PROJECT SUMMARY/ABSTRACT: Project 4 - Care Integration for Patients with Cancer Using Specialty Pharmacies This project aims to examine the integration of specialty pharmacies into systems/hospitals and independent practices and its impact on patients’ use of and adherence to orally-administered anticancer and supportive care drugs. Health care systems and independent practices have increasingly opened their own specialty pharmacies or are increasingly contracting with off-site contract pharmacy services—forms of structural integration. Alternatively, health systems or practices may work with specialty pharmacies that are completely independent. This Project will examine the extent to which pharmacy services are integrated into practices (in the presence and absence of structural integration) and the role of specialty pharmacies in working with oncologists and patients to ensure that patients can access, initiate, and adhere to prescribed oral anticancer medications and supportive care medications. This Project also will work closely with Project 1 to consider the impact of hospital 340B discounts on structural integration as systems open on-site pharmacies or contract with off-site pharmacy services. Working with Projects 1, 2, and 3 and the Cores, the team will conduct case studies to adapt an existing conceptual framework of integration to oncology care relevant to this setting. The team will survey leaders, managers, clinicians, and staff in systems, practices, and specialty pharmacies (including in-house and independent specialty pharmacies). The team will use administrative data from Medicare, Medicaid, and commercial insurers to describe key outcomes, including the proportion of patients filling oral anticancer drugs, time from visit to orally-administered anticancer medication fill among those who initiate treatment, and medication adherence among those who initiate treatment. We will assess the association of various forms of integration on these outcomes. The aims mirror the overall Project aims: Aim 1: Adapt an existing conceptual framework to describe key forms of integration (i.e., structural, functional, normative, interpersonal, process) for pharmacy services for patients with cancer who may benefit from oral anticancer medications. Identify mechanisms through which forms of care integration may produce better outcomes and more equitable care. Aim 2: Measure care integration in practice sites and specialty pharmacies and assess relationships among different forms of integration. Determine if and how integration varies by practice characteristics (e.g., 340B discounts, proportion of marginalized patients) and market factors (e.g., competition, payer mix). Aim 3. Assess the association of practice and specialty pharmacy integration with medication use outcomes and assess mechanisms through which integration improves or worsens outcomes and equitable care for marginalized subgroups based on race and ethnicity and residence in rural or...