Prime Therapeutics launches IntegratedRx – Oncology, partners on MIP Accreditation

by Angela Maas

As published in AIS’s Radar on Specialty Pharmacy

(Content reprinted with permission. Original article available on AIS’s website, available by subscription only.)

Many people fighting cancer must get their oral oncolytics from a central fill specialty pharmacy, which can add to the time it takes for a prescription to be filled, as well as potential waste when an oncologist changes a medication. Prime Therapeutics LLC recently unveiled a new program known as IntegratedRx – Oncology that the PBM says will help coordinate care for members and streamline the treatment process.

Prime serves more than 33 million people. It is collectively owned by 19 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.

In a traditional nonintegrated specialty pharmacy model, a provider “has minimal connection to [the] central specialty pharmacy,” says a Prime statement. But the new integrated program will offer a “connected physician, member and pharmacist experience.” The channel-agnostic program “makes Prime the only large PBM that doesn’t prioritize a central fill specialty pharmacy as the primary model to receive their oral oncolytic medications.”

Through IntegratedRx – Oncology, people with cancer can receive their oral oncolytics and companion medications in the clinical setting from their oncologist’s clinic or an affiliated hospital pharmacy. According to Prime, this program will help reduce drug costs, speed up the time it takes for people to receive their therapies, encourage better adherence and offer a better overall experience for patients. Several of the PBM’s clients will implement the program starting this fall, says the company.

The program follows an integrated care pilot that Prime conducted earlier this year in Florida, Minnesota and the Pacific Northwest with pharmacy services administrative organization (PSAO) McKesson Health Mart Atlas.

Prime also unveiled a partnership with the National Community Oncology Dispensing Association (NCODA) for its new Center of Excellence (CoE) Medically Integrated Pharmacy (MIP) Accreditation program. The PBM will prefer the program for IntegratedRx – Oncology. NCODA is a not-for-profit organization focused on strengthening oncology groups with medically integrated dispensing services. It developed a model for MIPs many years ago before this formal accreditation.

AIS Health, a division of MMIT, spoke with Joseph Leach, M.D., Prime’s chief medical officer, to find out more about the new offering.

AIS Health: Is IntegratedRx – Oncology one of the phases of the MedDrive program that Prime rolled out earlier this year?

Leach: No, IntegratedRx – Oncology and MedDrive are separate Prime programs. Beginning with the oncology offering, Prime is planning to build upon the IntegratedRx suite of products to streamline access to some prescription medications used to treat complex or chronic conditions.

AIS Health: How were Prime members previously receiving oral oncolytics and companion medications?

Leach: Prior to the IntegratedRx – Oncology offering, many patients were required to get their medicine from a central fill specialty pharmacy allowing little to no connection to the member’s provider. This practice resulted in a fragmented care experience, delays and frustration — both for the member and physician.

This progressive, integrated model allows patients to receive their oral cancer medications directly from their oncologist’s medically integrated clinic or affiliated hospital pharmacy and not a central fill specialty pharmacy.

With IntegratedRx – Oncology, a member’s physician and pharmacist are literally part of the same team. This coordinated care approach promotes lower drug costs, quicker time-to-medication, better adherence and an improved patient and provider experience for Blue plans and their members.

AIS Health: Can you share any details on what the expected lower drug costs will be with this program? PBMs often say that mail order is less expensive than other dispensing sites. Is Prime saying that’s not true?

Leach: From a financial standpoint, this new integrated model is expected to lower overall costs. Average wholesale price (AWP) discounts are better, and members may benefit from lower cost shares.

AIS Health: Can you share any details on the improved medication fill times and adherence rates?

Leach: An integrated pharmacy-provider model is proven to improve medication adherence and results in better care management for patients. Pilot results showed an above-average rate of adherence. Prime will monitor adherence as part of the IntegratedRx program. In the pilot, some patients were able to receive treatment up to two days faster, and Prime expects the integrated pharmacy dispensing program will speed up time to fill medication.

By connecting the care team to the practice pharmacy, the program removes roadblocks that can complicate and delay members’ cancer care journey.

AIS Health: What will be the program’s impact on AllianceRx Walgreens Prime?

Leach: Blue plans may continue to utilize AllianceRx Walgreens Prime for specialty pharmacy and home delivery.

