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Earlier this month the FDA approved an ORAL specialty therapy, Cuvrior (trientine tetrahydrochloride) from Orphalan SA, for the treatment of adults with stable Wilson’s disease who are decoppered and tolerant to penicillamine. Wilson’s disease is a devastating disorder affecting patients worldwide. It is a rare genetic storage disease caused by a defect in a copper transporter gene, leading to copper accumulation in the liver, brain, eye, and peripheral nerves. It is the first drug approved for Wilson’s disease in the United States in more than 5 decades.

Approximately one in 90 people may be carriers of the disease gene. Current prevalence is estimated to be only about 2,000-3,000 cases in the United States. Other affected individuals have been misdiagnosed with other neurological, liver, or psychiatric disorders.

The big question is….. “Is this a new drug??”
In fact, trientine tetrahydrochloride was first approved by the FDA is 1985….. Yes…. 37 years ago!
As we are seeing, there has been an increasing number of ‘old’ therapies being reapproved due to ‘tweaks’ in formulations or reissuing in a different form (usually oral).

CLICK HRE to read prescribing information

Orphalan announced that pricing will be released near to product launch.
Orphalan expects to launch Cuvrior in the United States by early 2023.
Given the very small patient population in the US it is a sure bet that Cuvrior will launch through limited distribution.

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FDA Approves New Drug for Wilson’s Disease

May 03, 2022 — The US Food and Drug Administration (FDA) has approved oral trientine tetrahydrochloride (Cuvrior, Orphalan) for the treatment of adults with stable Wilson’s disease who are decoppered and tolerant to penicillamine, the company has announced.

Wilson’s disease is a rare genetic storage disease caused by a defect in a copper transporter gene, leading to copper accumulation in the liver, brain, eye, and peripheral nerves.

Trientine is a copper-chelating agent that removes copper from the body by forming a stable complex that is eliminated through urine. Trientine may also inhibit copper absorption from the intestinal tract.

In trials Cuvrior met its primary efficacy endpoint by demonstrating noninferiority to penicillamine as measured by nonceruloplasmin copper. Penicillamine is currently approved as a first-line treatment of Wilson’s disease in the United States, with about one-third of patients developing intolerance, the company said.

Trientine tetrahydrochloride is already on the market in Europe, where it is sold as Cuprior.

Announcements for newly approved specialty drugs often state that the product will be available through specialty pharmacy via limited distribution (LD). However, the press releases rarely specify the specialty pharmacy(ies) selected as the designated partner(s).

Here are several LD deals that have been recently publicly confirmed subsequent to the approvals.

Amber Specialty Pharmacy announces today that they will begin dispensing LENVIMA (lenvatinib). Used by itself, LENVIMA treats differentiated thyroid cancer (DTC) when it can no longer be treated with radioactive iodine, and hepatocellular carcinoma (HCC) when it cannot be removed by surgery. LENVIMA is used with other medications to treat additional types of cancers, including advanced renal cell carcinoma (RCC) and advanced endometrial carcinoma. LENVIMA is manufactured by Eisai.

Biologics by McKesson recently announced that they were selected by CTI BioPharma Corp. as a specialty pharmacy provider of VONJO (pacritinib) for the treatment of intermediate or high-risk primary or secondary (post-polycythemia vera or post-essential thrombocythemia) myelofibrosis.

Biologics also announced that they were selected by Agios Pharmaceuticals as a limited network provider for PYRUKYND (mitapivat) for the treatment of hemolytic anemia in adults with pyruvate kinase deficiency.

We’ve written about the emergence of telehealth services for the past several years. As then, we continue to see positive uptake, albeit much slower than some pundits expected.

Specialty pharmacies have ramped up patient outreach recognizing that more contact directly correlates with better outcomes, avoided adverse events, and better compliance and persistence. Telehealth is one of the methods that continues to show promise as it is applicable to just about any disease / condition under the specialty pharmacy umbrella.

