NCODA Perspective: Protecting Access to Oncology-Optimized Limited Distribution Drugs 

Authors:
Jonas Congelli, RPh, Associate Executive Director, NCODA
Sharita Howe, PharmD, Director of Partner Strategy & Development, NCODA 

As oncology treatment becomes increasingly personalized, the role of medically integrated pharmacies (MIPs) in supporting patients through complex regimens has never been more essential. However, access to oral anti-cancer medications—particularly those classified as oncology-optimized limited distribution (OOLD) drugs —is being increasingly jeopardized by evolving pharmacy benefit manager (PBM) practices, and lack of understanding of the MIP model and the impact on patient care outcomes. 

At NCODA, we’re hearing more frequent reports from members that PBMs are diverting OOLD prescriptions away from MIPs to preferred specialty pharmacies, citing an inability to verify the MIP as “in-network.” While the specific reasons for this breakdown are not always clear, one concern raised is that PBMs may not be aware that certain MIPs are authorized to access these therapies.   This may stem, at least in part, from communication gaps between manufacturers and PBMs regarding which MIPs are authorized

The result? Delays in patient care, increased administrative burden on clinical teams, and diminished capture rates for in-house pharmacies that play a critical role in supporting patients through treatment. This issue is not only about access—it’s about continuity of care and patient safety. 

What We’re Doing 

In response to these challenges, NCODA recently convened a multi-stakeholder roundtable, bringing together pharmacies, manufacturers, and access leaders to examine root causes and potential solutions. While this is a complex issue, we are committed to proactive action. 

Our immediate next steps include: 

• Exploring a centralized, vetted MIP list that can be shared with PBMs and manufacturers to affirm network participation 

• Creating a standardized letter that MIPs can use when access is challenged, clearly outlining their eligibility and role 

• Developing consistent language for manufacturers to include in product materials that reflect the value of MIPs in care delivery 

We are also encouraging our manufacturer partners to consult with their legal and compliance teams about feasibility, and to collaborate with us in identifying additional strategies to protect MIP access. 

Why This Matters 

If we allow opaque network rules and inconsistent PBM practices to undermine access, patients are the ones who suffer. NCODA is committed to defending the role of medically integrated oncology care, and ensuring our members can continue to deliver the highest standard of care without unnecessary barriers. 

We look forward to sharing more updates and invite members to connect with us if they’re experiencing similar challenges.  Together, we can amplify the voice of oncology providers, protect access to critical therapies, and most importantly, advocate for the patients at the center of it all.