药房与医生实践的整合（也称为医疗整合配药）在肿瘤学领域正在不断增加。然而，人们对这种整合如何影响药物使用、支出、药物依从性或治疗开始时间知之甚少。旨在检查医师-药房整合与口腔肿瘤药物支出、使用和以患者为中心的措施之间的关联。这项队列研究使用美国一家大型商业保险公司的理赔数据，分析了 2011 年 1 月 1 日至 2019 年 12 月 31 日期间，14 个州接受药房整合与非整合社区肿瘤科医生治疗的患者结果指标的变化。商业保险患者的年龄为 18 岁至64 岁，患有以下晚期诊断之一：乳腺癌、结直肠癌、肾癌、肺癌、黑色素瘤或前列腺癌。数据分析于 2023 年 5 月至 2024 年 3 月进行。由药房整合肿瘤科医生进行的治疗，通过是否存在现场药房或非药房配药点来确定。口服、静脉注射 (IV)、总体和自付费用药物6个月的护理费用；服用口服药物的患者比例；天的口服药物供应量；药物依从性通过覆盖天数的比例来衡量；以及开始治疗的时间。使用双重差分估计器来估计肿瘤科医生的药房整合与每个感兴趣结果之间的关联。2012 年至 2019 年间，3159 名肿瘤科医生（745 名女性 [27.1%]，2002 名男性 [72.9%]）治疗了 23968 名患者（ 66.4% 为女性；53.4% 为 55-64 岁）。在 3159 名肿瘤科医生中，578 名 (18.3%) 从事与药房结合的实践（2011 年的低比率为 0%，2019 年的高比率为 31.5%）。在完整样本（包括所有癌症部位）中，医生与药房整合后，口服药物支出、静脉注射药物支出或总药物支出没有发现显着变化。然而，口服药物的供应天数有所增加（5.96 天；95% CI，0.64-11.28 天；P = .001）。自付费用、药物依从性或口服药物开始治疗的时间没有显着变化。在乳腺癌样本中，口服药物支出增加（244 美元；95% CI，41-446 美元；P = .02），静脉注射药物支出减少（-4187 美元；95% CI，-8293 美元至 -80 美元） ; P = .05)。这项队列研究的结果表明，肿瘤学实践与药房的整合与支出的显着变化或明确的以患者为中心的福利无关。

Integration of pharmacies with physician practices, also known as medically integrated dispensing, is increasing in oncology. However, little is known about how this integration affects drug use, expenditures, medication adherence, or time to treatment initiation.To examine the association of physician-pharmacy integration with oral oncology drug expenditures, use, and patient-centered measures.This cohort study used claims data from a large commercial insurer in the US to analyze changes in outcome measures among patients treated by pharmacy-integrating vs nonintegrating community oncologists in 14 states between January 1, 2011, and December 31, 2019. Commercially insured patients were aged 18 to 64 years with 1 of the following advanced-stage diagnoses: breast cancer, colorectal cancer, kidney cancer, lung cancer, melanoma, or prostate cancer. Data analysis was conducted from May 2023 to March 2024.Treatment by a pharmacy-integrating oncologist, ascertained by the presence of an on-site pharmacy or nonpharmacy dispensing site.Oral, intravenous (IV), total, and out-of-pocket drug expenditures for a 6-month episode of care; share of patients prescribed oral drugs; days' supply of oral drugs; medication adherence measured by proportion of days covered; and time to treatment initiation. The association between an oncologist's pharmacy integration and each outcome of interest was estimated using the difference-in-differences estimator.Between 2012 and 2019, 3159 oncologists (745 females [27.1%], 2002 males [72.9%]) treated 23 968 patients (66.4% female; 53.4% aged 55-64 years). Of the 3159 oncologists, 578 (18.3%) worked in practices that integrated with pharmacies (with a low rate in 2011 of 0% and a high rate in 2019 of 31.5%). In the full sample (including all cancer sites), after physician-pharmacy integration, no significant changes were found in oral drug expenditures, IV drug expenditures, or total drug expenditures. There was, however, an increase in days' supply of oral drugs (5.96 days; 95% CI, 0.64-11.28 days; P = .001). There were no significant changes in out-of-pocket expenditures, medication adherence, or time to treatment initiation of oral drugs. In the breast cancer sample, there was an increase in oral drug expenditures ($244; 95% CI, $41-$446; P = .02) and a decrease in IV drug expenditures (-$4187; 95% CI, -$8293 to -$80; P = .05).Results of this cohort study indicated that the integration of oncology practices with pharmacies was not associated with significant changes in expenditures or clear patient-centered benefits.