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
Caring for Cancer Patients is a PRIVILEGE
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
Caring for Cancer Patients is a PRIVILEGE
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)
Caring for Cancer Patients is a PRIVILEGE
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
Caring for Cancer Patients is a PRIVILEGE
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
Caring for Cancer Patients is a PRIVILEGE
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
Caring for Cancer Patients is a PRIVILEGE
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
Caring for Cancer Patients is a PRIVILEGE
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
Caring for Cancer Patients is a PRIVILEGE
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
Caring for Cancer Patients is a PRIVILEGE
In-Office Pharmacy:
Should Every Practice Have
One?
Barry Russo, MBA, Chief
Executive Officer, The Center for
Cancer and Blood Disorders
Lessons Learned
RETAIL PHARMACY
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 SCOPE
LESSONS 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 SCOPE
LESSONS LEARNED
Flu Clinics
 340B Contract Pharmacy
 Nutritional Supplements
 Mail order

OPERATIONAL PROCESS
LESSONS 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

SPACE
LESSONS 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
 Selling
Gel
the MA’s, Nursing and Support Staff
 Nutritional
Supplements
 Pre Chemo Meds
 “In
Network” for employees
 Agenda item for every Board Meeting
MARKETING
LESSONS 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 PERSISTENCY
LESSONS LEARNED

Why is it important?
 Specialty
Pharmacy Competition
 Win – Win
 Need a Process/System
 Support Outcome Measurement
 Provide Pharma Support
 Patient Portal Opportunity
SUMMARY THOUGHTS
LESSONS 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

In-Office Pharmacy:
Should Every Practice Have
One?
Gitesh Patel, Chief Executive
Officer, Sargas Pharmaceutical
Adherence and Compliance
International
Transforming Patient Care through Data Transparency and Analytics
www.spacinternational.com
No matter what the circumstances,
we will help you take your prescribed drugs on
time
www.spacinternational.com
Automation delivers Adherence & Compliance
Current Model
Payer
Oncologist
Insurance Eligibility
Patient Assistance Programs
Adherence &
Compliance Programs
Pharmacies
Patient
Co-Pay Assistance
Adherence and Compliance
Communications
Disease/Treatment
Understanding
Side Effect Management &
Reporting
www.spacinternational.com
Automation delivers Adherence & Compliance
SPAC Model
Payer
Insurance Eligibility
Patient Assistance
Programs
Pharmacies
Oncologist
Patient
Co-Pay Assistance
Adherence &
Compliance Programs
Adherence and Compliance
Communications
Disease/Treatment
Understanding
Side Effect Management &
Reporting
www.spacinternational.com
Automation delivers Adherence & Compliance
SPAC 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.
www.spacinternational.com
Automation delivers Adherence & Compliance
SPAC Model
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.
www.spacinternational.com
Automation delivers Adherence & Compliance
SPAC Model
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
www.spacinternational.com
Delivering better patient outcomes
while having fun!!
www.spacinternational.com
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.
www.spacinternational.com
A day in the life of a Cancer Patient.
Infusion
Transfusions
Lab Tests
Biopsy
Radiation
Chemo
Psychological stress
Financial
Stress
Imaging
studies
Holistic
therapy
Clinical
Trials
Family Stress
www.spacinternational.com
Automation delivers Adherence & Compliance
SPAC Model
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
www.spacinternational.com
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.
www.spacinternational.com
Automation delivers Chronic Care Management
SPAC Model
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.
www.spacinternational.com