The Impact of Multistep Order Transmittal (MSOT) within a Non-340B Specialty Pharmacy at a Comprehensive Cancer Center



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Purpose. Specialty pharmacy is a complex field that has been described as the fastest growing segment of the pharmaceutical industry. At MD Anderson Specialty Pharmacy, an initial review of preliminary data demonstrated that increased pharmacist time was spent on prescription transfers each month, largely due to payer-mandated specialty pharmacy requirements. Because of this, the decision was made to utilize a functionality within Epic known as Multi-Step Order Transmittal (MSOT) to aid in triaging prescriptions to the appropriate specialty pharmacy at the beginning of the prescribing process. The purpose of this study is to determine the impact of MSOT on specialty pharmacy services within a non-340B institution.

Methods. This study is a retrospective cohort study comparing outcomes pre- and post- MSOT implementation. Prescription data over a 6-month period (August 2021-January 2022) was obtained from MD Anderson’s EHR database and analyzed as pre-intervention data and compared to 6-month post-intervention data (August 2022-January 2023). The primary objective of the study was to analyze the impact of MSOT on oral oncology prescriptions through the specific endpoint of prescription fill rate pre- versus post-MSOT implementation. Secondary endpoints included potential capture rate, prescription turnaround time, impact on pharmacist workload, and identification of areas of further growth for MD Anderson Specialty Pharmacy.

Results. The pre-intervention group included 12,647 prescriptions, prescribed between August 1, 2021 and January 31, 2022. The post-intervention group included 15,716 prescriptions, prescribed between August 1, 2022 and January 31, 2023. The primary analysis showed a significantly higher prescription fill rate post-MSOT implementation compared to pre-MSOT (82.94% vs. 93.14%, p = 0.002). Despite an increase in prescription fill rate, secondary analyses revealed that there was not a significant difference seen in MD Anderson Specialty Pharmacy prescription turnaround time with the use of MSOT (1.29 days vs. 1.54 days, p =0.077). Potential prescription capture rate significantly increased from 41.4% to 51.4% (p = 0.002). 61% of prescriptions that could not be filled at MD Anderson Specialty Pharmacy were due to insurance plan requirements. Using an institutionally-accepted metric of 12 minutes per transfer circumvented, the post-MSOT data shows that 0.24 pharmacist FTE was saved and thus could be reallocated to other specialty pharmacy activities.

Conclusion. In conclusion, this study shows that the implementation of MSOT can positively impact the oral oncology prescribing process by increasing prescription fill rate while decreasing pharmacist time spent performing prescription transfers.



Specialty Pharmacy, Multistep Order Transmittal, MSOT