NCCN Developing Guidelines for Specialty Pharmacy in Oncology

Rowena N. Schwartz, PharmD, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, presented preliminary findings from the National Comprehensive Cancer Network (NCCN) Task Force on Specialty Pharmacy in Oncology. Although the exact definition of the Specialty Pharmacy varies according to healthcare plan, these pharmacies are meant to address gaps in care provided by community pharmacy practices.

The NCCN Task Force had several objectives, including assessing the usefulness of specialty pharmacies in distributing oncology drugs, looking for cost-saving benefits; and identifying any financial implications for oncology practices, cancer centers, oncologists, and patients. Patient safety was also a major concern, as was oncologists' potential legal or financial liability when using a specialty pharmacy.

Schwartz said the Task Force recognized several benefits to using Specialty Pharmacy in cancer care, such as helping to optimize treatment outcomes by ensuring medication adherence and appropriate use. The Specialty Pharmacy can also minimize unnecessary drug expenses and improve patient satisfaction. Schwartz said specialty pharmacists tend to be "very knowledgeable about the product they're dealing with," which allows them to provide patients with information. She added that the specialty pharmacy has also done well in making sure patients understand the cost of their care.

The Task Force also had concerns about Specialty Pharmacies and documented several challenges associated with their widespread adoption. For example, Schwartz said specialty pharmacies are currently not subject to any federal regulation or certification standards, something the Task Force considers necessary, along with oncology training.

Schwartz said the emerging role of expensive oral medications presents several challenges, including "management of side effects...coordination of authorization, drug distribution, and information provided to patients' family." She said Specialty Pharmacies could potentially contribute to "fragmentation of care...and optimal coordination of care is a key focus." As an example, Schwartz explained that if a patient gets their oncology drugs from a Specialty Pharmacy but the rest of their medications from a community pharmacy, it becomes more difficult to monitor possible drug interactions.

Cost-friendly strategies are needed to prevent excessive expense for the patient or medication waste when a patient needs to switch drugs, Schwartz said. Specialty Pharmacies will also have to work to avoid delays in providing treatments. Scwhartz noted that patient considerations vary depending on where the patient receives treatment--inpatient, in a clinic, or at home.

Despite the challenges, Schwartz said, "When you look at the role that Specialty Pharmacies stepped up to fill, you can see there is really an opportunity here." The Task Force will continue to meet and finalize its recommendations. The NCCN expects to publish its recommendations in the summer of 2010, as a supplement to the NCCN journal.