Financial impact from in-office dispensing of oral chemotherapy

Abstract

Background Oral chemotherapy agents are being prescribed more frequently in many cancer types. In-office dispensing of oral chemotherapy agents has demonstrated clinical benefits and also shown financial benefit to third-party payers. A previous publication estimated over $200,000 in cost savings annually from in-office dispensing solely from medications returned to stock for credit. However, pharmacists in the in-office setting perform many other interventions that may affect financial outcomes. Objective Assess financial impact of oral chemotherapy in-office dispensing by a clinic-based oral chemotherapy program serving five outpatient cancer centers in Southern Idaho. Outcomes include calculated monetary waste and cost avoidance of oral chemotherapy prescriptions from in-office dispensing and mail-order pharmacies. Methods Prescriptions received by the clinic-based oral chemotherapy program for filling through in-office dispensing and mail-order pharmacies were monitored for monetary waste and cost avoidance events from December 2016 through May 2017. Information was collected on the number of returned medications, therapy discontinuations, and dose adjustments. Monetary outcomes were calculated using average wholesale price. Results During the six-month evaluation, prescriptions filled through in-office dispensing had a total cost avoidance of $1,020,193 ( n = 154) and total waste of $154,985 ( n = 36) resulting in an estimated net cost avoidance annually of $1,730,416. Prescriptions filled through mail-order had a total cost avoidance of $20,497 ( n = 4) and a total waste of $80,394 ( n = 15) resulting in an estimated $119,794 net annual waste. Conclusions In-office dispensing of oral chemotherapy provided significant cost savings to third-party payers compared to mail-order pharmacy dispensing. Continued evaluation may help further justify the importance and value of in-office dispensing.