Dan Steiber, RPh

, I have had the privilege of selecting the finalists for the annual Next Generation Pharmacists Award over the last decade. Each year we review a bevy of entrants.

The applications are typically done by the entrant’s manager or peers. It never ceases to amaze me how these pharmacy professionals continue to advance patient care one year over the next. As expected, much of the focus is on the oncology space. Nearly all of the applicants have obtained multiple certifications in oncology and specialty pharmacy.

This month, I think it would be beneficial to share a handful of examples from among the many Next Generation-nominated candidates. Within each there are real-world experiences that many of our readers will hopefully find instructional and perhaps inspirational.

Examples of Innovation in Oncology Specialty Pharmacy

Our first candidate’s onboarding process establishes a relationship with each new patient and creates a patient profile where she is able to accurately assess new oncology therapies. She is able to clarify and adjust those therapies in collaboration with the oncology team where appropriate and counsel her patients thoroughly, including any adverse effect management. Importantly, our candidate is a board certified oncology pharmacist (BCOP) who is well trained to address any drug-related emotional ramifications on medication adverse effects that may present themselves. Most of this candidate’s oncology patients require a weekly check-in to assess progress with their medications, so she creates a strong familiarity and relationship with her patients and their families. Oncology is a complex disease state that often requires many high-cost medications. As a result, our candidate is well versed in working with insurance companies, manufacturers, and grants to eliminate as much cost to the patient as possible.

Our second candidate is managing a busy pediatric hospital pharmacy with a strong focus in oncology. Pediatric oncology patients require very careful dosing and frequent therapy adjustments based on the variability of younger and smaller patients. This candidate’s efforts have included a focus on reducing prescribing errors in pediatric oncology. The hospital is associated with medical and pharmacy schools, where students are often taught pharmacology classes in tandem between both institutions. This candidate has established a teaching program specifically focused on health care provider prescribing quality improvement, where future practitioners are trained side by side and collaboration becomes part of their future practice DNA. The program consists of oncology prescribing best practices with a pediatric focus. Her program includes information for newly trained pharmacists and medical residents on the best way to prescribe oncology medications and how to prevent potential medication errors. On a practice level, this candidate collaborates with all pediatric hospital departments to enhance bedside delivery. The impact of this activity over the past 12 months is that more than 1000 therapies are reviewed and optimized before the pediatric oncology patient is discharged. Truly, this candidate has a great influence on the care and medication delivery of her oncology pediatric patients.

Our third candidate is a specialty pharmacist and hospital pharmacy director at a large integrated delivery network (IDN) pharmacy. He and his team primarily serve oncology patients. This candidate has a passion for treating each patient holistically and addressing all of their care needs, not just pharmacy. Similar to our first candidate, he is known for going the extra mile to ensure that his patients’ oncology medications are approved through insurance, obtaining critically needed financial assistance through various foundations, as well as reaching out to assist in setting up patients with social support and transportation needs. He is known for creating a deep connection with his patients and the patient’s caregivers. This candidate’s efforts go beyond the institution and include serving on the local Susan G. Komen foundation community advisory board, which connects patients with breast cancer to their group’s support services. Additionally, this candidate has worked with a large pharmaceutical manufacturer’s program that supports patients with metastatic breast cancer to get better access to mammograms and preventive health. Recognizing the importance of integrating outreach programs into his practice, in addition to his work with the Komen foundation, this candidate is involved with the local Leukemia & Lymphoma Society, helping to lead fundraising efforts for its Light The Night and Team In Training initiatives in support of patients with blood cancer.

Our fourth candidate is an oncology pharmacist working in an IDN and managing its oncology clinical pathways program. This program aims to proactively provide patients with the education they need to be successful in their treatment journey and obtain ongoing assessments of a patient’s progress toward their treatment goals. The IDN’s clinical pathways program provides strategies designed around peer reviewed and approved treatment protocols by cancer type diagnosis, based on selections made by the broader oncology team. Using an implementation process, oncology patients are provided high-touch, patient-centered care pharmacy consultations, allowing the oncology team to intervene early if any issues are spotted, such as adherence, treatment efficacy, or adverse event mitigation issues. As a direct result of this candidate’s efforts over the past 5 years, she has built, updated, and maintained more than 175 unique medication and disease state-specific evidence-based clinical pathways, including oncology. In doing so, she increased the IDN’s clinical pathway program count in 2020 from about 120 clinical pathways to more than 170. As a result of this candidate’s efforts, the clinical pathways have aided in attaining an excellent proportion of days covered adherence rates year after year. As with our other candidates, this IDN’s program provides information for oncology staff to direct patients to co-pay assistance and patient assistance programs, as needed, to help individuals afford their high-cost oncology medications. It is important to note that 86.49% of patients participating in this IDN’s program were enrolled in co-pay or patient assistance initiatives and, in 2020, a total of $47,265,090 was saved for these patients.

