Physician dispensing of oral specialty drugs for advanced prostate cancer and its implications for patients

项目总结 每年有近35000人死于晚期前列腺癌，使其成为第二大致癌原因 人类之间的死亡。针对特定分子的口腔专用药物的开发导致了一种范式 男性可以在家中接受前列腺癌治疗的轮班。口腔特效药，如 阿比特龙和苯扎鲁胺与内科医生化疗的疗效相似，毒性更小。 截至2015年，它们是晚期前列腺癌最常见的一线治疗方法。这种新的治疗方法 范式一直伴随着交付系统中的同步变化。越来越多的处方 口腔专科药物是由泌尿科医生或内科肿瘤科医生在其办公室直接配药(参阅 如“医生配药”)。患者可能会从这种交付模式中受益，因为它让授权承担了责任 以及对开处方的医生提供经济援助的身份。结合了集成和 通过在护理点分发所隐含的协调，这种交付模式可以改善访问、及时性和 坚持服用这些特殊药物。然而，与医生配药相关的经济激励措施， 通过每个处方填充产生的边际，可以促进促进利用的处方行为 破坏这种传递系统变化的价值，例如在既往存在的患者中使用这些治疗方法 使他们容易受到不良药物影响的条件。要了解此交付模式的含义 对于患者，我们提出了以下建议：(1)测量医生处方对专科使用的影响 前列腺癌药物；(2)确定医生调配前列腺癌专用药物的影响 癌症对经济结果和应对行为的影响；以及(3)测量医生和医生之间的关系 前列腺癌特效药的配发和患者安全。这项研究的结果将会在现实世界中 对患有晚期前列腺癌的男性的影响，他们自然对获得最高质量感兴趣 治疗癌症，同时避免通常与口腔特殊药物相关的经济后果。

PROJECT SUMMARY Nearly 35,000 succumb to advanced prostate cancer each year, making it the second leading cause of cancer death among men. The development of oral specialty drugs targeting specific molecules has led to a paradigm shift in which men can receive treatment for their prostate cancer at home. Oral specialty drugs, such as abiraterone and enzalutamide, have similar efficacy as physician administered chemotherapy with less toxicity and are the most common first-line treatment for advanced prostate cancer as of 2015. This new treatment paradigm has been accompanied by concurrent changes in in the delivery system. Increasingly, prescriptions for oral specialty drugs are dispensed directly by the urologist or medical oncologist in their office (referred to as “physician dispensing”). Patients may benefit from this delivery model as it places the onus for authorization and identification of financial assistance on the prescribing physician. Combined with the integration and coordination implied by dispensing at the point of care, this delivery model may improve access, timeliness and adherence to these specialty drugs. However, financial incentives associated with physician dispensing, through a margin generated by each prescription fill, may foster prescribing behaviors promoting utilization that undermine the value of this delivery system change, such as use of these therapies in patients with preexisting conditions that predispose them to adverse drug effects. To understand the implications of this delivery model for patients, we propose the following: (1) To measure the effects of physician dispensing on use of specialty drugs for prostate cancer; (2) To determine the impact of physician dispensing of specialty drugs for prostate cancer on financial outcomes and coping behaviors; and (3) To measure the relationship between physician dispensing of specialty drugs for prostate cancer and patient safety. Results from this study will have real-world implications for men with advanced prostate cancer, who are naturally interested in getting the highest quality cancer care while avoiding the financial consequences commonly associated with oral specialty drugs.