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Specialty Pharmacy Continuum • May/June 2020
CLINICAL
Stakeholders adapt during pandemic
Community Cancer Care Amid COVID-19 When it comes to delivering cancer care amid the COVID-19 pandemic, it takes a village: Pharmacy benefit managers, Pharma, providers and clinic directors all are pulling together to ensure adequate access despite social distancing and other unprecedented pressures, experts noted during an April 3 webinar. “We can shut down the country, but we can’t shut down cancer,” said Ted Okon, the executive director of the Community Oncology Alliance (COA). “Cancer keeps going. With hospital campuses overflowing with COVID-19 patients, community oncology facilities have been essential to keeping cancer patients treated and monitored so that they are out of the hospital.” Sponsored by the Association for Value-Based Cancer Care, the webinar focused on the impact of COVID-19 on the cancer care delivery ecosystem and featured insights from more than 20 industry experts. COA has established a regularly updated COVID-19 webpage with practice resources and protocols for community oncologists, as well as a listserve for health care providers. Tennessee Oncology, one of the nation’s largest community cancer networks, has established three primary strategies to protect its patients, said the network’s president, Jeff Patton, MD: 1. Patients who are not in active treatment should stay at home and maintain checkups via telehealth. 2. Continue treatment for active-treatment patients. “We are still treating both curative and palliative patients, and keeping our clinics open and providers and patients safe is our focus,” Dr. Patton said. “Our visits for nonacute patients are down by 30%, but chemotherapy visits are off by only 2%.” 3. Acute diligence practices should be done in the clinic, including use of N95 masks and personal protective equipment for clinicians and CDC risk assessment of all patients and caregivers at the door. Only one caregiver is allowed to accompany each patient. Lucio Gordan, MD, the president of Florida Cancer Specialists (FCS), the largest independent medical oncology/hematology practice in the United States, said cancer care providers in the state are “bracing for impact.” He noted that infusion visits in the practice were down by only about 7%, but weekly follow-up visits had declined by 33% and new patient visits by almost 25%. Radiology also has declined, with CT scans down by almost 13% and PET
scans down by nearly 10%. “Telehealth is operational across our more than 100 clinic sites,” Dr. Gordan said. “We gave our chief technology officer three days to get it up and running and he had a solution in 19 hours.” The practice has the vast majority of nonclinical staff working from home with information technology support, including 85% of IT staff, 70% of the revenue cycle team, and 90% of the outpatient pharmacy group. “It was a herculean effort to get appropriate technology to allow more than 1,000 people to work from home over the course of four to five business days,” Dr. Gordan said. “But we were able to do it.”
At Florida Cancer Specialists, by early May, telehealth was operational across more than 100 of the network’s clinic sites.
Protecting Front-Line Staff FCS took additional steps to ensure its oncology pharmacy dispensing staff was protected immediately. “They have been sequestered in their own ISO 9 [clean]room with a separate entrance and its own HVAC system,” said pharmacy director Ray Bailey, BPharm, RPh. “They are masked and gloved and go through temperature checks and questionnaires at the beginning and end of their shifts.” FCS also has suspended all pickups in the pharmacy and any shipments to the clinic; everything now is being shipped by FedEx. “They have adapted and will not require physical signatures from our patients,” Mr. Bailey said. “They will ring the doorbell, and once they see the patient take the package, they sign ‘COVID-19’ on the signature pad.” He noted that for drugs with Risk Evaluation and Mitigation Strategies (REMS) requirements of periodic inperson laboratory or imaging tests— which include many cancer therapies—the FDA is temporarily allowing providers to waive such requirements during the public health emergency. (To access details on the agency’s easing of some REMS requirements, visit bit.ly/2wZ7r5j).
Expanded Telehealth Like many other providers during the COVID-19 pandemic, FCS also has expanded its telehealth program, with services now available to patients at all FCS sites. The strategy is intended to increase patients’ access to providers
while helping to reduce the potential spread of, or exposure to, illness, Telehealth visits, FCS noted, are covered by most insurance plans, and patients can expect “to pay the same or possibly less than an in-office visit.”
Minimal Supply Chain Disruptions To date, the oncology pharmacy supply chain has not experienced significant disruptions as a result of the pandemic, said webinar participants representing manufacturers and wholesalers. “We have multiple redundancy plans built out to ensure continued operations during this crisis,” said Barry Fortner, PhD, the senior vice president and president of specialty physician services at AmerisourceBergen. “The foundational oncology pharmacy space has not seen major disruptions to date, other than those we were already dealing with before this pandemic, and those specifically accentuated by COVID-19 such as hydroxychloroquine.” Brian Morrissey, the vice president of the strategic customer group for oncology at Pfizer, cited similar progress. “All of our plants in [effected] areas are fully operational, and in fact we have increased production and shifted demand to our most critical products,” he said. “We are also seeing unprecedented cooperation with regulatory authorities. Things that usually take months take weeks, and things that typically take weeks happen in days.” Eric Dozier, the vice president of
Oncology North America for Eli Lilly, said that the company is “able to maintain strong supplies across the oncology channel.” Both Mr. Dozier and Mr. Morrissey noted that while pivotal trials of new oncology agents are continuing, manufacturers have halted recruitment for new trials. “The last thing we want to do is be a burden on the system,” Mr. Dozier said.
PBMs Step In Many pharmacy benefit managers (PBMs) have adapted their policies and practices in light of the COVID-19 pandemic, said oncology pharmacy specialists participating in the webinar. “Many [PBMs] are now allowing 90-day fills and not requiring signatures from patients,” said Michael Reff, RPh, MBA, the founder and executive director of the National Community Oncology Dispensing Association. “A number of PBMs have also suspended audits, and in many cases pre-authorizations have been delayed or suspended. We really appreciate those efforts from the PBMs.” Mr. Reff noted that oncology practices also are innovating in response to the pandemic. “They are reaching out to local and state legislatures to find out if they can keep some oral therapies in-house as opposed to [using] mailorder pharmacies, to increase continuity of care.” —Gina Shaw The sources reported no relevant financial relationships.