Our fifth candidate also works in an IDN with a focus on clinical oncology program development. This candidate has created countless training guides, work instruction manuals, and checklists for placing oncology patients in the pharmacy system. Additionally, this candidate has helped implement a medical injectable program that allows the IDN’s pharmacy to efficiently work with providers and patients to get them infused or have physician-administered medications sent to providers, while also decreasing medication costs for employer groups. Lastly, this candidate created a workflow to promote the addition of manufacturer patient kits into new-to-therapy patient shipments, which helps patients obtain the information and tools to get started successfully on their new therapy.

Over the next few months, we will announce the final 3 candidates and, ultimately, the winner of the coveted Next Generation Pharmacist Award in October. In reality every candidate is a champion for the professional and, more importantly, the patient.

If you are considering focusing your professional career toward an oncology practice, much like the examples above, you have many options. Although it is not mandatory to be certified to practice in oncology, certification has become the gold standard. Many oncology pharmacists turned to specialization in cancer, which led to the development of a certification in pharmacy oncology practice. BCOPs have become an essential member of the care team. Patients and providers have come to know the BCOP as someone who is always available to answer their questions and knows the ins and outs of complex treatment and the extras, such as providing new patient starter kits that contain manufacturer information, calendars, and pamphlets about adverse event management, pictorials of how the drug is dosed, diet advice, and drug monograph information that goes with oncology treatment. Patients are often overwhelmed because of the amount of information and the number of new situations and providers they are interacting with. The BCOP becomes their drug navigator. If you are a pharmacist interested focusing your practice in oncology, you might want to explore becoming a BCOP.

The Board of Pharmacy Specialties created a specific certification for oncology, BCOP, which focuses on the certification of specialists in oncology pharmacy. Certification allows the qualified specialty pharmacist to practice at an advanced level of pharmacy practice in a complicated disease state and work in multiple practice settings. Many BCOPs can be found working in a team-based practice alongside a medical oncologist. In this setting, BCOPs work side by side with oncology teams, review patient histories, and develop cancer treatment plans throughout their oncology patients’ disease. With this expertise in understanding the complex therapies, the BCOP can effectively monitor for, prevent, and manage oncology patient drug related adverse events. Becoming a BCOP means pharmacists become recognized by the pharmacy profession, their peers, oncology institutions, payers, and other oncology providers as someone who is well qualified to be an oncology therapy expert on the health care team.

operates Genesis Pharma Consultants, a practice responsible for commercial operations and trade-supply chain strategy development. Steiber has served in senior positions in pharmacy, distribution, and industry over the course of his 40-year career, and is a licensed pharmacist in Texas, Washington, California, and Pennsylvania. He is affiliated with several professional associations and publications and is a frequent speaker on behalf of many professional organizers. Steiber graduated from Washington State University College of Pharmacy and Pharmaceutical Sciences in Spokane. He has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University and Northwestern University.

Articles

This month, I thought it would be beneficial to share a handful of examples from among the many Next Generation Pharmacist-nominated candidates. 

Profiling the Best in Oncology Care: Patients Are the Winners

It was a year and a half ago we saw the world’s eyes turn to health care as its rescuer. From day 1 of the COVID-19 pandemic, the pharmacist was considered a key player.

Pharmacists have continually been ranked as the most accessible health care professionals. Be it specialty, community, or institutional pharmacy, patients and fellow health care professionals can access a pharmacist willing to give time and expertise 24 hours a day. Because of our training, we pharmacists are natural problem solvers, and although we may not have an instant answer for every question, our education has taught us how to use resources to find an appropriate response and often a solution. When COVID-19 emerged, many medical offices stopped, or severely limited, patients’ access, but pharmacies kept their doors open, adjusted their physical layouts, and kept adapting to the crisis.