A recent press release caught our eye as it bolsters the notion that telehealth is getting ready for prime time. As described, the Specialty Pharmacy Alliance (HOSP) has worked out a deal for their members to obtain URAC accreditation in Telehealth….. yes, another tutti-fruity accreditation flavor. As SPs search for ways to differentiate themselves adding yet another accreditation is one way to strut one’s stuff.

But, not all pundits are so bullish on telehealth. Doug Long, Vice President, Industry Relations, IQVIA, shared some thoughts on the subject at the recent Asembia conference. He stated that the pandemic did drive telehealth usage and that a recent poll showed that more than 1 in 8 Americans engaged in a video consult with a health care professional in recent months.

However, he suggested that the pandemic and the related shift to telehealth had mixed results on the specialty pharmacy market with telehealth reaching only 15% of patients and that the pace has stalled as the pandemic effects have subsided. One reason he suggests is that telehealth platforms don’t have access to the labs and the vitals and things that make doctors comfortable with prescribing new therapies. Long did cite that telehealth is going gang busters in the mental health patient management segment.

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URAC-HOSP Partnership to Focus on Specialty Pharmacy, Telehealth Accreditation

By SPC News Staff
A new partnership between Health System Owned Specialty Pharmacy Alliance (HOSP) and the accreditor URAC will make specialty pharmacy and telehealth accreditations more affordable for HOSP members while fostering collaboration between the organizations.

The partnership, announced during the AXS22/ Asembia Specialty Pharmacy Summit, will broaden the scope of benefits for HOSP members and allow the two organizations to work together on accreditation and certification measures, HOSP Board Chairman Gary Kerr, PharmD, told Specialty Pharmacy Continuum.

“We aim to educate our members and provide them with the tools they need as well as find new ways to work with partners like URAC in the integrated specialty pharmacy ecosystem,” Dr. Kerr said. “Education and collaboration around accreditation also support the HOSP mission to share common experiences and knowledge with industry partners, so we can grow and find timely solutions to our challenges together.”

As telehealth use increases in the wake of the COVID-19 pandemic, telehealth accreditation continues to evolve as well.

“This increase in utilization applies to how pharmacies manage patients and medication adherence during the pandemic,” Jeffrey Carr, URAC’s vice president, business development, said in an email. “URAC does not want price to be a barrier to improving quality. Our partnership allows HOSP members a more affordable option to pursue new pharmacy and telehealth accreditations.”

HOSP is a nonprofit coalition of major health systems focused on integrated specialty pharmacy best practices and advocacy.

“We select partners who align with our commitment and efforts to strengthen patient care through the integrated specialty pharmacy model,” Dr. Kerr said. “Our partners understand the value and importance of collaboration in the advancements in research, advocacy and education that are required to advance the quality of care to patients.”

The rumors about a big divestiture move by Centene Corp. finally materialized last week. Centene announced that they are spinning off both its PantherRx Rare pharmacy business as well as MagellanRx.

The PantherRx Rare divestiture is easier to understand….. sort of.
We were not able to confirm what Centene paid in January of 2021 (only 16 months ago) for the acquisition of PantherRx Rare. PantherRx was just sold for $1.4billion. Analyst estimates of 2022 EBITDA for PantherRx are in the area of $70 million which works out to an EBITDA multiple of ~20x!!! Given the long-term rosy forecasts for rare therapies, it is most curious that Centene would want to cull its herd by selling off perhaps its biggest cash cow.

MagellanRx is the pharmacy division of Magellan Health….. which itself is a division of Centene. Here is where it gets a little complicated. MagellanRx is a PBM and also a large national specialty pharmacy. The specialty pharmacy subdivision consists of a group of acquired providers which include Acaria Specialty Pharmacy (itself subsumed by MagellanRx’ Envolve Health)….. and don’t forget Exactus Pharmacy Solutions and Foundation Care sub-sub-sidiaries.

We remain a bit confused after reading the numerous press releases on the two deals in recent days. There has been no mention of Acaria/Envolve which generated upwards of $2billion in non-rare specialty revenue in 2021 according to published reports. We must assume that these operations are part of the MagellanRx spin off going to Prime Therapeutics. Trying to unpack the numbers becomes very difficult without specific EBITDA data for the PBM vs. the specialty pharmacy operations.