The IntegratedRx – Oncology program represents Prime’s channel independent approach of identifying solutions that drive the best financial, pharmacy choice and quality outcomes for Blue plans and members. It makes Prime the only large PBM that doesn’t prioritize a central fill specialty pharmacy as the primary model to receive their oncolytic medications.

AIS Health: What roles are AmerisourceBergen and Shields Health playing?

Leach: Prime is collaborating with the health care companies to operationalize and ensure success of the program. McKesson Health Mart Atlas, AmerisourceBergen and Shields Health Solutions are offering the IntegratedRx – Oncology program to eligible hospital, health system and independent oncology practice customers.

AIS Health: In order for provider office, hospital and health system pharmacies to participate in this program, must they have NCODA CoE MIP accreditation? What are some of the requirements for that accreditation? Are there any other requirements for participating in IntegratedRx?

Leach: The NCODA CoE MIP accreditation is one of several accreditations the oncology pharmacies may earn to participate in IntegratedRx – Oncology. This first-in-market accreditation — which aligns with Prime’s essential accreditation criteria — is a component of required credentialing for IntegratedRx – Oncology.

The NCODA Center of Excellence Medically Integrated Pharmacy (MIP) Accreditation program is the only industry accreditation focused on medically integrated pharmacies. It will allow medically integrated pharmacies like those participating in Prime’s IntegratedRx – Oncology program to measure more accurately factors such as medication adherence, which can lead to improved care for patients.

The program, based on compliance with the ASCO [i.e., American Society of Clinical Oncology]/NCODA Patient-Centered Standards for Medically Integrated Dispensing, focuses on enhanced patient care and quality of services. NCODA is committed to empowering medically integrated pharmacies to deliver the highest level of performance that brings sustainability and value for all stakeholders. This program achieves the quadruple aim goals of improved clinician experience, better outcomes, lower costs and improved patient care. The key areas of focus include medication adherence, patient education and safety, cost avoidance and waste reduction, continuous quality improvement, financial assistance and patient satisfaction.

AIS Health: Will providers participating in IntegratedRx have any additional benefits, such as automatically receiving prior authorization for therapies they prescribe?

Leach: The coordinated care approach between oncologist and pharmacist leads to a direct line of communication and teamwork around a patient’s overall care. Both have access to the information they need — when their patient receives their medication and treatment, when they receive lab tests and whether the patient has been in the hospital or experiencing side effects from medication or treatment. The pharmacist has access to a patient’s full medical record and to the doctor and patient, and together, they can make any changes or adjustments in medication doses or refills as needed to give the patient the best experience.

Through IntegratedRx, we are working with our partners to streamline the authorization processes.

AIS Health: Was Prime’s pilot program focused on oncology? Can you disclose any of its results? How long did it run?

Leach: Yes, Prime’s medically integrated dispensing pilot began in February and was focused on oncology. The integrated care pilot indicated benefits to providers as well as patients, including shorter fill times allowing patients to begin treatment up to two days faster, significantly better medication adherence and reduced drug costs. The pilot also showed an early trend toward waste reduction. We will continue to measure these outcomes over time.

AIS Health: What are some issues that people with cancer face when they need to go through a central fill specialty pharmacy for their medications?

Leach: Patients may experience fragmented care when members of the care team don’t have direct access to patient records, e.g., lab results and medication side effects. For patients and caregivers, this can mean hours spent making calls to coordinate their own care. In the traditional model, expensive medication is often discontinued and therefore wasted, but that can be prevented through truly integrated care. Finally, patients may wait days to weeks to begin treatment as they wait for specialty medication to arrive.

Getting a cancer diagnosis is overwhelming, and new cancer treatments are complex. This new integrated model puts patients first and reduces the amount of time that it takes for them to receive their cancer medication and begin their treatment. Patients feel better when they know that there is strong communication between their oncologist and pharmacist and that their care is being delivered in a coordinated way.

AIS Health: It sounds like Prime plans to expand IntegratedRx to other conditions. Can you disclose what those may be? When might that happen?

Leach: Beginning with the oncology offering, Prime is planning to build upon the IntegratedRx – Oncology suite of products to streamline medication delivery for various other medical conditions. IntegratedRx offerings will be focused on chronic conditions for which specialty drugs play an increasingly important role in the treatment.

Contact Leach through Jenine Anderson at jenine.anderson@primetherapeutics.com.