In this new Urology Medical Perspectives series, “Expert Perspectives on Advanced/Metastatic Prostate Cancer,” key experts in managing hormone-sensitive or castration-resistant prostate cancer share insights into advancements in the field, including considerations on using various leuprolide formulations for advanced or metastatic prostate cancer. In this interview, Benjamin H. Lowentritt, MD, FACS, from Chesapeake Urology Associates in Baltimore, Maryland, discusses different leuprolide formulations and the financial and operational challenges associated with their use in a medical practice.
Urology Times®: Does your institution have more than 1 type of leuprolide formulation on formulary? Do you typically specify a particular regimen when writing prescriptions?
LOWENTRITT: Currently, we offer both types of leuprolide acetate in our practice for all the different intervals that they're provided. We certainly want to allow for our physicians to have [a] choice across the platform to cater care toward any patient’s needs. That's always been our approach to it, both in duration of the depot preparations as well as the particular agent that's being used.
Urology Times®: Do you think that cost is a barrier for providing leuprolide to patients? How does the cost compare across the individual formulations?
LOWENTRITT: When you're talking about cost, there are 2 [issues]. The cost to the patient should be the same, because [use of all formulations is] essentially billed the same. To the payer, [it all looks] the same. The cost to the practice can be different. On a certain level, yes, that is important, because, as a practice, we don't want to be underwater on a treatment or have any risk of losing money on a therapy that we're trying to offer. In many cases, we're doing these as a buy-and-bill, so they're provided in our practices. We're on the hook for the cost side, as well, so that does have an impact in certain cases. Our goal is always to offer everything to our patients and to our doctors to use, but it is important to be aware of the cost to the practice.
Urology Times®: Which team members at your practice address challenges specific to leuprolide prescriptions, such as those related to coding, prior authorization, and billing and reimbursement?
LOWENTRITT: We have a number of teammates [who] are involved throughout the whole process [of providing] leuprolide. Certainly, our operations team is involved in scheduling and ordering, since we provide these [agents] in our office settings; [this team] is involved from the get-go. Our procurement team is involved in making sure [that] we have the correct supply in the correct place. We have a prior authorization team that authorizes every injection given [so] that we have a fresh authorization, even if a patient's been on longstanding therapy or maybe getting it multiple times a year. We always want to make sure [that] those are updated. And then, of course, our billing and reimbursement team follows through on any of that aspect [throughout] the course of treatment. It is a multidisciplinary team in that respect.
Urology Times®: What are some of the strategies that you use in your practice to address these challenges?
LOWENTRITT: To make the injection process flow as [smoothly] as possible, it takes effort across the whole practice. As I mentioned earlier, it's important to actually have the right product in the right office for the right patient. We're a practice [with] a number of locations, so [it] is essential [to] make sure that the initial communication is done correctly so that the right medication is available when the patient's actually coming in. [It is also important to] make sure that the prior authorizations happen so that the patient isn't coming in too early for their therapy, where there might be a question of whether it would be reimbursed. That's a component, as well. Of course, [we also] make sure that we follow through on the clinical aspect to make sure that the therapy [is] appropriate for the patient. That's always [a] critical first step.
We have our teams looking forward several weeks to make sure that we're ordering the correct preparations at the right time. We certainly don't want to have a very large inventory. Some [formulations] require refrigeration, [and] some require mixing. There's an expense to just holding onto the medication, so we want to make sure that we're keeping up with and staying slightly ahead of our demand while not becoming overloaded with a certain amount of a particular formulation. It takes a fairly well-oiled group mentality to pull this off in the most effective way.
Transcript has been edited for clarity.