Remote clinical pharmacist impact on reducing total cost of care in Enhancing Oncology Model–enrolled oncology practices.

Abstract

1501 Background: The national cost of cancer care is estimated to exceed $245 billion by 2030, primarily due to the high cost of cancer drugs. The Enhancing Oncology Model (EOM) is a voluntary 6-month, 2-sided, risk-based payment model implemented by the Centers for Medicare and Medicaid Services (CMS) to improve cancer care while simultaneously reducing the total cost of care (TCOC). The US Oncology Network (The Network) comprises approximately 50% of all providers participating in EOM nationwide across twelve practice sites. In The Network, drug costs represented an average of 63% of a patient’s TCOC. This study aims to demonstrate the impact of a pharmacist in reducing TCOC in the EOM model. Methods: 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) to preferred products, use of a preferred PD-1 agent in metastatic NSCLC, decreased upfront usage of long-acting growth factor (GF) in metastatic cancer, and preferred use of zoledronic acid over alternatives. ClinReview pharmacists (CRP) remotely reviewed oncology treatment orders for cost-savings opportunities. CRPs updated eligible treatments per practice protocols or reviewed with the treating oncologist. Interventions were submitted by the CRP into a tracking system and marked as an EOM-related intervention. TCOC reduction was calculated using the difference between the CMS allowable for the original treatment ordered and the new order. Results: From July 1, 2023, to December 31, 2024, seven CRPs within five of The Network’s EOM participating practices evaluated over 5,600 patients for medication initiatives. A total of 1,271 interventions were identified, with 1,180 accepted. The sum of TCOC reduction amounted to 8,982,235. Further breakdown of each initiative and average TCOC reduction per intervention are shown in Table 1. In addition to the six initiatives, the CRP contributed an additional 1,201,326 in medication savings associated with drug selection. Conclusions: CRP’s medication initiatives within The Network’s EOM participation reduced TCOC by nearly $9 million across five practices. Key initiatives such as pembrolizumab dose banding and preferred use of zoledronic acid were the largest contributors. These findings demonstrate the potential for pharmacist-driven interventions to lower costs and drive the success of value-based care models in oncology practices. EOM Initiative n (%) TCOC Reduction, $ Average TCOC Reduction per intervention, $ moAB dose rounding 443 (35) 1,537,273 3,470 Pembrolizumab dose banding 106 (8) 1,962,105 18,510 TIC 356 (28) 1,510,945 4,244 Preferred PD-1 agent for NSCLC 26 (2) 153,117 5,889 Decrease GF use 37 (3) 109,822 2,968 Zoledronic acid use 181 (14) 2,157,895 11,992