To help clarify (maybe not)….. Centene shelled out $2+billion to acquire Magellan in January of 2021. It appears that Centene will retain Magellan health services (includes a national behavioral health platform) and spin off only the Rx services (PBM and specialty pharmacy) for $1.35billion. Yeah, we need EBITDA to determine if this was a good deal….. and for whom.

The point that seems to have been glossed over is that Centene’s decision to get out of the PBM market comes after it has settled a series of pharmacy benefit management-related Medicaid cases across multiple states. The company said it will reserve a whopping $1.1 billion to settle these cases. That leaves Centene with about $1 billion which the company has already said it will use for stock buyback.

Over the years few new specialty therapies have been approved for Cardiology conditions. That may be about to finally change with a recent FDA approval.

Last week the FDA approved a new ORAL specialty therapy, Camzyos (mavacamten) from Bristol Myers Squibb (via MyoKardia, Inc., a wholly-owned subsidiary), indicated for (deep breath now) the treatment of adults with symptomatic New York Heart Association (NYHA) class II-III obstructive hypertrophic cardiomyopathy (obstructive HCM) to improve functional capacity and symptoms. Camzyos is the first and only FDA-approved allosteric and reversible inhibitor selective for cardiac myosin that targets the underlying pathophysiology of obstructive HCM.

Obstructive hypertrophic cardiomyopathy is an often un/mis-diagnosed condition in which the heart muscle thickens and impairs its ability to pump blood. Patients often have symptoms like those seen with heart failure. Symptoms have generally been treated with beta blockers and calcium channel blockers. Camzyos helps heart muscle fibers relax more in between beats, allowing more blood entering the ventricles to be pumped out when they contract helping to resolve symptoms. Echocardiogram assessments of left ventricular ejection fraction LVEF are required before and during treatment.

BMS announced a list price of $89,500 for a year of treatment. BMS also forecasted that they see sales in excess of $2 billion by 2029, slightly under analysts’ consensus.

BMS also indicated that Camzyos will only be available through the Camzyos Risk Evaluation and Mitigation Strategy (REMS) Program due to meaningful risk of heart failure due to systolic dysfunction.

Prescribers must be certified by enrolling in the REMS Program. Additionally, patients must also enroll in the REMS Program and agree to comply with ongoing monitoring requirements.

BMS also announced that Camzyos will be dispensed only to REMS enrolled patients through select, certified specialty pharmacies in a limited distribution program.

CLICK HERE to access prescribing information

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FDA approves new drug to improve heart function in adults with rare heart condition

FDA has approved Camzyos (mavacamten) capsules to treat adults with symptomatic New York Heart Association (NYHA)External Link Disclaimer class II-III obstructive hypertrophic cardiomyopathy (oHCM) to improve exercise capacity and symptoms.

Disease or Condition
oHCM is a rare disease that occurs when the heart muscle thickens, mostly in the septum (the heart wall that separates its right and left sides) and obstructs blood flow from the heart to the rest of the body.

The severity of oHCM varies, but it can cause serious symptoms and death. Symptoms include palpitations (the sensation the heart is pounding), shortness of breath, swelling of the legs, and decreased exercise capacity, which significantly impact daily activities and quality of life.

Effectiveness
The effectiveness and safety of Camzyos to treat NYHA class II-III oHCM was studied in adults who were randomly assigned to receive Camzyos or a placebo for 30 weeks. At the end of the study, 37% of participants treated with Camzyos improved on an endpoint measuring exercise capacity and symptoms, compared to 17% of participants in the placebo group.

Safety Information
Camzyos reduces contraction of the heart muscle, which can cause heart failure or totally block functioning of the ventricles (lower chambers of the heart). Patients who have a serious intercurrent illness (such as a serious infection) or arrhythmia (atrial fibrillation or other uncontrolled fast heart rhythm abnormality) are at greater risk of developing impaired heart muscle contraction and heart failure with Camzyos.

