Evaluating the Impact of Oncology Optimized Limited Distribution on Access to Oral Oncology Therapies

DOWNLOAD FULL WHITE PAPER

Prepared by Wafa Samara, PharmD, and Chris Lehmer, PharmD, MBA

This NCODA white paper evaluates how oncology pharmacy integration and distribution design influence real-world access to oral oncology therapies. Using dispensing data from the City of Hope integrated oncology pharmacy network, the analysis compares therapies distributed through Oncology Optimized Limited Distribution (OOLD) and open distribution pathways. Findings demonstrate how pharmacy integration, workflow coordination, and distribution strategy collectively shape therapy access, initiation, and ongoing patient engagement.

Case Study Overview

This analysis examined prescription activity for three later-line metastatic colorectal cancer therapies:

• Fruquintinib (OOLD distribution)
• Trifluridine/tipiracil (open distribution)
• Regorafenib (open distribution)

The City of Hope integrated oncology pharmacy model combines medically integrated pharmacies, specialty pharmacy services, and national mail-order capabilities to coordinate therapy access across the care continuum.

The evaluation explored operational and patient-centered metrics including:

• Prescription capture within the health system
• Successful dispensing (fill rate)
• Time to therapy initiation
• Treatment continuation and patient retention

Results demonstrate how integrated pharmacy workflows and optimized distribution networks influence medication access, care coordination, and long-term therapy engagement.

Key Insights from the White Paper

• Higher prescription capture with OOLD distribution. Fruquintinib demonstrated a 77.4% capture rate versus 53.3% and 49.4% for open distribution therapies, highlighting the value of retaining prescriptions within integrated oncology pharmacy programs.
• Higher fill rates within integrated pharmacy workflows. Fruquintinib achieved an 81.1% fill rate compared with 56.9% and 67.4%, demonstrating how coordinated benefits investigation, prior authorization, and financial assistance improve therapy initiation.
• Timely therapy initiation across integrated systems. Average time to fill was approximately 4 days for fruquintinib, comparable or faster than open distribution therapies.
• Improved treatment continuation and patient retention. 67.2% of patients receiving fruquintinib continued therapy beyond the initial dispense, compared with 58.4% and 33.3% for open distribution therapies.
• Affordability was not a primary driver of discontinuation. Average patient copays remained below $25 across therapies, emphasizing the importance of coordinated pharmacy support rather than cost alone.

Why This Matters for Oncology Practice

Oral oncology therapy access increasingly depends on how distribution models align with oncology care teams. This evaluation shows that distribution strategy directly influences:

• Care coordination and communication
• Administrative workload and workflow efficiency
• Speed of therapy initiation
• Long-term patient engagement and adherence

Models that include medically integrated oncology pharmacies help reduce fragmentation and support continuous patient management from prescription through treatment. As oral oncology continues to expand, distribution design should be recognized as a core component of high-quality cancer care delivery.

References

Meier CR, et al. Journal of Oncology Practice. 2018.
Fein AJ. American Journal of Managed Care. 2019.
National Community Oncology Dispensing Association (NCODA). Oncology Optimized Limited Distribution resources.
Takeda Oncology. FRUZAQLA real-world duration of therapy data (2023–2025).