UPJ INSIGHT Effects of In-office Dispensing by Single-specialty Urology Practices on Management of Advanced Prostate Cancer
By: Lillian Y. Lai, MD, University of Michigan Medical School, Ann Arbor; Samuel R. Kaufman, MS, University of Michigan Medical School, Ann Arbor; Mary Oerline, MS, University of Michigan Medical School, Ann Arbor; Megan E. V. Caram, MD, Veterans Affairs Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Michigan, University of Michigan Medical School, Ann Arbor; Avinash Maganty, MD, University of Michigan Medical School, Ann Arbor; Vahakn B. Shahinian, MD, University of Michigan Medical School, Ann Arbor; Brent K. Hollenbeck, MD, University of Michigan Medical School, Ann Arbor | Posted on: 18 May 2023
Lai LY, Kaufman SR, Oerline M, et al. Effects of in-office dispensing by single-specialty urology practices on management of advanced prostate cancer. Urol Pract. 2023;10(3):229-235.
Study Need and Importance
As management of advanced prostate cancer has evolved to include novel oral targeted therapies, urology practices have become interested in providing these therapies directly to patients through in-office dispensing–a form of care delivery that allows prescriptions to be dispensed on-site or through a pharmacy owned by the practice. However, the scope of this new delivery model and its effects on utilization are unknown.
What We Found
In-office dispensing increased from 1% to 30% of single-specialty urology practices from 2011 to 2018, with 28 practices adopting dispensing in 2015 (see Figure). Prescriptions for abiraterone and/or enzalutamide increased almost 9-fold among practices with dispensing and 2-fold among practices without dispensing. Although the number of prescriptions increased, the volume of patients with advanced prostate cancer managed by practices did not change after adopting in-office dispensing.
Our findings must be considered in the context of several limitations. First, our sample is limited to Medicare beneficiaries and our findings may not be generalizable to younger and commercially insured patients. Second, we only focused on the changes surrounding the year before and after adoption of in-office dispensing. Third, we are unable to account for potential imbalances in the severity of metastatic disease between practices, which may influence treatment decisions.
Interpretation for Patient Care
In-office dispensing resulted in an increase in the number of prescriptions for oral targeted therapies for men with advanced prostate cancer. As this model of care delivery is increasingly adopted by urology practices, it will be important to understand its effects on quality and patient out-of-pocket costs.