Because of the risk for heart failure, patients treated with Camzyos must be monitored with echocardiograms, an imaging test that shows how well the heart is working. Patients must also avoid certain prescription and over-the-counter medicines that interfere with the metabolism (breakdown) of Camzyos.

Because of the potential for developing symptomatic or life-threatening heart failure if monitoring is not followed or if Camzyos is used with medicines that impair its metabolism, Camzyos is only available through a restricted program called the Camzyos Risk Evaluation and Mitigation Strategy (REMS). The REMS program helps ensure safe use by lowering the risk of heart failure due to impaired heart muscle contraction.

We’ve written frequently on two of the biggest trends in channel access, the shift away from buy-and-bill to other, less costly, sites of service as well as payer policies that have shifted reimbursement away from physician / hospital purchased drugs to specialty pharmacies. An article we want to review today is from Drug Channels. It is a great read and includes some fresh data to document these trends.

That article, an excerpt from a larger market report available for purchase from the company, first refreshes our understanding of the types of patient access now being employed. By now we are all familiar with White Bagging and Brown Bagging (if not, read the article). A term that is beginning to catch on is Clear Bagging in which the hospital-owned specialty pharmacy does the fulfillment.

What the data shows is that there has been a significant increase in White Bagging over the past two years with a 20% increase at physician practices and a 25% increase at hospital outpatient departments. Brown Bagging has virtually disappeared in these settings. Strangely, buy-and-bill at Home Infusion companies actually increased by a whopping 41% in the same time period and Brown Bagging more than doubled. Go figure! The data is based on a very large ‘n’ of payers nationally.

There are several points for further consideration.
– First, the list of impacted drugs goes beyond Oncology….. and is growing.
– Secondly, a number of specialty pharmacies have been designated by manufacturers as limited distribution (LD) partners (often exclusive) for certain drugs….. even bypassing traditional wholesalers. Since virtually all of these SPs are now also licensed distributors they can sell direct for professional use as a buy-and-bill drug….. under the medical benefit. (Not popular with hospitals and many providers.)
– Next, Payer and PBM policies have ramped in the past year+ to push these transactions over to the pharmacy benefit (even less popular) through rewriting the patient benefit plan…. including introducing patient OOP if billed as a medical benefit.
– Concurrently, PBMs and Payers have been able to co-opt these dynamics to further their cost management efforts on other, non-LD drugs. The data does not separately break out these LD drugs which further muddies up the total White Bagging picture.
– And finally, we can more easily understand why hospitals are increasingly desperate to redirect fills internally to owned specialty pharmacies to recapture lost buy-and-bill revenue.

White Bagging Update: PBMs’ Specialty Pharmacies Keep Gaining on Buy-and-Bill Oncology Channels
Drug Channels

Limited distribution (LD) has contributed to the growth of a couple dozen specialty pharmacies over the past decade. When a pharmaceutical manufacturer selects a specialty pharmacy as a member of their limited network prescriptions are routinely channeled to these SPs for fulfillment and they enjoy the usually greater revenue associated with these therapies. And, an increasing number of LD therapies have awarded exclusive deals to a single SP. The exclusive deals are most often for a rare/orphan therapy and these are usually among the most costly.

We’ve often written about the benefits that the manufacturers enjoy from these distribution arrangements. But what about the benefits that can accrue to a payor? A recent article was recently published highlighting a variety of benefits…. and even some deliverables that SPs can offer to payors.

Here are the top line benefits that payors should seek in a LD program.

