Redefining Oncology Distribution

Advancing Medically Integrated, Patient Centered Care Through Oncology Optimized Limited Distribution

The number of available oral anti-cancer medications has steadily increased over the past two decades, with oral medications playing a major role in the treatment of multiple tumor types.1 Alongside this evolution, the medically integrated dispensing pharmacy (MIP) has become a best-in-class model for dispensing anti-cancer therapies while preserving a high standard of coordinated, patient centered care.

NCODA defines a MIP as a dispensing pharmacy within an oncology center of excellence that supports a patient-centered, multidisciplinary team approach.2 This model enables real-time communication across the care team, improves access to anti-cancer therapies, and enhances outcomes by keeping treatment within the clinic’s workflow. By integrating medication distribution directly into the oncology practice, MIPs streamline therapy initiation and monitoring, reduce treatment delays, and create a seamless experience for both patients and providers.3,4,5

While MIPs are well positioned to provide timely, coordinated care, their ability to dispense oral anti-cancer medications is often limited by how manufacturers choose to distribute their therapies.6,7 In some cases, manufacturers may include PBM-affiliated mail-order specialty pharmacies (PBM-SPs)—those vertically integrated with large PBMs and payers—as part of their distribution network. This can prevent MIPs from filling prescriptions in-house, forcing patients to receive medications from external pharmacies that are disconnected from their care team.7

Limited distribution networks (LDNs) were originally intended to ensure clinical expertise and oversight of specialty medications,8 but when PBM-SPs dominate these networks, it can disrupt continuity of care and delay therapy initiation. As more oral therapies come to market, the structure of these distribution networks plays an increasingly important role in the quality and coordination of cancer care.

This paper explores the interdependent relationship between the MIP and LDNs, highlighting how thoughtful distribution design can strengthen patient care and support optimal treatment outcomes. It also provides historical context for how these models have evolved and introduces updated terminology to bring clarity to the varying structures of LDNs across oncology.

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