Everyone on the planet was waiting for a miracle to eradicate COVID-19 with a vaccine, and through Operation Warp Speed, vaccines arrived before 2020 had ended. The innovation our pharmaceutical industry demonstrated was unprecedented in human history. It came in the form of the newest technologies in our space, messenger RNA vaccines, soon followed by more traditional vaccine manufacturing processes.

It seems that COVID-19 has influenced so much of our daily lives, from wearing masks and social distancing to cancelation of many events and programs, and limitations placed on many businesses' operations. The impact on global economies continues to evolve as we reopen and attempt to get back to normal. Entire industries were shut down or severely scaled back. The production of many products was curtailed, which has resulted in shortages—and having less often also means paying more to purchase products.

The path out of the COVID-19 pandemic has been driven by pharmaceutical products. Traditionally, the media and public have focused on the high costs of specialty pharmaceuticals rather than the benefits; however, in times of crisis, no price is too high. Pharmacists are the world’s drug experts, and there has been an interesting shift in perception as, for many, the pharmaceutical industry is no longer the dispassionate business it was perceived to be.

Our industry has a window to demonstrate more value than ever before. And pharmacy has never been more relevant. Do you recall when the headlines were focused on which vaccine presented the fewest logistical challenges and “pharmaceutical logistics” became household words? I loved it because I could actually tell folks, “That’s my deal.”

The new normal has shifted the patterns of our professional lives. What was previously considered extreme behavior—social distancing, the use of face masks, hand sanitizers, infrared thermometers, plexiglass screens, and personal protective equipment—became the rule. Although we have gradually opened commercial channels, I predict that many behaviors will be changed forever.

A similar life-changing event that affected our daily lives was 9/11. Do you recall when we would sail through airport security? Look at the norms of travel now. Similarly, we will see many changes from the COVID-19 crisis become permanent.

Over the last year, boards of pharmacy made dozens of adjustments to professional practice, many of which empowered pharmacy, allowing our profes- sion to reach new levels of expertise, and we stepped up to the challenge. Pharmacy has been integral to access to testing, and in tandem with mass vaccina- tion sites, we brought solutions to every neighbor- hood. For those who were severely ill, we repurposed existing therapies, creating COVID-19 “cocktails.” For oncology pharmacists, this expertise was not new, because they have been doing the same with chemo- therapies for decades.

New therapies mean new learnings, and on the continuing education (CE) front, we were required to raise the bar by upgrading our knowledge. Many of us traditionally got our CE through live programs at conferences or association meetings. However, with the shutdowns, events were canceled or shifted to virtual programs. Pharmacy Times® Continuing Education (PTCE) has offered dozens of programs on the expanded role of pharmacists in the COVID-19 era. A positive effect has been that, as a direct result of this shift to real-time online programs, thousands of pharmacists are now being educated on pertinent topics in truly unprecedented numbers.

Infusion-based therapy has been the mainstay for most oncology treatment plans for years. Infusion of oncology products generally is split between the community oncology infusion suite and the outpatient institutional setting. The increased risk of exposure to the virus to patients, who often have severely compromised immune systems, required great modifications in treatment plans and how those plans were carried out. Oncology pharmacists played an influential role in transitioning patients from infused to oral cancer treatments whenever possible. This shift had a significant impact on specialty pharmacy, because it saw demand rise for oncology treatment dosage adjustments. The oral therapy trend is here to stay.

Not all IV therapies have oral alternatives. In many cases, however, clinics have been able to shift to home infusion, where the drugs are administered in the relative safety of the patient’s own home, thereby reducing the potential exposure to COVID-19 for all parties. The Centers for Medicare & Medicaid Services (CMS) earlier in the year issued an interim final rule that allows infused or injected Medicare Part B drugs to be administered at home. These services can be reimbursed by CMS if administered by a home health agency, so long as a provider is present or the visit is conducted via telehealth. We expect many of the shifts in sites of care to remain, as should compensation for services.

The pandemic forced businesses to move to a work- from-home environment wherever possible, and it seems to have been done efficiently. As society continues to reopen, both employers and employees will have to make tough choices, like moving back to the office or continuing with what is in now place. Employees who have been working from home might now be using a hybrid approach, with time in the office and time working remotely. Likewise, we saw a significant transition with specialty and oncology pharmacy, where many of the nondispensing clinical services were performed through telecommunication to reduce the risk of a patient contracting COVID-19. Our health care infrastructure supported many of the fundamental aspects of remote clinical visits, and we already had much of the technology in place; however, we were able to reach new levels of deployment. Patients and their oncology pharmacists were able to interact from the safely of their own home.

