Expert urologists discuss the impact of their formulary on prescribing abiraterone for metastatic castration-resistant prostate cancer (mCRPC), emphasizing its use in special patient populations and the importance of accessibility. They highlight the role of educational support and collaboration with manufacturers in facilitating access to treatments not typically included in the formulary, especially for unique patient groups. They emphasize the importance of manufacturer collaboration, Medicare changes, and specialized programs for aiding low-income seniors, underscoring the commitment to enhancing patient access and compliance in healthcare.
Christopher M. Pieczonka, MD: I want to shift gears. So we have the support. We have, you know, our APC navigators that help with that. We have pharmacy staff that are looking at sort of the day-to-day changes. I'm really excited for the Medicare changes coming. And I think in 2025, that cap is going to be able to be broken down into multiple payment options.
Jose De La Cerda, MD, MPH: So we'd be able to offer that as well. Thank you. A lot more of these therapies, and not just Abiraterone, I mean, a lot of these other sort of radioligand therapies coming down the pipeline, a lot of these new health developments (NHDs) that we're going to be maintaining here in our facility. Another thing I think that we need to focus on is sort of the manufacturer support. I mean, we try to collaborate with them, we try to get them within our practice, see what they can do to help us. Sometimes patients might not realize that they qualify for dual eligibility, that they might be a Medicaid patient as well, and that might help them. And so we try to team up with sort of manufacturer support to help them with that, to give them information, to help with foundations and things of that nature. Do you all use anything like that up in New York?
Christopher M. Pieczonka, MD: Yeah, we actually have a program called EPIC that's essentially for low-income seniors who are sort of in the donut hole where they can end up getting, it's not so much free drug, but a significant copay that the state helps kick in on. So that's useful and we will try and sign patients up for that. The other thing that we have been doing is we've partnered with a third-party agency to do chronic care management. So Medicare patients are eligible as part of their Medicare beneficiary to have chronic care managed through essentially nursing support and to help, you know, with any type of social development of care. So can't really do this on a non-Medicare, but Medicare patients with their consent are able to essentially have, you know, there's billing that can be done with a specific code. And we partner with a company that has registered nurses. And essentially, they're the ones who can help kind of coordinate care.
So in our particular region, you know, we have one of our offices near the Canadian border. It's almost the better part of three hours away. And so, you know, they can help sort of facilitate, you know, not so much paying for the ride but can we help assist with the county services that you have. Can we sort of share that with you and that's been something that's been, I think, beneficial. The hang-up on that originally was a lot of the chronic care management services don't use registered nurses and because we're in New York state, we need to kind of work through that. So that's been pretty helpful. Do you do something like that? Are you familiar with that?
Jose De La Cerda, MD, MPH: Yeah, that's a great point. I didn't even sort of consider that, but we've actually brought chronic care management in-house where we have a dedicated staff and team that's looking at patients with prostate cancer, they're ensuring compliance, they're ensuring that they are filling their prescriptions and that they are getting the treatment that they need. But it's not just prostate cancer, they're doing it for general urology, you know, managing their BPH, their OAB, their follow-ups, and we're able to do that for a lot of the Medicare patients. And they kind of reach out. We have a lot of Spanish-speaking patients here. We have Spanish-speaking chronic care management that's able to really talk to the patient and the family, ensuring that the patients are getting all the adequate needs that they need from us. And then patients love it. You know, if they miss an appointment, they can talk to the CCM team, and then they can get them in real quick to see us, probably overbook us.
Christopher M. Pieczonka, MD: That's the problem, but still it makes it easy for the patient. I mean, I think we're kindred spirits regarding research. The nice thing about research is I have more support, more resources that I can do when we see research patients. I found that the CCM is research-like, in particular, you said somebody that, you know, patients may not have a cell phone or they need to buy their minutes or, you know, how we can learn how to communicate with them to make sure they make their appointments you know and that type of thing. So that I think has really been a very good thing for our patients' care.
*Video transcript AI-generated and reviewed by Urology Times® editorial staff.