On Behalf of the Physicians of Xxx, We Are Writing to You Today to Express Our Deepest

Dear Patient:

On behalf of the physicians of xxx, we are writing to you today to express our deepest concern with the policies and actions implemented by your employer/insurance company. Our correspondence today is intended to help explain the impact that this policy has on access to the highest quality care available. We hope this letter will shed light on our position. xxx has been informed that your employer/insurance company has implemented a pharmacy vendor program whereby a third party has been selected to supply the medications necessary to treat your disease. This change would adversely impact the cancer treatment process and place patient’s care jeopardy. For example, we believe the imposition of a third-party in the treatment process poses the risks of the following consequences:

 It creates serious drug integrity and quality hazards-such as drug deterioration due to heat, staleness, and inadequate repackaging-that could significantly impact your care;  It also creates serious drug safety risks-through such means as tampering, excessive dilution, and the introduction of “black market” and counterfeit products-that as the Kansas City-Courtney experience and other tragic instances illustrate, puts patients in grave danger;  It creates serious drug distribution risks-such as delayed or lost packages that could result in life threatening situations and force patients to be hospitalized;  It interferes with the physician-patient relationship by violating the physicians patient care management responsibilities through the imposition of a third party in this intensely complex treatment process, while increasing physician, pharmacist and nurse liabilities;  It places a serious burden on productivity of our patients by forcing them to make additional trips to the center for separate evaluation for chemotherapy and after a 24- 48 hour delay of the actual chemotherapy administration;  It eliminates the clinical flexibility need by physicians to change a patient’s treatment on short order due to the time delay in ordering and receiving medications through the imposed outside vendor.

Ultimately, we believe that the unintended consequences of this policy sacrifice quality of care in the name of price control and set a precedent that undermines the physician’s ability to manage and control your care. For these reasons we are unable to administer drugs obtained outside of our control.

If you chose to obtain your oncology and support drugs from your employer/insurance companies designated vendor, we will assist you in transitioning your care to another facility or physician who is willing to accept the liabilities associated with pharmacy vendor imposition.

If you chose to continue obtaining your oncology and support drugs from your physician, the financial counselor will advise you regarding the financial aspects going forward.

We sincerely regret the inconvenience this policy has forced upon the treatment process and remain committed to assuring the integrity of the system in which our patients receive their care.

Respectfully, The Physicians of xxx