In-Office Pharmacy: Should Every Practice Have One? Jeff Patton, M.D., Chief Executive Officer Tennessee Oncology, Chief Medical Officer Rain Tree Oncology

In-Office Pharmacy:Should Every Practice Have One?

Jeff Patton, M.D., Chief Executive Officer Tennessee Oncology,Chief Medical Officer Rain Tree Oncology Services

Oncology Paradigm Shift

Migration from intravenous to oral oncolytics

20-30% community oncology practice pharmaceutical revenue is oral today

35-40% current oncology pipeline is oral

Caring for Cancer Patients is a PRIVILEGE

Closed door retail pharmacies within community oncology practices are critical for patients, practices and manufacturers


Why are these oncology pharmacies critical for patients?

Faster access◦ Full inventory◦ Access to EMR makes PA faster

Improved patient experience◦ Multiple studies confirm patients want outreach from their providers not third

parties

Potential for Improved patient adherence◦ Studies show better patient engagement when information comes from their

providers

Pharmacists and technicians have full EMR access◦ Closed door system for refills


Why are these oncology pharmacies critical for patients?

Financial Assistance◦ Dedicated patient advocates familiar with all various manufacturer

support programs◦ Fully versed in foundation support

Tennessee Oncology Experience◦ 2013 provided over $ 5 million in copay, foundation and provided drug

(oral, injectable and IV)


Why are these pharmacies critical to practices?

Financial◦ Severe margin pressures◦ Evolution to orals decreases IV retail and infusion code revenue◦ Pharmacies add an additional diversified revenue stream


Why are these pharmacies critical to practices?

Operational◦ Provide full continuum of care◦ Chain pharmacies and specialty pharmacies lead to fragmentation of

care delivery◦ Patients can receive mixed messaging◦ Providers don’t often receive feedback from those entities


Why are these pharmacies critical to pharmaceutical manufacturers?

Adherence◦ Compete like crazy for the Rx◦ Then script is not filled or doses are missed

Access◦ Community oncology is your premier customer◦ 340B threat


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=Ia6CzL_vyZvUFM&tbnid=aPqIpn_p8-BtVM:&ved=0CAUQjRw&url=http://www.drugchannels.net/2013/02/the-coming-battle-over-340b-contract.html&ei=2DRcU-rHDqrb2QWRz4HQDg&bvm=bv.65397613,d.b2I&psig=AFQjCNHmp9vxw9p8WEpQuZ5UIewfZbX0NQ&ust=1398638154539181

RainTree Oncology and the Oral Channel

Summer 2011 zero oral oncolytic GPO contracts

Summer 2014 80% of oral revenue going through Tennessee Oncology’s pharmacy is under GPO contract


RainTree Oncology

Oral GPO

Summer 2014 launching IV and injectable GPO

Data and Analytics Company◦ Business Intelligence for practices◦ Data analytics for pharmaceutical manufacturers through


Community Oncology Pharmacy Challenges

Extremely skinny gross margins

Cannibalizes more financially attractive infusion business

Benefit design◦ Many patients have better infusion benefits than oral benefits◦ Many patients financial burden with oral therapy is problematic



Barry Russo, MBA, Chief Executive Officer, The Center forCancer and Blood Disorders

RETAIL PHARMACY

Lessons Learned

THE CENTER FOR CANCER AND BLOOD DISORDERS

JUST A FEW FACTS ABOUT US…..

19 Physicians 9 Locations Med Onc, Rad Onc, Gyn Onc, Breast

Surgery Imaging Complimentary Medicine Retail Pharmacy Established 2006) –

Currently average 70 Rx per day

DEFINING YOUR SCOPELESSONS LEARNED

Open Door vs. Closed Door Pricing Licensure

Medications to Dispense Oncology Drugs only Supportive Drugs Schedule Drugs Other related Drugs – Cardiac, GI Compounding

Oral Chemo Education Medication Therapy Management (MTM)

DEFINING YOUR SCOPELESSONS LEARNED

Flu Clinics 340B Contract Pharmacy Nutritional Supplements Mail order

OPERATIONAL PROCESSLESSONS LEARNED

Point of Sale (POS) System Accounting Issues Reporting Support RX Tracking in relation to Satellite clinics Payer and Pharma Audits

Contracting in the Specialty Network Space Prior Authorization – Integrating with the

Clinic Flow Foundation and CoPay Support – Unique

and a large volume

SPACELESSONS LEARNED

Location, Location, Location Consider the potential for other retail

sales OTC Medicine Nutraceuticals Gifts Logo clothing

Assume Growth

MARKETING LESSONS LEARNED

Internal Getting the Physicians engaged

Promethazine Gel Selling the MA’s, Nursing and Support Staff

Nutritional Supplements Pre Chemo Meds

“In Network” for employees Agenda item for every Board Meeting

MARKETINGLESSONS LEARNED

External Flyers

Posted in all your clinic sites New Patient Packets

Direct Patient Contact Education Location Satellite Visits Personal Delivery to Chemo Suites