• End-to-end solutions. LDD access allows a specialty pharmacy to meet most of the specialty needs of its clients. For example, if the pharmacy does not have access to a product, it can work directly with the manufacturer to attempt to gain access on behalf of the patient.
• Rapid access to medications. Because there is no delay or expense related to third-party suppliers, payors can quickly access hard-to-find medications. Being part of an exclusive or narrow distribution network can allow pharmacies to have expedient contract additions to its payors. In addition, specialty pharmacies that have deep relationships with pharmaceutical manufacturers can begin discussions early about the specialty drug pipeline and how quickly patients can access drugs once available on the market.
• Greater patient satisfaction. Central and local pharmacies operating under singular clinical programs allow for a consistent patient experience aimed at driving adherence and improving overall treatment experience.
• Reduced costs. When a specialty pharmacy manages the full drug therapy needs of patients, its pharmacists and nurses can support possible medication issues, such as side effects that could lead to nonadherence. In turn, those patients who remain on their drug regimen provide a healthier membership to the payor, potentially reducing overall costs.
• Actionable insights. Specialty pharmacies can provide their payors regular reports outlining utilization and spending of all medications, including LDDs. Many specialty pharmacies offer real-time access to critical information through proprietary client data and insights tools. These tools can often visually transform a payor’s current business data into interactive insights, enabling the payor to best evaluate its overall payor strategy and respond to patient needs and market trends. [This data is also integral to supporting value based contracts.]

Specialty pharmacies should consider the following ways to help payors meet their goals:

• Control costs and improve outcomes. Specialty pharmacies should partner with payors to proactively control costs by delivering actionable insights through unique market-leading programs that complement existing member management solutions.
• Empower patients and providers with an enhanced specialty experience. Consider implementing solutions that can add value to patients and providers. For instance, timely notifications and online refills make it easy for patients to access their medications and manage their conditions. Allowing the patient experience to move from fragmented care to total patient care allows patients to be more proactive in their health management journey.
• Become a trusted partner. Through various partnerships, payors will benefit from understanding the competitive and consolidated healthcare landscape and how it affects drug costs. The goal of specialty pharmacies should be to serve as a strong but nimble partner that understands the changing industry dynamics. By doing so, the relationship between a specialty pharmacy and payors will directly affect—and improve—overall patient experience and outcomes.

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How a Specialty Pharmacy’s Limited Distribution Drug Expertise Benefits Payors

Limited distribution drugs (LDDs) are high-touch medications to which only a handful of specialty pharmacies have access. Because these medications usually have specific requirements, pharmaceutical manufacturers may choose to limit distribution of the drug to only a few specialty pharmacies. Pharmaceutical manufacturers choose a specialty pharmacy as a trusted partner because of its ability to support patients throughout their treatment journey.

CLICK HERE to read the full article

Ana M. Cavanaugh, RPh, MBASenior Director, National Payer Sales and Account Management, Pharmacy ServicesAllianceRx Walgreens Prime

Option Care Health announced that it has acquired the Specialty Pharmacy Nursing Network (SPNN) for $60 million in an all-cash transaction. SPNN will maintain its current operations and continue serving an array of infusion providers, specialty pharmacies and biopharmaceutical manufacturers as a separate enterprise within Option Care Health. This marks the most recent chapter in the 13-year climb from start-up by industry veteran Cheryl Ann Gregory.

Specialty Pharmacy Nursing Network, Inc. (SPNN) is a national network of CRNI, OCN, IgCN, PICC and IV certified specialty nurses who administer specialty pharmacy therapies to patients in the home, physician offices and ambulatory infusion centers (AICs).

Demand has risen significantly for these expert clinicians given the recent proliferation of therapies for rare, chronic, and orphan disorders. SPNN’s professional staff also provides specialty pharmacy therapy education / clinical instruction, clinical call support, and patient outcome reporting.

The last item, patient outcome reporting, has become one of the more valuable services….. especially to pharmaceutical manufacturers. With the growth of value based / outcomes contracting, clinically reliable data has become a critical commodity.

Examples of key data tracking include:
Data Management and Integration
• Aggregated de-identified data reporting compliant with HIPAA regulations
• Assessment and surveys developed based on Best Practice Standards

Administrative Control
• Centralized administration, database management, scheduling
• Fast and reliable response time

Nursing Resources
• Coordination of nursing in/between the home, physician office or AIC
• Customized nursing assessments

Reporting
• Documented patient care services provided following therapy-specific metrics
• Market access, therapy starts/stops, etc.
• Tailored reporting to support manufacturer programs as well as REMS reporting

SPNN has also worked diligently to grow its national geographic footprint to service both urban and rural patient requirements….. an area of great concern for both manufacturers and health plans.

Given demand and related cost of therapy, it is no surprise that Option Care has moved to expand its toolbox through this acquisition.