When we break down much of the activity, we find that specialty oncology pharmacists are engaged in many ways of serving the patient. These include care coordination, insurance approval assistance, financial assistance for high out-of-pocket co-pays, drug interaction checks, patient education, and adverse effect monitoring. All these services can be efficiently performed in a remote setting. The oncology pharmacist is the medication expert on the team and should be the educator when it comes to the drug therapy to guarantee a consistent and informed process. The pandemic has broadened our practice site, because much of this activity has migrated to the telephone or to digital platforms such as Zoom, Microsoft Teams, and others.

The practice of oncology pharmacy has evolved greatly over the past 18 months. Pharmacists have gained many new learnings and insights into our practice. As a result of the pandemic, pharmacists were forced to adapt many of their processes. As such, pharmacists will continue to be the key resource in the delivery of optimum oncology drug treatment.

Pharmacists should consider preparing a business case for the future by tracking positive patient outcomes. Thorough documentation processes, some- thing oncology pharmacists are already familiar with, will be important. Be prepared to tell your story. In the long term, the role of the specialty oncology pharmacist is expected to expand to other services with the skills they hone during these times of adversity. Specialty pharmacy should embrace the new normal to help prepare for any future pandemics. We all should look back at the last few months and reflect on what we can take with us moving forward.

® will be soon be engaging our oncology pharmacy readers with a survey. We want to learn what you did to adapt your practice and the impact of those activities in improving outcomes. One goal we have at 

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® is committed to setting the publication standard through peer-written articles focused on the real world of oncology pharmacy practice.

Pandemic Lessons: The Evolution of Pharmacy Practice

As a direct result of the global pandemic, the landscape for oncology health care professionals has changed. Additionally, there has been a significant shift within the pharmaceutical industry and its strategy and tactics relative to managing oncology products and services within the cancer community.

Another Breakout Year for Oncology Approvals 

Despite the challenges of the pandemic, 2020 proved to be a robust year for new drug approvals, including a significant number of oncology therapies, as the FDA successfully shifted gears to a higher level to keep pace. Oncology products came out on top with new approvals for a wide variety of cancer types, including 12 treatments for lung cancer.

 In 2021, there may be an even greater uptick in new approval because the pandemic made it challenging for FDA staff to do the necessary inspections required to approve some products. A vaccinated and protected agency may be able to expedite those approvals this year. Many eyes are on the new administration to see if whether they continue this momentum.

The Oncology Product Supply Chain Is Complex 

Because I have been involved in the pharmaceutical supply chain for years, people often ask me exactly what I do professionally. It’s easier to tell them I’m a pharmacist rather than explain the complexities of the oncology specialty industry. Coronavirus disease 2019 (COVID-19) vaccines and their handling suddenly made the specialty pharmaceutical supply chain a household word, and it made the headlines of every newspaper around the globe. The oncology industry and oncology pharmacists have been experts in the movement and management of their products, particularly with the number of specialty therapies that mandate different manufacturing and distribution processes over the more traditional products.

The supply chain process requires tight integration among various stakeholders, from the point of manufacturing and packaging to product administration. Pharmacists have learned that the best supply chain starts with a patient-centric approach and works back upstream from this anchor point—understanding the role that each stakeholder plays in the process and supporting specific needs and touchpoints along the path. There must be transparency and quality communication, leveraging technology wherever possible to link those stakeholders in real time. Patient and product safety is always paramount so that standardized processes are understood and enforced to assure high-quality and access. Given the high cost of oncology products, payers must be integrated into the mix to ensure vital medications are paid in a timely manner. So much of what the pharmaceutical industry does is outsourced; therefore, platforms must be developed based on standards and interchangeability. The Drug Supply Chain Security Act outlines steps to build an electronic, interoperable system to identify and trace certain prescription drugs as they are distributed in the United States.

Oncology Pharmacists Are Patient Navigators 

Health care is a decentralized process, and although great strides have been made to integrate workflows, it still takes patient advocates and navigators to assist in the process. Oncology pharmacists have aggressively stepped into this very important role. Although the goal of the industry has been to provide new and innovative therapies to treat new and existing cancers, these products often come at a high price.

