Background: The use of oral oncolytic therapies in the treatment of cancer is rising dramatically.　Cost barriers to obtaining drugs and side effects of therapies lead ¹ to poor adherence to oral regimens resulting in detrimental outcomes. External specialty pharmacies have attempted to assist patients but this often leads to further fragmentation of care. We report on the performance of a medically integrated pharmacy within a large community oncology practice to achieve better patient outcomes. Methods: The Texas Oncology medically integrated pharmacy (MIP)consists of oncologists, oncology nurses, advanced practice providers, and specially trained pharmacy staff utilizing real-time access to the patient’s electronic medical and pharmacy records when oral therapy is prescribed.　The team processes　prior authorizations and patient assistance requests,　ensures drug delivery, provides education, monitoring, and follow up of side effects for oral therapies. The care team is available to provide early intervention and side effect management. Treatment initiations, dose adjustments, and treatment discontinuations are communicated seamlessly in real time. Results: Texas Oncology MIPs process over 14,500 prescriptions annually with a 99% prior authorization approval rate. Service is timely with a representative sample of 4 practices showing 64% of prescriptions filled within 24 hours of prescribing and 72% filled within 72 hours. Prior authorization and patient assistance were the leading causes of delays. The patient assistance team processes over 3,200 requests annually with over $121 million copay assistance obtained. Adherence to therapy within Texas Oncology is over 92% for the 7 most commonly prescribed oral oncolytic drugs.　Patient satisfaction surveys reveal 96% satisfaction with the medically integrated pharmacy. Conclusions: The MIP is a fully aligned team based approach for the delivery of oral oncolytics. A medically integrated pharmacy provides timely access, copay assistance, monitoring and management of side effects resulting in increased adherence to therapy and an overall improvement in quality and satisfaction.