Cancer docs: NY’s new prescription rules threaten to interrupt patient care (Guest Opinion)
The following commentary is co-authored by Dr. Makenzi Evangelist, medical oncologist at Hematology Oncology of New York, serving the Albany region and secretary of the Board of Directors; Dr. Karen Tedesco, Medical Oncologist and NYOH board vice chair; Dr. Tarek J. Sousou and Dr. Anthony J. Scalzo of Hematology Oncology Associates of CNY, serving the Central New York region.
As oncologists, one of the most important things we can offer our patients is a clear and complete treatment plan tailored to their individual needs. As a puzzle board, we work with the patient to develop the best treatment plan for their disease. These pieces are brought together by experience, training, education and research to formulate the most appropriate drug regimen for each patient. If any of these pieces are missing, most importantly, direct oversight of the treatment plan, care is compromised and leads to poorer patient outcomes.
Both physicians and patients deserve access to a variety of options that can be applied to address the complexities of a patient’s cancer diagnosis. However, the New York State Department of Health has implemented a policy change that directly affects Medicaid recipients’ access to the care they deserve: Medicaid patients can no longer fill oral cancer prescriptions at their doctor’s offices. theirs. Instead, they must use a mail order pharmacy.
When we think of a cancer diagnosis, our thoughts gravitate toward treatments like intravenous chemotherapy and radiation. Over the past few years, oral cancer drugs have also become more prominent in patients’ treatment plans. Using the clinics’ physician dispensing services, patients can easily access their oral cancer medication locally with the support and guidance of trained clinical staff, including nurses and pharmacists. This helps ensure timely and safe administration and provides patient-specific counseling and guidance to mitigate side effects.
The personal connection the patient has with the entire care team is paramount. We are the faces they get used to seeing when their treatment begins and we are the experienced practitioners who answer their questions and concerns. Providing patients with the comfort and confidence they need to work through their cancer diagnosis is imperative. It builds morale and reassures patients that their oncology team is closely managing their treatment plan.
Removing a patient’s access to a physician’s prescription disrupts their physician’s treatment plan and causes an unnecessary disruption to the patient’s medication regimen. Replacing this service with mail order pharmacies comes with concerns. Mail order services ship from remote pharmacies, which can delay delivery and disrupt the synchronization of patients’ medications with their course of treatment. In addition, mail-order services may not be timely with necessary dose adjustments or be familiar with changes in patient health status. Cancer patients may be prescribed different medications during their treatment plan, with dosage changes often made based on response to therapy or to minimize side effects. What does a patient do if the mail order pharmacy sends an outdated medication because it does not have access to the most up-to-date patient information? This can delay the initiation of a new dose and lead to unnecessary waste and increased costs for the patient and the health care system when the apparent purpose of the policy change is to reduce costs.
If the patient cannot receive his medication directly from the oncologist, the treatment becomes fragmented. Oncologists, nurses and pharmacists are intricately involved in educating patients about their medication and how to self-administer it safely at home. Mail order pharmacies may contact the patient about the medication and provide conflicting information that was specifically prescribed by the physician, leading to confusion and increased patient anxiety. The oncologist understands the purpose of the patient’s treatment plan and how oral cancer therapies are incorporated into intravenous cancer treatment protocols, whereas mail order services lack the knowledge and expertise to make these important contributions. In addition, physician dispensaries offer guidance on financial assistance programs, unlike mail order services.
For the safety and well-being of cancer patients, oncologists must manage the entire treatment protocol without interference from custom pharmacies. New Yorkers who receive Medicaid should have the right to access available services that will simplify their care. New York can and must do better. Protect their access. Save their lives, New York.
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