COMPLIANCE AND PERSISTENCYLESSONS LEARNED

Why is it important? Specialty Pharmacy Competition Win – Win Need a Process/System Support Outcome Measurement Provide Pharma Support Patient Portal Opportunity

SUMMARY THOUGHTSLESSONS LEARNED

As Dr. Patton mentions, oral volume will continue to grow – 35-40% of Oncology pipeline – As a result, establishing successful strategies for Retail Pharmacy is essential.

It is important to ensure the Retail Pharmacy is seen as an integral component of the Practice – a treatment modality – not just a business unit.

Competing in the Specialty Pharmacy space is an important strategy for community oncology – remember this in all interactions with Pharma and your GPO


Gitesh Patel, Chief Executive Officer, Sargas PharmaceuticalAdherence and Compliance International

Transforming Patient Care through Data Transparency and Analytics

www.spacinternational.com

http://www.spacinternational.com/index.php

No matter what the circumstances, we will help you take your prescribed drugs on time



Oncologist

PharmaciesPatient Assistance Programs

Co-Pay Assistance

Insurance Eligibility

Disease/Treatment Understanding

Adherence and Compliance Communications

Side Effect Management & Reporting

Patient

Payer

Adherence & Compliance Programs


Automation delivers Adherence & ComplianceCurrent Model


PharmaciesPatient Assistance Programs

Co-Pay Assistance

Insurance Eligibility

Disease/Treatment Understanding

Adherence and Compliance Communications

Side Effect Management & Reporting

Payer

Adherence & Compliance Programs

Oncologist Patient


Automation delivers Adherence & ComplianceSPAC Model


WHY SPAC?• SPAC provides the compliance, adherence, chronic

care management and 24/7 medication monitoring by hand holding the patients.

• SPAC captures revenue, visits, scripts and provides better patient care.

• SPAC delivers better outcomes and survival

• SPAC keeps the physicians informed through the entire treatment cycle in real time.




WHY SPAC?

• SPAC program activates in the exam room when the script is written and then it tracks the delivery of that entire treatment.

• SPAC is a conduit that connects patients, physicians, insurance companies, co pay programs, authorization programs and other patient services.

• SPAC’s vision is to provide the patient with the drug in the most efficient manner by working with the providers.




WHY SPAC?• SPAC provides administrative support via a personal phone

contact or mobile applications like Apple or Android • SPAC helps schedule the follow up and captures patient

reluctance (e.g. mouth sores, fatigue) to treatment in real time.

• SPAC cloud application works with patient, primary care, oncologists, other specialists, and dispensing pharmacies, specialty pharmacies, infusion centers, hospitals, patient centered medical homes, Accountable Care Organizations.

• SPAC follows up on the patient on a daily, weekly and monthly basis




Delivering better patient outcomes while having fun!!



Partnership with the Physicians

• mHealth applications that engage the patient with their physicians.

• Immediate feedback on patient symptoms and performance status.

• Patient health information exchange portal for the multispecialty.



A day in the life of a Cancer Patient.

Chemo

Radiation

Biopsy

Lab TestsInfusion

Transfusions

Imaging studies

Holistic therapy

Family Stress

Clinical Trials

Financial Stress

Psychological stress



Providing any patient services that do not begin with their physician leads to confusion for the patient and all other service providers.

Sargas has developed its patient centered solutions with the oncologist and their staff such that they are aware and have control over their patient's experiences




Partnership with Patients

• Minimizing the barriers that prevent patients from quickly accessing their treatments.

• Utilizing all possible means including mHealth to communicate with patients and their caregivers or family members in the way that works best for them. Text messages, phone follow-up and email messages regarding treatment compliance.

• Care teams comprising of nurses and certified health professionals to assist the patients 24/7 with their treatment needs.



Physicians would bill Medicare for chronic-care management using a new G code. It would apply to at least 20 minutes of management services over 30 days for a patient whose multiple chronic conditions are expected to last at least 12 months, or until death, and that represent a significant risk for death, functional decline, or acute exacerbation or decompensation. Chronic-care services must be available on a 24/7 basis, but a clinical staff member can provide them at the midnight hour on an "incident-to" billing basis without direct supervision.


Automation delivers Chronic Care ManagementSPAC Model


Documents

In-Office Pharmacy: Should Every Practice Have One? Jeff Patton, M.D., Chief Executive Officer Tennessee Oncology, Chief Medical Officer Rain Tree Oncology