The oncology pharmacist’s role is to navigate through the bureaucracy as the patient’s advocate on behalf of the oncology team. With the pandemic, the role of the oncology pharmacy team has required even greater coordination to ensure medication therapy goals are met in a patient-centric manner. The pandemic pushed institutional facilities and personnel to operate on overload. The oncology pharmacy team continued to put patients first and responded to the pandemic by creating innovative practices to help triage patient care. Oncology pharmacists have seen a shift to oral oncology products as alternatives to clinic- or institutionally infused products where possible. Given this is more of a specialty pharmacy benefit, the role of the oncology pharmacy team has never been greater.

The good news is that after 2020, there will be nearly 20 new oncology products to integrate into the therapy mix. Also, in 2020, pharmacists saw major attempts to help manage drug costs, but most will either not get off the ground with the new presidential administration or may be adopted with even greater vigor. Either way, the oncology pharmacist will be in the center.

There has been a shift with government-sponsored programs to increase access to specialty products using newer tactics such as value-based pricing. The oncology pharmacy team has been instrumental in tying many of the elements together, measuring oncology product treatment value to assure patient access and drug coverage. Manufacturers and oncology pharmacist have come to better align their goals around these elements to help provide an accurate reflection of a product’s effectiveness in treating cancers.

The oncology pharmacy is charged with obtaining access and payment for products, followed by administration or the dispensing process. This may include working with the manufacturer’s hub.

Manufacturers have invested tremendous resources to assist the patient and the oncology team in getting the most value out of their products. This partnership is established by sharing data and communications, often through this publication, 

. Brand managers have come to realize, through this pandemic, the importance of written communication in digital or print.

Oncology product managers are dedicated to directing programs designed to support patients through their care journey, using the products for which they are responsible. With oncology pharmacists, the patients they serve and data they manage are instrumental in linking all the services together. The industry realizes and supports this process through education and resources, giving oncology pharmacists the tools to get the job done. 

 has a large portfolio of tools to facilitate this process that extends far beyond the publication.

Technology Enhancements in Oncology Pharmacy 

The pandemic has forced technology to the forefront of health care in oncology pharmacy. Pharmacists witnessed a tectonic shift in work and health care environments, driven by the adoption of telehealth and other technologies assisting in getting through this crisis. The pandemic continues to be a great disruptor of health care; however, technology has enabled the oncology industry to broaden its reach beyond the 4 walls of the institution to enter the home of the patient, thereby insulating them in the risk of exposure to pathogens. By minimizing face-to-face interaction to the most urgent cases, a paradigm shift will, with hope, sustain itself past the pandemic.

Health care has been generally viewed as a locally managed process. Through technology, many patient care elements can be accessed and supported remotely or on a more national basis. Post pandemic, there may be a more hybrid approach to patient care in oncology pharmacy. Oncology pharmacists will need to be embedded with the overall oncology team, supporting oncologists and nurses. However, they have demonstrated that follow-up and support can take place through technology, saving time and resources or, importantly, expanding the net of patient care. Some see this as a reimbursable process through collaborative practice agreements in place with providers and payers in support of oncology pharmacy.

Staying Oncology Patient Centric Through Data 

If oncology pharmacists learned anything through the ongoing pandemic process, it’s that they must adapt quickly. Treating cancer is not something that can be put off to a later day like a haircut or even elective surgery. It must be met head-on and aggressively managed despite the pandemic. It takes a potent mix of empowered oncology pharmacists and patients together with their caregivers to get this done, and there is no one-size-fits-all approach.

At the heart of quality patient care is the patient, but to understand and share this information, the oncology pharmacist must leverage useful data. Documentation and data sharing are the cornerstones of how quality oncology patient management programs are optimized. Oncology pharmacy utilizes accurate and predictive analytical tools enhanced through artificial-like intelligence to help identify and engage patients with cancer through the various stages of their care.

Oncology pharmacy is responsible for acting on data to facilitate a greater outcome for the patient. Data help identify disease faster in oncology, and with precision medicine, the information assures the right drug is tailored to the right patient based on their diagnosis. Patient-centric data are key.

