Recommended Citation
Atienza S, Aranda R, Clayton C, Winkler E, Hamm M, Kallenborn K. Outpatient Restricted Medications Workflow Optimization. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
Many oncology medications are restricted to outpatient (outpatient restricted medications [ORMs]) due to delayed pharmacologic effect and significant cost. To enforce restrictions and promote cost avoidance, we developed an appeals process for requests to administer ORMs in the hospital.
Purpose:
To standardize an appeals process in Wisconsin Advocate Health sites when oncologists request ORMs.
Methods:
A literature search demonstrated a lack of quality reviews and similar multidisciplinary appeals processes. The Pharmacy and Therapeutics committee determined the list of ORMs while involvement in the appeals process was decided to be best addressed by the oncology team. The original workflow was implemented in January of 2021. ORMs were identified by the pharmacist during order processing. Once identified, the pharmacists collaborated with the Oncology Medical Director and the site Chief Medical Officer to approve or deny administration. During utilization of this process, several discharge barriers were identified. This prompted involvement of other healthcare team members, including the Care Management Team and Physician Advisor, which began in July 2023. These teammates addressed the discharge barriers, and the financial implications associated with the consideration of the ORMs. Data collection was obtained prospectively through the electronic medical record, a patient roster Excel document, and a BI Power report to identify ORMs administered.
Results:
Data was compared yearly from 2021 to 2024. The percentages of ORMs not administered in the hospital compared to the total amount was 66.7%, 68%, 60.7%, and 69.2% for 2021, 2022, 2023, 2024, respectively. Most frequently considered ORMs over the 4 years were pembrolizumab, bevacizumab-awwb, and atezolizumab. As oncologists became familiar with the process, the percentage of pharmacist interventions decreased: 75%, 55%, 42.9%, and 17.3%, respectively. Cost avoidances resulting from denial of ORMs were over $204,000, $278,000, $281,000, and $335,000, respectively.
Conclusion:
A multidisciplinary process was successfully implemented to adhere to appropriate medication administration restrictions.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Outpatient Restricted Medications Workflow Optimization
Background/Significance:
Many oncology medications are restricted to outpatient (outpatient restricted medications [ORMs]) due to delayed pharmacologic effect and significant cost. To enforce restrictions and promote cost avoidance, we developed an appeals process for requests to administer ORMs in the hospital.
Purpose:
To standardize an appeals process in Wisconsin Advocate Health sites when oncologists request ORMs.
Methods:
A literature search demonstrated a lack of quality reviews and similar multidisciplinary appeals processes. The Pharmacy and Therapeutics committee determined the list of ORMs while involvement in the appeals process was decided to be best addressed by the oncology team. The original workflow was implemented in January of 2021. ORMs were identified by the pharmacist during order processing. Once identified, the pharmacists collaborated with the Oncology Medical Director and the site Chief Medical Officer to approve or deny administration. During utilization of this process, several discharge barriers were identified. This prompted involvement of other healthcare team members, including the Care Management Team and Physician Advisor, which began in July 2023. These teammates addressed the discharge barriers, and the financial implications associated with the consideration of the ORMs. Data collection was obtained prospectively through the electronic medical record, a patient roster Excel document, and a BI Power report to identify ORMs administered.
Results:
Data was compared yearly from 2021 to 2024. The percentages of ORMs not administered in the hospital compared to the total amount was 66.7%, 68%, 60.7%, and 69.2% for 2021, 2022, 2023, 2024, respectively. Most frequently considered ORMs over the 4 years were pembrolizumab, bevacizumab-awwb, and atezolizumab. As oncologists became familiar with the process, the percentage of pharmacist interventions decreased: 75%, 55%, 42.9%, and 17.3%, respectively. Cost avoidances resulting from denial of ORMs were over $204,000, $278,000, $281,000, and $335,000, respectively.
Conclusion:
A multidisciplinary process was successfully implemented to adhere to appropriate medication administration restrictions.
Affiliations
Aurora St. Luke's Medical Center, Aurora Sheboygan Memorial Medical Center, Advocate Christ Medical Center