Physician dispensing of oral specialty drugs for advanced prostate cancer and its implications for patients

PROJECT SUMMARY Nearly 35,000 succumb to advanced prostate cancer each year, making it the second leading cause of cancer death among men. The development of oral specialty drugs targeting specific molecules has led to a paradigm shift in which men can receive treatment for their prostate cancer at home. Oral specialty drugs, such as abiraterone and enzalutamide, have similar efficacy as physician administered chemotherapy with less toxicity and are the most common first-line treatment for advanced prostate cancer as of 2015. This new treatment paradigm has been accompanied by concurrent changes in in the delivery system. Increasingly, prescriptions for oral specialty drugs are dispensed directly by the urologist or medical oncologist in their office (referred to as “physician dispensing”). Patients may benefit from this delivery model as it places the onus for authorization and identification of financial assistance on the prescribing physician. Combined with the integration and coordination implied by dispensing at the point of care, this delivery model may improve access, timeliness and adherence to these specialty drugs. However, financial incentives associated with physician dispensing, through a margin generated by each prescription fill, may foster prescribing behaviors promoting utilization that undermine the value of this delivery system change, such as use of these therapies in patients with preexisting conditions that predispose them to adverse drug effects. To understand the implications of this delivery model for patients, we propose the following: (1) To measure the effects of physician dispensing on use of specialty drugs for prostate cancer; (2) To determine the impact of physician dispensing of specialty drugs for prostate cancer on financial outcomes and coping behaviors; and (3) To measure the relationship between physician dispensing of specialty drugs for prostate cancer and patient safety. Results from this study will have real-world implications for men with advanced prostate cancer, who are naturally interested in getting the highest quality cancer care while avoiding the financial consequences commonly associated with oral specialty drugs.