avoids passing surprise bills to patients and ensures financial stability for their cancer program.

From Oncology Issues

  •  The Oncology Pharmacy Navigator
    Rice K, et al.
    Patients with cancer experience a variety of difficulties in accessing and managing their medications. The Legacy Health Cancer Institute established an oncology pharmacy navigator to decrease barriers to patient access, reconcile medication lists, and alleviate the financial burden of cancer care.
  •  Implementation of Drug Vial Optimization to Reduce Drug Waste
    Amerine LB, et al.
    In the Department of Pharmacy at the University of North Carolina North Carolina Cancer Hospital, discarding partial drug vials was a significant source of waste. With their Innovator Award–winning drug vial optimization program, the program maximized the lifespan of drugs within single-dose vials and realized an annual cost savings of more than $40 million.
  •  Immuno-Oncology: Breaking Barriers, Exploring Solutions, Improving Patient Care
    The ACCC Immuno-Oncology Institute developed a multidisciplinary curriculum workshop bringing together faculty experienced in delivery of immunotherapy with cancer program staff in the earlier stages of IO integration. Over the past two years, these IO Visiting Experts Programs were hosted by ACCC Cancer Program Members nation-wide.
  •  Back to CAP?
    Secretary Alex Azar has expressed strong interest in revitalizing Medicare’s Competitive Acquisition Program (CAP) and introducing negotiation into Part B drug pricing.
  •  Drug-Specific Videos for Patient Chemotherapy Education
    Weese JL, et al.
    Long, written descriptions of chemotherapy and its side effects, particularly when prescribing multiple drugs, are often ignored by patients who are overwhelmed by their cancer diagnosis and treatment. From the perspective of the patients, it was clear that all patients needed basic information regarding chemotherapy, including how to react to different situations while on chemotherapy and specifics about the drugs they were going to receive.
 

Additional Resources

Infusion

Patient-Centered Scheduling: Costs & Benefits of Extending Practice Hours

This special report from ACCC examines the pros and cons of extended infusion suite hours. Included is a tool to help practices and programs assess the feasibility of extending hours of care.

Oral Chemotherapy

Dispensing Pharmacy Patient Education Tool

Physician dispensing is governed by state law and regulated by State Boards of Pharmacy. While some states do not allow physician dispensing, most of the states that allow it require dispensing physicians to alert their patients about other options to fill their prescription(s). In response to this need, ACCC has developed this patient education tool that can be used across care settings.

News Coverage

ACCC Marks 15th Anniversary of Oncology Pharmacy Education Network; Honors Founding Leaders

Listen to ACCC President Ali McBride discuss ACCC's educational opportunities, from NSCLC to multiple myeloma to CLL:

 

Accelerating Biosimilar Uptake in the US Market: Barriers and Solutions

 

Oncology Drug Database

Access ACCC's comprehensive resource for coding, billing, and reimbursement for oncology drugs.
Access the Database

ACCCBuzz Blog Posts

Long-Awaited, Much-Debated: Proposed OPPS & PFS Rules


August 09, 2019
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At the end of last month, the Centers for Medicare & Medicaid Services (CMS) released the much-anticipated calendar year (CY) 2020 Medicare Payment rules.

Touted by CMS as an effort to “empower patients with price transparency and increase competition to lower costs for Medicare beneficiaries,” the proposed Outpatient Prospective Payment System (OPPS) rule for 2020 introduces new price transparency requirements for hospitals, while continuing the agency’s focus on site neutrality, curbing 340B costs, biosimilars, and bundling.

The CY 2020 Physician Fee Schedule (PFS) proposed rule aims to align with the agency’s Patients Over Paperwork initiative with measures to reduce providers' paperwork burden, remove unnecessary reporting measures, and reward clinicians for time spent with patients.  

The price transparency details included within the OPPS and PFS proposed rules for CY 2020 are a direct follow-up to an Executive Order from President Trump and his administration’s promise to infuse pricing transparency into the drug pricing reform conversation. The Executive Order released earlier this summer required follow-up within 60 days from the Department of Health and Human Services (HHS) on the feasibility of this proposal, and these proposed rules serve to satisfy that requirement. The oncology community is eager to continue the drug pricing reform conversation from both a legislative and regulatory perspective, and we want to ensure the complexity and cost of cancer care is seen in these proposals.

Read on for a summary of ACCC’s top-line takeaways for cancer programs and practices from the CY 2020 proposed rules.

Proposed CY 2020 Hospital Outpatient Prospective Payment System:

340B Program
CMS proposes to continue to pay an adjusted amount of the average sales price (ASP) minus 22.5 percent for certain separately payable drugs or biologicals that are acquired through the 340B program. The proposed rule, as is, makes no changes to the covered entities this policy applies to.

CMS acknowledges the ongoing litagation regarding the 340B payment adjustment and solicits comment on alternative payment options for CY 2020 and potential remedies for CY 2018 and CY 2019 payments.

Price Transparency
CMS proposes to require hospitals and insurers to publicly post standard charge information and negotiated rates for a limited set of services in an “easy-to-understand, consumer-friendly, and machine-readable format.” The agency proposes to select 70 shoppable services and require hospitals to select at least an additional 230, for a minimum total of 300. CMS proposes to impose penalties on hospitals of $300 per day for noncompliance.

Biosimilars
For 2020, CMS proposes to continue the current policy to make all biosimilars eligible for pass-through payment and not just the first biosimilar biological product for a reference product.

CMS proposes to continue to pay non-pass-through biosimilars acquired under the 340B program at the ASP minus 22.5 percent of the biosimilar’s own ASP rather than the ASP minus 22.5 percent of the reference product’s ASP.

Site Neutrality
As finalized in the CY 2019 rule, for CY 2020, CMS proposes to complete the two-year phase-in of the reduction in payment for clinic visit services furnished in excepted off-campus, provider-based departments. CMS proposes to pay these departments the site-specific PFS rate for the clinic visit service.

Proposed CY 2020 Physician Fee Schedule:

CMS proposes codes for telehealth services covering bundled episode of care for the treatment of opioid disorders.

CMS backed away from proposed Evaluation and Management (E/M) code consolidation for level 2 through level 5 visits put forth in the CY 2019 PFS. Based upon the proposed 2020 rule, we expect to see continued review of E/M codes within the 2021 rule-making cycle. Due to the complexity of oncology care and reliance on level 4 and 5 visits for many patients, the cancer care community applauds CMS for rethinking the finalization of this proposal.

CMS proposes increased payment for care management services.

CMS proposes updates for year three of the Quality Payment Program (QPP), including a proposed new Merit-based Incentive Payment System (MIPS) improvement activity on drug cost transparency and a new way for clinicians to participate in MIPS under the “MIPS Value Pathways” (MVPs).

The CY 2020 OPPS proposed rule was published in the Federal Register on Aug. 8; the proposed CY 2020 PFS is scheduled for publication in the Federal Register on Aug. 14.  

The deadline for submitting comments is 5:00 pm on September 27, 2019. CMS will issue a final rule in November 2019.

ACCC's policy team continues to analyze the impact of these proposals on oncology and will provide in-depth information to members in an upcoming webinar. Stay tuned!
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Access CMS’s press release and fact sheet on the proposed 2020 OPPS rule; CMS’s press release and fact sheet on the proposed 2020 PFS and QPP rule; and CMS’s fact sheet on the proposed 2020 QPP rule.