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Option Care Health Completes Acquisition of Specialty Pharmacy Nursing Network Inc.

BANNOCKBURN, Ill., April 12, 2022 (GLOBE NEWSWIRE) — Option Care Health, Inc. (“Option Care Health”), the largest independent provider of home and alternate site infusion services in the United States, announced today that it has completed the acquisition of Specialty Pharmacy Nursing Network Inc. (“SPNN”). SPNN is a national leader in providing highly skilled specialty nursing resources across a broad portfolio of healthcare providers with over 400 nurses across the country.

The acquisition builds upon the market-leading nursing platform Option Care Health established with its acquisition of Infinity Infusion Nursing LLC (“Infinity”) to expand access to clinical resources across the United States. Leveraging Option Care Health’s national infrastructure, the acquisitions of Infinity and SPNN establish a more comprehensive clinical platform focused on delivering extraordinary care. The consummation of the SPNN acquisition expands Option Care Health’s nursing team to more than 2,900 nurses nationwide.

“I am thrilled to welcome the entire SPNN team to the Option Care Health family. SPNN’s track record of growth and clinical expertise is unsurpassed and highly complementary to our relentless focus on reimagining the infusion care experience. The acquisition is a critical strategic investment to further enable our future growth”, commented John Rademacher, Chief Executive Officer of Option Care Health.

Option Care Health acquired SPNN on April 11, 2022, for $60 million in an all-cash transaction. SPNN will maintain its current operations and continue to serve a broad array of infusion providers, specialty pharmacies and biopharmaceutical manufacturers as a separate enterprise within Option Care Health.

The FDA approved the 35th biosimilar last week, Alymsys (bevacizumab-maly) from Amneal Pharmaceuticals, for seven cancer indications of the reference product, Avastin from Genentech. It is an infused therapy, so specialty pharmacies won’t have much contact with Alymsys.

Alymsys joins two previously approved biosimilars to Avastin. Myvasi (Amgen, approved in 2017) and Zirabev (Pfizer, approved in 2019).

Patent concerns?
Patent battles were in full bore for years but Avastin did not have the dozens of patents to block competitor approvals as seen in other biosim cases. With the final patent issues resolved, doors are now open for the three biosimilars. Inroads into market share were slow on the uptake but are gaining share rapidly as competition will further gain payer preferences.

Follow the Money
Is all the wait worth it? In short, yes….. especially for Amneal which did not have to spend a mountain of cash on legal challenges. These biosimilars are being sold outside the US and are generating revenues for the biosim manufacturers.

Avastin isn’t the most expensive therapy in the cancer toolbox, but it isn’t cheap either at about $4,000 per cycle. Depending on cancer type and other clinical variables, a patient may receive as few as six cycles or as many as 22. By the way….. Avastin is still among the top selling drugs on the market. Nuff said….

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FDA Approves Amneal Pharmaceuticals’ Avastin Biosimilar, Bevacizumab-maly

April 13, 2022 — Amneal said the product, to be sold under the name Alymsys.
It is the second of 3 biosimilars the company expects earn approval in the US this year.

Amneal Pharmaceuticals Wednesday said the FDA approved the company’s Biologics License Application (BLA) for bevacizumab-maly, a biosimilar referencing the originator product (Avastin).

Amneal said the product will be sold under the name Alymsys. It is the third bevacizumab biosimilar approved in the United States.

Earlier this year, Amneal received approval of filgrastim-ayow (Releuko) which references Neupogen. The firm’s pegfilgrastim biosimilar referencing Neulasta is currently under FDA review.

Bevacizumab-maly was developed by mAbxience. The vascular endothelial growth factor inhibitor is indicated for the treatment of:

Metastatic colorectal cancer, in combination with intravenous fluorouracil-based chemotherapy for first or second-line treatment
Metastatic colorectal cancer, in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy for second-line treatment in patients who have progressed on a first-line bevacizumab product-containing regimen
First-line non-squamous non-small cell lung cancer, in combination with carboplatin and paclitaxel
Recurrent glioblastoma in adults
Metastatic renal cell carcinoma in combination with interferon alfa
Persistent, recurrent, or metastatic cervical cancer, in combination with paclitaxel and cisplatin or paclitaxel and topotecan
Epithelial ovarian, fallopian tube, or primary peritoneal cancer, in combination with paclitaxel

Avastin, made by Roche, brought in $7 billion for the company in 2018, according to Forbes.

