The recent reversal of prescription delivery flexibilities, which were permitted during the COVID-19 Public Health Emergency (PHE), has raised concerns in the medical community. A comprehensive study conducted by a group of Texas-based community oncology practices has shed light on the potential repercussions of this policy shift, particularly on at-risk cancer patients who heavily rely on home-delivered specialty medications. The study, focusing on the impact of the end of public health emergency oral dispensing flexibilities, emphasized the disproportionate effects on patients residing at considerable distances from health care facilities and those within communities facing significant health care disparities.

According to multiple studies, the integration of medically integrated pharmacies for oral cancer drugs has yielded positive results, enhancing patient adherence and reducing medication waste in comparison to external pharmacy services. However, anti-kickback regulations have limited the capacities of medical practices, especially in terms of delivering prescriptions to patients’ homes from physician offices. During the PHE, temporary flexibilities allowed physician-owned pharmacies to provide oral cancer therapies to patients unable to physically visit clinics. Nonetheless, with the termination of the PHE, the Centers for Medicare & Medicaid Services (CMS) decided to withdraw this flexibility, prompting a need to examine the consequences of this regulatory change on vulnerable patient populations.

Researchers analyzed the pharmacy database of a large statewide community oncology practice, specifically focusing on patients with Medicare Part D coverage who relied on home-delivered prescriptions during the PHE. The study team then evaluated the distance of these patients’ primary residences from the nearest clinic, followed by matching this data with the address deprivation index (ADI), a well-established approach for assessing varying needs across different zip codes.

The study identified a total of 970 patients who received home-delivered prescriptions under traditional Medicare Part D. Of these patients, 71% (687) resided within a 20-mile radius of the nearest clinic, while 22% (213) lived between 20 and 50 miles away. Furthermore, 7% (70) of patients lived more than 50 miles from the closest clinic, and 60 addresses could not be properly matched to the ADI database. When considering the ADI rankings, 40% of patients living within 20 miles of the clinic faced significant risks of disparity, a figure that rose to 67% for those residing 20-50 miles away and 61% for individuals living more than 50 miles from the clinic.

The authors concluded that the removal of flexibilities related to home prescription delivery is anticipated to impose a substantial burden on Texas-based patients by compelling many individuals to undertake long journeys to obtain essential cancer medications. Additionally, the study underscored the unequal impact of this policy change on patients situated farther from health care facilities and those residing within communities grappling with heightened health care disparities. To mitigate these challenges, the researchers urged policymakers to consider revising existing regulations to allow medically integrated pharmacies to continue home delivery services for cancer specialty drugs, thereby aligning with CMS’s overarching mission of promoting health equity.

Wilfong LS, Dave N, Hemmen W, Feinberg E, Doshi GK. Impact of the end of public health emergency oral dispensing flexibilities for at-risk patients in a community oncology practice. Presented at: the 2023 ASCO Quality Care Symposium; October 27-28, 2023; Boston, MA, and virtual; Abstract 209.