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. While offering numerous potential benefits, MID also presents challenges for implementation and widespread adoption.
What is Medically Integrated Dispensing?
Traditionally, cancer patients receive prescriptions from their oncologist and then fill them at an outside pharmacy. Medically integrated dispensing streamlines this process by bringing the pharmacy function within the oncology care setting. As Katherine Tobon, PharmD, BCOP, of Moffitt Cancer Center, explains, “Medically integrated dispensing is a care model in which the prescribing, the dispensing, as well as the monitoring all take place in 1 health care system rather than being dispersed to outside pharmacies.” This involves an internal specialty pharmacy, a dedicated team, and a clinical team working collaboratively to manage a patient’s medication journey.
Benefits for Patients and Providers
The advantages of MID are multifaceted. A primary benefit is faster treatment initiation. By eliminating the step of an external pharmacy, patients can begin their regimens more quickly, potentially improving outcomes. Perhaps even more importantly, MID enhances safety and monitoring. Because all information – prescriptions, dispensing records, and patient monitoring data – resides within the same electronic medical record (EMR), healthcare providers have a more complete and accurate picture of the patient’s condition. This is particularly crucial for complex cancer treatments.
Tobon highlights this improved safety, stating that MID “leads to faster treatment initiation for patients and improves safety and monitoring because that safety and monitoring are all happening within the same EMR; we’re not missing any information.” The model also fosters a more cohesive patient experience. Patients work directly with their oncology team and an integrated pharmacy team, creating a sense of continuity and support. MID aligns well with the growing trend toward value-based and risk-based payment models in healthcare.
Challenges to Implementation
Despite the clear benefits, implementing MID is not without its hurdles. One significant requirement is a robust team of highly trained clinical practitioners, pharmacists, and specialty pharmacy personnel. The need for specialized expertise adds to the initial investment and ongoing operational costs. Startup costs, in general, can be substantial, representing a barrier for some oncology centers.
Payer models also present a challenge. Insurance coverage for medications dispensed through MID pharmacies can vary, potentially limiting patient access. As Tobon notes, “There’s always the possibility of limited drug access for our new specialty medications as they come out, and there’s the need for highly trained professionals and the higher startup costs in the beginning.” Access to newly approved specialty medications can also be a concern, requiring proactive management and advocacy on behalf of patients.
The Role of the National Community Oncology Dispensing Association
Organizations like the National Community Oncology Dispensing Association (NCODA) are actively advocating for the expansion of the medically integrated pharmacy model. NCODA’s patient satisfaction surveys demonstrate strong support for MID, with 95% of patients who receive medications through an MID are satisfied or very satisfied with the experience
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MID and the Evolving Oncology Landscape
The increasing number of oral anticancer medications available is further driving the need for integrated dispensing solutions. In 2019, ASCO partnered with NCODA to develop evidence-based standards for MID, and since then, the FDA has approved 35 novel oral anticancer medications. This proliferation of oral therapies necessitates careful medication management and monitoring, areas where MID excels.
The shift towards value-based care is also a key driver. MID supports this model by improving patient outcomes, reducing costs associated with medication errors and non-adherence, and enhancing the overall quality of care. By keeping medication management within the oncology practice, providers can better coordinate care and ensure patients receive the right medications at the right time.
Looking Ahead
Medically integrated dispensing represents a significant step forward in oncology care, offering the potential to improve patient outcomes, enhance safety, and streamline the medication management process. While challenges related to cost, staffing, and payer coverage remain, the benefits of MID are increasingly recognized. As the oncology landscape continues to evolve, with a growing emphasis on integrated and patient-centered care, MID is poised to play an increasingly important role in delivering high-quality cancer treatment.