After a treatment plan is collaboratively established with the oncology team, it is the oncology pharmacist’s role to ensure drug therapy is implemented. The oncology pharmacist can leverage data to check patient adherence through education and understanding. 

 operates Genesis Pharma Consultants, a consulting practice responsible for commercial operations and trade-supply chain strategy development. Steiber has served in several senior positions in pharmacy, distribution, and industry over the course of his 40-year career. Steiber is a licensed pharmacist in Texas, Washington, California, and Pennsylvania. He is affiliated with several professional associations and publications and a frequent speaker on behalf of many professional organizations. Steiber graduated from Washington State University College of Pharmacy. He has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University and Northwestern University.

2020: a strong year for new drug therapy approvals-despite many COVID-19 challenges. FDA. January 8, 2021. Accessed January 20, 2021. https://www.fda. gov/news-events/fda-voices/2020-strong-year-new-drug-therapy-approvals-despitemany-covid-19-challenges

As a direct result of the global pandemic, the landscape for oncology health care professionals has changed.

Lessons From the Pandemic for Oncology Pharmacy

Oncology pharmacists have been involved in caring for patients with cancer for several decades. With the explosion of new therapies for cancer, the role of the oncology pharmacist continues to expand.

The coronavirus disease 2019 (COVID-19) continues to dominate the headlines, but we will get through the pandemic and back to our core practice soon. We have already been recognized as the primary professionals to administer a COVID-19 vaccine because pharmacists are proven, accessible, clinically educated, experts in supply chain, and willing to lead.

We hope your 2021 plan of action includes strategies for approaching these and other trends in the oncology pharmacy market.

Oncology Pharmacists are Leading the Process of Medication Selection 

This year, there is a shortage of well- trained oncologists, and those who are practicing are extremely busy. Oncology pharmacists are not only filling in gaps, but are also expanding the scope of their practices.

Choosing the right drug for the right patient based on a diagnosis of cancer is essential to optimizing treatment outcomes. As the drug experts, oncology pharmacists in all practice settings have evolved to become integral parts of the cancer care team.

Oncology pharmacists are found participating and leading pharmacy and therapeutics committees in the institution/ hospital setting and in advanced community oncology clinics. They also provide evidence-based care to their patients.

The list of duties for oncology pharmacists includes educating patients and caregivers about their medications, and improving medication adherence. Pharmacy education today has been “futureproofed” and, through continuous education, oncology pharmacists provide clinical knowledge using enhanced literature evaluation training and understanding of the complexity of cancer care.

Oncology pharmacists are also involved in the development of treatment guidelines, establishment of standards, enforcement of policies, and application of clinical pathways in all areas of practice, including hospital, institutional, specialty, and ambulatory.

There have been significant advancements in new oral oncology drugs, and specialty oncology pharmacists are the predominant dispensers of these products. We expect the bar to be raised even higher in 2021, given the ongoing pandemic.

Many products require specialty handling and extraordinary standards concerning logistics to ensure the cancer drug is put into the patient’s hands in optimal condition. Specialty oncology pharmacies must focus on the highest degree of quality for patients and their fellow health care providers. Specialty pharmacies will be measured on their ability to improve overall clinical outcomes, and on a patient-to-patient basis. Through the development of unique programs and services—such as patient-based drug utilization plans&mdash;optimal oncology therapy and cost- management outcomes are maximized.

Oncology pharmacy teams use multiple forms of communication to provide cancer education and drug information for patients. Integrated technology solutions used to ensure care coordination between fellow health care providers are in place to address any gaps in care, adverse effects, safety, dosing, and product selection.

I recently participated in a panel with several oncologists throughout the country who commented on and complimented the stellar experiences they had in their collaborations with specialty oncology pharmacists. Oncologists want more of that interaction and pharmacist empowerment.

Payer Influence and the Role of Oncology Pharmacy

It is no secret that newer innovations in the drug treatment of cancer will result in higher drug costs. Changing reimbursement practices will continue to have impact on the payer’s approach to new therapies and will put pressure on the conventional models of cancer care delivery. We will see more demands from health plans and prescription benefit managers (PBMs) to increase the use of evidence-based drug management strategies including comparative evidence research, and testing quality and biomarkers to drive appropriate cancer therapy selection.

The effect on patients comes into play with aggressive cost-sharing provisions in most plans. Patients and their families have been called upon to make tough decisions about therapy based on their financial standing. The oncology pharmacist will continue to be embedded in the process, navigating the bureaucracy as the patient’s advocate and on behalf of the oncology team. We will see an increase in the integration of medical and pharmacy benefits that have historically been siloed, and more coordinated care in the coming year.