The National Home Infusion Association (NHIA) recently published the results of a survey of patients who had received a home chemotherapy infusion to gauge their level of satisfaction across a number of metrics. The results show that these home infusion patients are very satisfied with services, understand medication instructions, and 89.54% of the patients completed their therapy with only 0.02% adverse reactions related to the administration.

National Home Infusion Association (NHIA) estimates that approximately 132,000+ patients annually received home infusions of chemotherapy agents since 2019 with the trend increasing. Given the criticism of home chemo infusions by hospital-based infusion providers it is not surprising that NHIA would want to ensure that their patients were satisfied with the home infusion experience.

The purpose of this study was to quantify the level of patient satisfaction and to determine any reason for discontinuation from home infusion services. The findings showed a very low rate of discontinuation with more than 90% completing therapy. Of those that did not complete therapy 8+-% died of non-administration-related causes or were hospitalized for non-administration-related causes.

As noted in the published table (click below), patient ratings were very strong in support of home provided services with the majority of metrics in the 90%++ range (strongly agree).

Some deeper evaluation is required related to two outlier results. Question 11, “I was satisfied with the overall quality of the home infusion services provided” dropped precipitously. NHIA points out that when the top two results are combined (Strongly Agree and Mostly Agree) the results increase to 97%. The score in Question 12 – “I would recommend home infusion to family and friends,” similarly suffered but fares much better when the top two options are combined. Future surveys may want to take a deeper dive in these areas to understand patient thinking or rephrasing certain questions.

Several questions relate specifically to the local home infusion company. However, others can be attributable to the specialty pharmacy providing both the therapy and critical services, e.g., authorization and billing (usually worked out before shipment of the drug to the home care company.) For example, in Question 3 patients are asked about delivery of the medication prior to the scheduled appointment. It received the third lowest score and indicates an opportunity for a specialty pharmacy quality improvement assessment.

CLICK HERE to read the full text of the report and VIEW THE TABLE

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Chemo at Home: High Rate of Satisfaction, Low Rate of Discontinuation

Overall, 97% of patients said they were satisfied with at-home chemotherapy infusions.

The following article features coverage from the NCCN 2022 Annual Conference.

Receiving chemotherapy infusions at home appears to be safe, and patients reported a high rate of satisfaction, according to research presented at the NCCN 2022 Annual Conference.

Most patients in the study completed at-home chemotherapy as planned, and none of them stopped treatment because of adverse drug reactions.

In a survey, most patients said they understood their medication instructions, were informed about potential side effects, and were satisfied with at-home chemotherapy.

Researchers assessed the safety of home chemotherapy infusions in 153 patients using 3 parameters — treatment completion, adverse drug reactions, and unplanned hospitalizations.

The researchers also surveyed 328 at-home chemotherapy recipients using a 12-question survey developed by the National Home Infusion Association. The survey responses were submitted between 2019 and 2021.

The survey used a Likert scale (“strongly agree” to “strongly disagree”), and the following answers are the highest rated option (“strongly agree”).

All patients said the home infusion pump was clean when delivered, and 99% said it worked properly. Most patients said they knew who to call for help (98%), responses to after-hours calls met their needs (86%), and the nurse or pharmacist explained the possible side effects of treatment (91%).

Nearly all patients said they understood the instructions on how to wash their hands (98%), give home infusion medications (97%), care for the IV catheter (97%), store their medications (96%), and use the home infusion pump (98%).

Jen Smith for Journal of National Comprehensive Cancer Network

Simpson MC, Haines DJ. Patient satisfaction and reason for discontinuation of home infusion for cancer patients. Presented at NCCN 2022 Annual Conference; March 31 – April 2, 2022. Abstract HSR22-168.