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- Title
Cancer Treatment Before and After Physician-Pharmacy Integration.
- Authors
Kanter, Genevieve P.; Ozluk, Pelin; Chi, Winnie; Fisch, Michael J.; Debono, David; Parikh, Ravi B.; Jacobson, Mireille; Bekelman, Justin E.; DeVries, Andrea
- Abstract
This cohort study examines the implications of physician-pharmacy integration for the use of, cost of, and adherence to anticancer drugs among patients with late-stage cancer. Key Points: Question: How does physician-pharmacy integration change oral oncology drug expenditures, use, and patient-centered measures? Findings: In this cohort study of 3159 community oncologists of pharmacy-integrating physicians and nonintegrating physicians, there was a slight increase in use but no significant change in oral oncology drug expenditures after integration. Physician-pharmacy integration was associated with no discernible benefits for patients in out-of-pocket expenditures, medication adherence, or time to treatment initiation. Meaning: Findings of this study suggest that physician-pharmacy integration is not associated with change in the care of patients with cancer. Importance: Integration of pharmacies with physician practices, also known as medically integrated dispensing, is increasing in oncology. However, little is known about how this integration affects drug use, expenditures, medication adherence, or time to treatment initiation. Objective: To examine the association of physician-pharmacy integration with oral oncology drug expenditures, use, and patient-centered measures. Design, Setting, and Participants: This cohort study used claims data from a large commercial insurer in the US to analyze changes in outcome measures among patients treated by pharmacy-integrating vs nonintegrating community oncologists in 14 states between January 1, 2011, and December 31, 2019. Commercially insured patients were aged 18 to 64 years with 1 of the following advanced-stage diagnoses: breast cancer, colorectal cancer, kidney cancer, lung cancer, melanoma, or prostate cancer. Data analysis was conducted from May 2023 to March 2024. Exposure: Treatment by a pharmacy-integrating oncologist, ascertained by the presence of an on-site pharmacy or nonpharmacy dispensing site. Main Outcomes and Measures: Oral, intravenous (IV), total, and out-of-pocket drug expenditures for a 6-month episode of care; share of patients prescribed oral drugs; days' supply of oral drugs; medication adherence measured by proportion of days covered; and time to treatment initiation. The association between an oncologist's pharmacy integration and each outcome of interest was estimated using the difference-in-differences estimator. Results: Between 2012 and 2019, 3159 oncologists (745 females [27.1%], 2002 males [72.9%]) treated 23 968 patients (66.4% female; 53.4% aged 55-64 years). Of the 3159 oncologists, 578 (18.3%) worked in practices that integrated with pharmacies (with a low rate in 2011 of 0% and a high rate in 2019 of 31.5%). In the full sample (including all cancer sites), after physician-pharmacy integration, no significant changes were found in oral drug expenditures, IV drug expenditures, or total drug expenditures. There was, however, an increase in days' supply of oral drugs (5.96 days; 95% CI, 0.64-11.28 days; P =.001). There were no significant changes in out-of-pocket expenditures, medication adherence, or time to treatment initiation of oral drugs. In the breast cancer sample, there was an increase in oral drug expenditures ($244; 95% CI, $41-$446; P =.02) and a decrease in IV drug expenditures (–$4187; 95% CI, –$8293 to –$80; P =.05). Conclusions and Relevance: Results of this cohort study indicated that the integration of oncology practices with pharmacies was not associated with significant changes in expenditures or clear patient-centered benefits.
- Subjects
UNITED States; PATIENT compliance; INTERPROFESSIONAL relations; HEALTH insurance reimbursement; RESEARCH funding; ANTINEOPLASTIC agents; CANCER patient medical care; ORAL drug administration; EVALUATION of medical care; DESCRIPTIVE statistics; RETROSPECTIVE studies; PATIENT-centered care; LONGITUDINAL method; TUMORS; ONCOLOGISTS; DRUGS; CONFIDENCE intervals; FACTOR analysis; DATA analysis software; HOSPITAL pharmacies; INTEGRATED health care delivery; MEDICAL care costs; INSURANCE companies; DRUG utilization; MEDICAL practice; EVALUATION
- Publication
JAMA Network Open, 2024, Vol 7, Issue 5, pe2412998
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.12998