Impact of In-Office Dispensing Adoption by Urology Practices on Oral Specialty Drug Use in Advanced Prostate Cancer

A paradigm shift in advanced prostate cancer toward the use of oral specialty drugs has been accompanied by increased involvement of urologists. In fact, some urology groups can deliver these medications in the office, providing them directly to their patients.

A retrospective cohort study was performed using a 20% national sample of men with advanced prostate cancer enrolled in Traditional Medicare and managed by independent urology groups between 2011 and 2019. Urology groups with and without in-office dispensing were identified. Multivariable logistic regression was used to assess relationships between urology group characteristics and in-office dispensing. A difference-in-differences design was used to measure the effect of in-office dispensing on the use of oral specialty drugs within urology group markets compared to markets without dispensing.

Urology group characteristics associated with adoption of in-office dispensing included large practice size (OR 2.9, 95% CI 1.2-6.5), increasing volume of men with advanced prostate cancer (OR 1.1 per 10-patient increase, 95% CI 1.0-1.2), decreasing social vulnerability of the group's patient population (OR 0.81 per 0.1 unit increase, 95% CI 0.69-0.95), lower competition (OR 1.02 per 100 unit increase in the Herfindahl-Hirschman Index, 95% CI 1.0-1.1), and radiation vault ownership (OR 3.1, 95% CI 1.1-8.4). Compared with markets of urology groups that did not adopt in-office dispensing, adopting markets experienced a significant increase in oral specialty drug prescriptions (adjusted difference-in-differences estimate, 46 prescriptions per 1000 men, p < 0.001).

Adoption of in-office dispensing by independent urology groups increased oral specialty drug prescriptions for advanced prostate cancer within a group's market.