Growth Spurt for In-House Pharmacy at Florida Group

OncLive Chairman,

Mike Hennessy

Despite all you hear about the war between specialty pharma and the independent oncology practice, it is possible for some independents to turn their in-house pharmacy operations into growth machines. Such a feat has been accomplished by Florida Cancer Specialists & Research Institute, a growing chain of independents that told Oncology Business Management for this month’s issue that the oral oncologic side of their business now represents 35% of their in-house pharmacy and could very well reach 50% in the next five years. This achievement with orals comes despite the efforts of specialty pharma and other industry players to capture new drug revenues by establishing single-source distribution.

FCS is a group of 90 practice locations and roughly 190 physicians that has come to dominate the Florida market for cancer services. It represents the largest independent oncology group in the country. Much of the growth in pharmacy at FCS stems from transformation of in-house dispensing activity at independents that joined the group. Previously, many of them did not dispense orals. That changed when they joined FCS. In addition, many wasteful practices were eliminated, including white-bagging. The practice of obtaining pre-paid drugs directly from specialty pharma for administration in doctors’ offices typically does not generate revenue for the physician but does add to the workload and leaves the physician liable for outcomes. Those interviewed by Oncology Business Management for our story this month on in-house pharmacy said they eschew this practice.

Among independents, FCS is leading the way on in-house pharmacy emphasis. They are building this business hand-in-hand with the development of their value proposition for the new age of cost-conscious, patient-centered care. When they go to payers and drug manufacturers with the argument that they should retain dispensing rights for new oncolytics, they make sure to mention that, as independents, they are cheaper than hospital systems. They also contend that by administering drugs they remain in control of the care process from start to finish, thereby ensuring a level of involvement and quality that specialty pharma may find hard to match. The next step of the value argument, of course, is proving that these assertions are correct—that quality of care and outcomes are indeed better and less wasteful. FCS is working on that, too.

As previously stated, this effort is paying off. Here is what Ray Bailey, RPh, pharmacy director for FCS, told Oncology Business Management: “When I came here six years ago, there was only a handful of drugs in the dispensary. I could see it on the horizon. The practice did. Our board and managing partners saw the potential out there, but I don’t think any of us thought it would get that big. I didn’t.” There’s potential for further expansion of in-house pharmacy, he said. “I think if you look at targeted therapies, it’s not just orals. There are monoclonals, and immuno-oncology, and, potentially, nanotechnology.”

Amid all of the talk of 340B drug program inequities, the talk of crushing pressure from large institutional players, such a level of optimism cannot help but be a shot in the arm for struggling independent oncology practices. Read all about this—and more—in this month’s Oncology Business Management.