Remote Clinical Pharmacist Impact on Reducing Total Cost of Care in Enhancing Oncology Model-Enrolled Oncology Practices.

Abstract

The Enhancing Oncology Model (EOM) is a voluntary, risk-based payment model implemented by the Centers for Medicare & Medicaid Services (CMS) to improve cancer care while reducing the total cost of care (TCOC). The US Oncology Network (The Network) comprises approximately 50% of all prescribers participating in EOM nationwide across 12 practice sites. In The Network, drug costs represented an average of 63% of a patient's TCOC. The aim of this study was to demonstrate the impact of a remote clinical pharmacist in reducing TCOC in the EOM. Medication initiatives were clinically evaluated and adopted at an individual practice level and included: monoclonal antibody (moAB) dose rounding, pembrolizumab dose banding, biosimilar therapeutic interchange (TIC), use of a preferred PD-1 agent, decreased up-front usage of long-acting growth factor in metastatic cancer, and use of zoledronic acid over alternatives. ClinReview pharmacists (CRPs) remotely reviewed oncology treatment orders for cost-saving opportunities and updated orders per protocols. Interventions were tracked by the CRP, and TCOC reduction was calculated using the difference between the CMS allowable for the original treatment ordered and the new order. From July 1, 2023, to December 31, 2024, seven CRPs within five of The Network's EOM participating practices evaluated over 5,600 patients. A total of 1,180 interventions were accepted, with moAB dose rounding and TIC being top contributors. The projected sum of TCOC reduction amounted to $8,982,235, or $1,604 USD per patient. In addition to the six initiatives, the CRP contributed an additional $1,201,326 USD in medication savings associated with drug selection. CRP's medication initiatives within The Network's EOM participation reduced TCOC by nearly $9 USD million, highlighting the potential for pharmacist-driven interventions to lower costs and drive the success of value-based care models in oncology practices.