In the last year, the field of oncology has continued to grapple with significant challenges that have imposed formidable hurdles on cancer care worldwide.
Unforeseen disruptions in the pharmaceutical supply chain, compounded by increased demand and complex manufacturing processes, have contributed to a scarcity of crucial medications essential for cancer treatment. As early as May 2023, a litany of publications from NBC News, NPR, and The New York Times gained national attention regarding oncology medication shortages.
Further, The White House intervened, taking action to improve access to carboplatin, 5-fluorouracil and methotrexate. These shortages primarily encompassed first-line therapies, leaving oncology providers with limited options and potentially compromising patient outcomes.
Scope of intervention
In response to these challenges, Ochsner Health's pharmacy and oncology service lines engaged in urgent collaborative efforts to address the shortages at hand. The primary objective was to ensure that every Ochsner Health oncology patient received uninterrupted access to medications vital for each person's treatment and well-being.
The project focused on mitigating the effect of drug shortages on patient care by building robust relationships with wholesalers and suppliers to ensure a steady supply, prioritizing medication allocation based on clinical need and potential outcomes, and keeping all stakeholders informed and engaged throughout the process.
Inventory management and outcomes-based tiering
Ochsner Health implemented a comprehensive strategy to tackle the oncology drug shortages. Centralized tracking of drug supplies and daily reviews of system-wide inventory levels were crucial. This involved identifying the current inventory and delineating it into days on hand. Partnerships with Vizient and Novaplus Reserve provided access to alternative supplies and bulk purchasing options.
Developed by lead physicians and pharmacists, the outcomes-based tiering system categorized patients based on cancer type, stage, potential for cure or prolongation of life, and availability of alternative regimens.
The outcomes-based tiers allowed for the continuation of therapy for curative intent usage and rare cancer types without alternative therapy options. Providers could submit case-by-case tiering exception requests to a clinical leadership panel consisting of physicians and pharmacists in several specialties. Plans were discussed in oncology physician section head meetings, pharmacy leadership meetings and email communications.
Additionally, primary oncology providers were given talking points for discussions with patients regarding the drug shortage and action plan.
Monitoring and strategic sourcing
Weekly meetings between system pharmacy and physician leaders were held to review inventory projections and adjust the tiering system as necessary. Continuous manual updates of on-hand inventory, medication administration data and clinical assessments ensured optimal utilization.
These efforts ensured that patients with the best outcome potential could receive the appropriate therapy. Data analytics were used to benchmark supply chain performance and identify gaps. Collaborations with key vendors and manufacturers, along with the use of therapeutic alternatives, helped maintain drug availability.
These strategies were essential in maintaining a continuous supply of oncology medications during shortages.
Outcomes and impact
The strategy produced significant positive outcomes. Quantitatively, a 97% compliance rate with Novaplus contracts was achieved, maintaining rebate eligibility for four consecutive quarters.
The stable supply of 100% of critical oncology medications listed on drug shortage in 2023 allowed for over 2,200 administrations of 5-FU, 1,800 of carboplatin and 1,100 of cisplatin to successfully meet on-time treatment dosing for cancer patients.
Qualitatively, patient satisfaction improved, reflecting reduced anxiety and a better care experience.
Clinician confidence in treatment planning increased, leading to optimized therapeutic interventions and better patient outcomes. The initiative also maintained financial stability and the integrity of Ochsner Health cancer care services, preventing potential disruptions.
Ensuring a stable and consistent supply of oncology medications during a shortage is paramount for several critical reasons. First and foremost, uninterrupted access to these medications is essential for the well-being and survival of cancer patients, allowing them to receive timely and appropriate treatment without unnecessary delays.
Consistent medication supply enables oncologists to adhere to established treatment protocols, optimizing the effectiveness of therapeutic interventions and minimizing the risk of disease progression. Moreover, a reliable supply of oncology medications supports the development of comprehensive and personalized treatment plans, fostering better patient outcomes.
Beyond individual cases, a continuous supply contributes to the overall resilience of Ochsner Health, ensuring financial stability and maintaining the integrity of Ochsner Health cancer care services. This prevents potential disruptions that could strain cancer care in the state of Louisiana.
Ochsner Health's approach to mitigating oncology drug shortages stands out for its multifaceted and innovative nature. Combining advanced inventory management, strategic sourcing, data analytics and an outcomes-based tiering system created a comprehensive solution to the complex issue of drug shortages.
The extensive collaboration with Vizient, Novaplus, and internal stakeholders exemplifies a pioneering approach to leveraging collective resources and knowledge. Utilizing predictive analytics to anticipate and mitigate shortages proactively sets this strategy apart as a forward-thinking solution. The focus on sustainability through consistent contract compliance and cost-effective sourcing ensures long-term financial viability and resilience.
This initiative not only addresses immediate drug shortage issues but also establishes a scalable model that can be replicated across other areas of pharmacy practice, demonstrating its broad applicability and potential for lasting impact.
Conclusion
Ensuring a stable and consistent supply of oncology medications during a shortage is crucial for the well-being and survival of cancer patients. Ochsner Health's innovative strategy optimizes therapeutic interventions, supports comprehensive and personalized treatment plans, and enhances the resilience of healthcare delivery.
This approach upholds the standard of care, improves patient quality of life, and ensures the stability of healthcare services amidst challenging circumstances.
Ryan Pepper is the assistant vice president of pharmacy supply chain; Jessica Foy, PharmD, is the system oncology clinical pharmacy manager; Neil Hunter, PharmD, is the director of sterile drug compounding operations; and Audry Barrera, PharmD, is a pharmacy administration fellow. All work at New Orleans-based Ochsner Health.