As a result of mergers involving health care plans, pharmacies, and PBMs, plan sponsors are demanding that programs provide insight into medical and pharmacy benefits. Expect to see even greater impact from Integrated Delivery Networks offering comprehensive health plans as a solution.

Despite the challenges brought on by the pandemic, the pharmaceutical industry continues to churn out new oncology therapies at a frenetic pace. We anticipate by the end of 2020 that more than 21 new drugs will have been approved to treat cancer, which would break the record of 17 cancer drug approvals set in 2018. These new approvals range from biologics to small- molecule drugs to chimeric antigen receptor (CAR) T-cell therapies. We anticipate some potential therapies may be approved in the first quarter of 2021, including idecabtagene vicleucel, the first CAR T-cell therapy for multiple myeloma, which is expected to cost approximately $475,000 for a 1-time infusion.

Precision medicine continues to mature, and the pace of discovery and implementation of targeted therapies will accelerate. Oncology pharmacists will have the ability to select a medication and dose based on patient-specific genomic factors. These personalized therapies will domi- nate oncology headlines this year and in the future.

Expanded Formats to Increase Oncology Pharmacists’ Knowledge

As a pharmacist, I have always found attending conferences a great way to enhance my professional education and to network with my peers. Finding time and bearing the expense of attending meetings can be a challenge. The pandemic changed all that, and we had to find new ways to stay smart and current. My crystal ball says we will see a huge shift in how continuing education is obtained. I am not saying meetings such as American Society of Clinical Oncology (ASCO), American Society of Health-System Pharmacists (ASHP), Asembia and others will necessarily go away, but we can expect more options in the future, and 2021 will be a test of the longevity of virtual meetings.

Our own PTCE team is on track to provide oncology pharmacists access to meetings they may not have been able to attend in the past. The programs are the same as would have been offered in person, but are now offered through a proprietary platform created by PTCE. Stay tuned to Directions in Oncology Pharmacy® as we provide you with oncology pharmacy education opportunities in 2021. All you have to do is register for the CE event and you’ll receive a reminder with a link directly to the program, which is broadcast with a live video of the speaker and presentation slides. Attendees can even respond to real-time surveys, and the speakers will discuss the results.

Growth of Institutional/Hospital Oncology Pharmacy and Accreditation

Accreditation has become the new norm in oncology specialty pharmacy, and the area’s largest growth is in institutional and hospital settings. Much of the shift toward accreditation has been because of the trends involving new product development. These pharmacies are in a strong position to provide a continuity of care through integrated systems and data sharing, and coordinating care with accountable care organizations that may participate in risk-based contracting.

Keeping patients in a close ecosystem provides a greater level of control and accountability. In the traditional inpatient hospital model, patients are released from the institution or hospital only to receive their outpatient drug services from traditional entities such as retail and specialty pharmacy. The shift to institutionally owned oncology specialty pharmacy facilitates a setting where orders are kept in house, resulting in increased revenues and potential profitability.

As oncology pharmacists face more performance-based reimbursement, they will rely more on technology, as they use data and analytics to reduce costs and to support quality patient care. Expect more pressure to create standardization so that disparate systems are better integrated, and data becomes harmonized. We learned much about virtual health care in 2020, and we will see the continued exponential growth in platforms connecting patients and providers. We will see an even greater shift in oncology pharmacy in 2021 around virtual patient care. This avenue is truly the future.

We will also see great strides in the use of pharmacy- based mobile applications, and this use will provide oncology pharmacists with relevant data to help implement and document the care of their patients with cancer.

These are some of the most significant trends devel- oping for 2021. Keep this article if you choose, and see if our predictions hold true come the end of this year. Enjoy this issue and pass it on.

, operates Genesis Pharma Consultants, a consulting practice responsible for commercial operations and trade-supply chain strategy development. Steiber has served in several senior positions in pharmacy, distribution, and industry over the course of his 40-year career. Steiber is a licensed pharmacist in Texas, Washington, California, and Pennsylvania. He is affiliated with several professional associations and publications and a frequent speaker on behalf of many professional organizations. Steiber graduated from Washington State University College of Pharmacy. He has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University and Northwestern University.

With the explosion of new therapies for cancer, the role of the oncology pharmacist continues to expand.