The Community Oncology Alliance Patient Advocacy Network (CPAN) invites you to join us on Thursday, case October 27th from 12:00-1:00 pm EDT for a briefing regarding the potential interruption of access to needed oral medications to patients with cancer, stemming from recent actions by Pharmacy Benefit Managers (PBMs) and in particular, CVS Caremark, to restrict network access.
During the call you will hear about how this brewing crisis will impact millions of Medicare patients with cancer across the country as well as the long term systemic issues that will result.
Join us to learn why this significant change in care will negatively impact the patients served through your various foundations or organizations. We need your help and hope you can set aside an hour for this important and time-sensitive discussion.
When: Thursday, October 27th – 12:00 Noon – 1:00PM EDT
Where: To register and receive dial-in information, please email Johanna Hopkins at firstname.lastname@example.org. *Registration is required.
- Joshua Cox, Pharm.D., BCPS, Director of Pharmacy, Dayton Physicians Network
- Thomas Harwood, NSHOA Cancer Center, Long Island, NY
- Rose Gerber, Director of Patient Advocacy and Education, COA
- Mary Kruczynski, Director of Policy Analysis, COA
- Ted Okon, Executive Director, COA
Health insurers today frequently outsource administration of prescription drug benefits to Pharmacy Benefit Managers (PBMs), which are third-party entities responsible for contracting with pharmacies, negotiating rates, and processing drug claims.
The Pharmacy Benefit Manager (PBM) CVS/Caremark, a division of CVS Health, has announced that effective January 1, 2017 it will declare all cancer care clinics dispensing oral cancer drugs as “out-of-network” despite the fact that for the past 13 years they have been “in network.”
This recent action will force cancer patients to obtain their medication away from their site of cancer care. The immediate impact is a dangerous disruption in seniors’ cancer care, likely increasing treatment non-adherence and errors, as well as increasing costs. Perhaps most importantly, this decision does not benefit patients—it only serves CVS by pushing more business towards its specialty and mail-order pharmacies.
Today, when a patient is treated at a community oncology clinic and is prescribed an oral cancer drug, they can often receive it the same day during a single, integrated visit. When Pharmacy Benefit Managers (PBMs) require patients to mail-order cancer drugs there can sometimes be a delay of weeks, even up to over a month as the facility processes the claim and ships it out. For example, one patient recently faced a delay of 32 days before receiving their cancer medication. The typical turnaround time for a cancer medication to reach the patient from a mail-order pharmacy is 7-10 days.
Most concerning is that even as patients and providers are being warned of the change, there is no transition of care or continuity of care planning by CVS for the millions who are currently (or soon will be) undergoing active cancer treatment as of January 2017.
No other Pharmacy Benefit Manager (PBM) or major payer has taken this position. However, if CVS is successful, we anticipate that others will follow suit shortly. Time is of the essence – the CVS change will take place on January 1, 2017. It is critical that the cancer care community start raising awareness of this issue and making some noise!