Lucio Gordan, President and Managing Physician at Florida Cancer Specialists and Research Institute, shared a post on LinkedIn:
“Thank you NCODA / ASCO authors of this paper including Florida Cancer Specialists and Research Institute experts on the matter. Your work and parameters put the necessary expectations and boundaries for a truly integrated pharmacy dispensing. It is about quality and access.
1. The article establishes updated standards for medically integrated dispensing (MIP) within oncology practices, emphasizing the safe, timely, and coordinated delivery of oral anticancer and supportive-care medications.
2. MIP is defined as a dispensing model embedded directly within the oncology care team, in contrast to fragmented models using external mail-order or retail pharmacies that operate independently of clinical workflows.
3. The rationale for MIP is driven by the expansion of oral oncolytics with complex dosing, narrow therapeutic windows, and significant toxicity monitoring requirements that benefit from integration with oncology clinicians.
4. The authors highlight problems documented with non-integrated dispensing: treatment delays, inadequate communication, inconsistent medication reconciliation, lack of rapid toxicity management, and patient confusion about regimen requirements.
5. Increasing reliance on oral anticancer therapies places more responsibility on patients, making robust, clinically coordinated pharmacy oversight essential for ensuring adherence, safety, and persistence.
6. The paper proposes core standards for MIP programs: comprehensive medication reconciliation at each cycle, pharmacist–clinician collaboration, standardized toxicity and adherence assessments, and structured patient education at each dispensing or refill.
7. Operational expectations include compliance with pharmacy regulations, secure chain-of-custody processes, inventory controls, documentation, billing accuracy, and integration of pharmacy functions into the oncology practice’s clinical systems.
8. The article describes potential benefits of MIP: improved safety, fewer treatment interruptions, enhanced patient satisfaction, more efficient supportive-care dispensing, and better clinical oversight of evolving toxicity or polypharmacy.
9. Implementation challenges include staffing needs, financial sustainability, payer restrictions favoring external specialty pharmacies, administrative load, and the infrastructure necessary to align pharmacy and oncology operations.
10. The authors emphasize the need for robust, prospective comparative studies assessing MIP versus external specialty pharmacy models with endpoints such as adherence, toxicity events, hospitalization rates, time-to-treatment, and overall clinical outcomes.”
Title: Medically Integrated Dispensing Pharmacy: ASCO-Network for Collaborative Oncology Development and Advancement Standards Update
Authors: Luis E. Raez, Xylina T. Gregg, Gurjyot K. Doshi, Scott Freeswick, Austin Cox, Neal Dave, Kashyap B. Patel, Melissa S. Dillmon, Stuart Genschaw, Elizabeth V. Bettencourt, Eileen Peng, Elizabeth Bell, Stacey McCullough, Bill Wimbiscus, Michael Reff
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