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Wholesale Supply Channels: Impact of COVID-19 on Cancer Care and the Road to Recovery

May 2020 Vol 13, No 2 - AVBCC COVID-19 Highlights, COVID-19
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The series of webcasts on COVID-19 from the Association for Value-Based Cancer Care (AVBCC) included a recent presentation titled “Wholesale Supply Channels: COVID-19 Impact on Cancer Care and Road to Recovery.” This webcast included a panel of healthcare experts who focused on wholesale supply channels for the distribution of drugs and medical or surgical supplies to community oncology care providers.

Several common themes emerged as the panel explored the challenge of ensuring an uninterrupted flow of crucial materials to the areas with the greatest demand during the ongoing coronavirus crisis. They stressed that patient care must remain the most important goal in the face of the unique challenges wrought by the pandemic.

The thought leaders agreed that the primary focus must be on the continued supply of drugs for patients with cancer, despite a surge in the demand for some oncology drugs that are also being used to treat manifestations of the virus.

Another common theme centered on the challenges that all healthcare stakeholders face as they attempt to sustain their financial viability—including the distributors, the community practices they serve, and the drug manufacturers. The experts recognized that all stakeholders are making accommodations as they confront “the new normal.” There was also consensus that financial instability anywhere in the healthcare distribution chain would have an adverse effect on businesses as well as on the delivery of patient care.

AVBCC Founder and webcast series moderator, Burt Zweigenhaft, Hon PhD, DLitt, noted that it takes an “extreme amount of coordination to produce quality cancer care” from the manufacturers, to the representatives, and to the warehouse workers who pack and ship the orders. “One of the unusual things is that there is usually very predictive movement in the wholesale distribution chain, but there is nothing predictive about COVID-19; the channel has been strained from top to bottom all along the chain,” he said.

“Clearly, the whole pandemic has injected—or maybe revealed—the risk in the supply chain, given the international nature of pharma and biotech ingredient sourcing and manufacturing,” said Kevan Corbett, VP/GM, GPO Services & Business Solutions, McKesson. Mr Corbett added that McKesson has been in constant communication with suppliers to diversify supply and carry additional inventory to ensure that patients with cancer will continue to receive their medications.

“Supply is one side, but demand spike is another, and with the event of the pandemic, it has spiked the demand in unprecedented ways, especially for drugs that show promise in the treatment of COVID-19,” said Mr Corbett.

He noted that case studies showing that Bruton ­tyrosine kinase (BTK) inhibitors may protect against pulmonary injury in patients with COVID-19 have led to an increase in demand for the currently available BTK inhibitors.

Although this increased demand would ordinarily be a healthy aspect of the business, Mr Corbett said, “We still have an obligation to our clinic customers and their oncology patients not to disrupt their access to meds.” He therefore monitors for unusual purchases to ensure that cancer treatments can proceed uninterrupted.

One consequence of social distancing is the steep decline in new cancer diagnoses and new patient visits, according to Mr Corbett. He said that this foreshadows a downturn in fiscal activity that will add stress to community cancer providers.

Brian Ansay, President, Specialty Physician Services ION Solutions & IPN Solutions Group Purchasing Organizations, AmerisourceBergen, continued the discussion, saying that he and his associates have been spending considerable time trying to understand the market and the pressures on community oncology practices and have been monitoring the hot spots that have been hardest hit by the virus. He noted that community oncology practices are facing unprecedented challenges, with the shuttering of medical offices, personnel shortages, and a decrease in the number of office visits.

Mr Ansay said that June and July could prove to be difficult months, as practices attempt to get patients into surgery and treatment after the long delay. “People are thinking creatively about the new challenges,” Mr Ansay said. He further stressed that the number one goal is to ensure the continued viability of community oncology practices.

“At the end of the day, we all have a responsibility ultimately to keep practices viable to treat the vulnerable patients who are out there,” he concluded.

Mick Besse, MBA President, AmerisourceBergen, Besse Medical, discussed the supply shortages related to essential personal protective equipment (PPE) for healthcare workers, including masks, gowns, gloves, and other protective gear. He observed that to a large extent, the supply channel for these products originates outside of the United States. Although manufacturers have stepped up to meet increased demands for these products, and the supply chain is highly regulated to prevent gray market product infiltration, some suppliers with illegitimate products still creep into the distribution chain. The ongoing challenge will be to identify sources for PPE that are consistent and legitimate.

Mr Besse added that although most businesses had emergency plans in place before the pandemic, those plans were designed with individual emergencies in mind, not with the expectation that everyone would need to put their plans into play simultaneously. All stakeholders in the supply chain are now struggling with the same problems—how to pay vendors, keep employees, and serve their shared customers and patients.

Patrick Schmidt, CEO, FFF Enterprises, used a football analogy to describe the COVID-19 crisis, saying that this novel coronavirus has a “clear and unfettered path to the end zone.” He added that “in the absence of active immunity…COVID-19 antibodies are our most precious national resource.” Access to these antibodies, as well as a vaccine, he maintained, present the quickest route to recovery.

Mr Schmidt explained that his team spends considerable amount of time on the question of how to help find a weapon against this new coronavirus in what he described as “a defenseless nation.” He urged anyone who has recovered from COVID-19 to donate plasma, stressing that there has been a drastic decrease in the number of plasma and blood donations since the beginning of the outbreak.

“Until a vaccine is available, our best defense are the antibodies of healthy individuals who donate plasma,” Mr Schmidt said. He predicted that the shortage in plasma will result in a shortage of IGIV and SCIG—2 biologic agents that are critical to the survival of patients with compromised immune systems, including patients with cancer, who contract the novel coronavirus.

During the closing remarks, Dr Zweigenhaft said that getting supplies to the front lines was crucial in the fight against the pandemic, and that “the wholesale distribution channel is where it all happens.”

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Last modified: June 16, 2020
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