Medically Integrated Dispensing (MID) in Oncology: Benefits & Impact | AJMC

The landscape of cancer care is evolving, with a growing emphasis on integrated, patient-centered approaches. A key component of this shift is medically integrated dispensing (MID), a model where the prescribing, dispensing, and monitoring of medications all occur within a single healthcare system, rather than relying on external pharmacies. This approach is gaining traction in oncology, offering potential benefits for patients, physicians, and pharmacists alike.

As defined by the Network for Collaborative Oncology Development and Advancement (NCODA), a medically integrated pharmacy is a dispensing pharmacy located within a cancer center of excellence, fostering collaboration among team members and prioritizing patient engagement. This differs significantly from traditional pharmacy dispensing, where medication is obtained separately from the physician’s care team, potentially limiting access to crucial clinical information.

Kenneth Komorny, PharmD, BCPS, of Moffitt Cancer Center, explains that MID streamlines the process and enhances communication. “As defined by NCODA, a medically integrated pharmacy is a dispensing pharmacy that’s located at the Cancer Center of Excellence that involves collaboration with different team members and patient engagement,” he stated. This integration allows for a more comprehensive understanding of a patient’s needs and facilitates more informed treatment decisions.

Benefits Across the Oncology Care Continuum

The advantages of MID extend across the entire oncology care pathway. Data suggest improvements in several key areas, including patient adherence, reduced medication abandonment, faster time to fill prescriptions, increased patient satisfaction, and potential cost savings. These benefits are supported by a growing body of research, including a recent review article published in The American Journal of Managed Care (AJMC) highlighting the positive impact of medically integrated pharmacies.

Recent data from Moffitt Cancer Center, presented at a national conference, further illustrate these benefits. A study involving patients with metastatic prostate cancer compared outcomes for those receiving prescriptions through the center’s medically integrated pharmacy versus those using external, non-affiliated pharmacies – including pharmacy benefit manager (PBM) specialty pharmacies like Onco360 or Biologics. The results were striking.

Patients receiving their medications through the integrated pharmacy experienced a two-fold reduction in prostate-specific antigen (PSA) levels and a 50% lower rate of serious adverse events. Critically, there were zero hospitalizations in the integrated pharmacy group, compared to six hospitalizations in the control group. These hospitalizations were primarily linked to disease progression and blood pressure complications, known side effects of androgen receptor blockers commonly used in prostate cancer treatment.

The economic impact was also significant. The study estimated an $83,000 cost avoidance for patients utilizing the medically integrated pharmacy, demonstrating the potential for MID to not only improve patient outcomes but also reduce overall healthcare expenditures.

How MID Improves Patient Care

The benefits of MID stem from the enhanced coordination and communication it fosters. By having a pharmacy team embedded within the oncology practice, pharmacists can work directly with physicians, advanced practice providers (APPs), and nurses to optimize medication regimens, monitor for adverse effects, and address patient concerns promptly. This collaborative approach ensures that patients receive the most informed and effective treatment possible.

Traditional pharmacy dispensing often creates a fragmented approach to cancer care. Important treatment decisions may be made without a complete picture of the patient’s needs, potentially impacting care and outcomes. The integrated model addresses these challenges by providing a seamless and comprehensive experience, ensuring that oncology patients receive the support they need throughout their treatment journey.

Addressing Challenges and Future Directions

While the benefits of MID are becoming increasingly clear, challenges remain. Startup costs associated with establishing an internal specialty pharmacy can be substantial. Navigating payer barriers and securing reimbursement for dispensed medications can be complex. However, as the healthcare industry continues to move towards value-based care models, the advantages of MID – improved patient outcomes, reduced costs, and enhanced care coordination – are likely to drive further adoption.

The ongoing research and data collection, such as the study conducted at Moffitt Cancer Center, are crucial for demonstrating the value of MID to payers and policymakers. As more evidence emerges, It’s anticipated that MID will become an increasingly integral part of comprehensive cancer care, ultimately benefiting patients and the healthcare system as a whole.

The shift towards medically integrated dispensing represents a significant step forward in oncology care, prioritizing patient-centeredness, collaboration, and value. By bringing pharmacy services directly into the oncology practice, healthcare providers can deliver more streamlined, supportive, and effective treatment, improving outcomes and enhancing the quality of life for individuals facing cancer.