Dan Steiber, RPh

Today, the positive impact of oncology product approvals has evolved to the point where, in many cases, there are multiple treatment options to choose from when targeting a specific disease state. However, this opportunity for drug selection has opened the door for payers to leverage one drug over another in terms of coverage offerings, creating new challenges for care teams and patients during the treatment process.

Furthermore, the oncology products patients receive may vary from what was ordered by the oncology professional due to not only the broader treatment options available but also the higher costs of treatments and subsequent payer coverage decisions. However, the oncology pharmacy team often has their own reimbursement specialist with the experience, background, and relationships necessary to ensure what was originally ordered remains in the patient’s treatment plan.

Because of this changing dynamic in product selection and access, the role of oncology pharmacists as key patient therapy advocates has strengthened, as oncology pharmacists work on the patient’s care team to ensure patients have access to lifesaving therapies that meet their clinical needs.

Receiving a cancer diagnosis is a lifealtering experience for the patient and their family, with therapy selection as just one of many factors to consider on the road ahead. Under the best of circumstances, the health care system can be daunting to traverse for patients, but following a cancer diagnosis, it can become significantly more challenging.

However, there are newer and more efficacious therapies available that have evolved and emerged over the past several years. Yet, patients faced with the bewildering task of navigating the health care system alone in order to receive these emerging treatments may come up short in terms of reaching the best possible outcome available for the treatment of their disease.

A patient with a new diagnosis will benefit greatly from the support of a care team that includes the medication expertise of oncology pharmacists to help them navigate the complexity of the treatment landscape that lies ahead. With support from an oncology pharmacist, the oncology team can help alleviate a host of anxieties for patients who are starting and then adhering to a complex oncology treatment plan.

When a patient receives a diagnosis, the clinical oncology pharmacist can immediately support the care team by helping to develop a treatment plan. Once the drug component is selected, the pharmacy opens their toolkit of solutions for patient access challenges, including setting up prior authorizations and co-pay assistance. Depending on the dosage form, the oncology pharmacy team can also ensure the selected products can be paid for by the patient.

Additionally, the route of administration or dosage form may be infused, subcutaneous, or oral, and in most cases a mixture of all 3. The logistics of ordering the products and ensuring they are all made available to the patient or provider in a timely manner can be coordinated by a clinical oncology pharmacist.

The reimbursement specialist on the oncology pharmacy team also can help minimize the patient’s out-of-pocket costs by ensuring what was ordered remains in the patient’s treatment plan. The reimbursement specialist’s toolkit often includes information technology resources and databases to help handle the required documents in a paperless and expedited manner.

Over the past 3 to 5 years, real-time access to coverage has emerged, and terms, such as electronic benefit verification and electronic prior authorizations, have been refined so the oncology team or specialty pharmacy can identify what is covered; offer alternative therapies, if appropriate; and assess the fiscal impact of each selection, including co-pays. The results of such assessment can help guide decisions around seeking alternative forms of payment, which are often tied to electronic resources such as manufacturer-sponsored patient assistance programs (PAPs).

In the United States, the majority of patients with cancer are often buffered from the extraordinary costs of oncology drugs through employer health insurance, Medicaid, or Medicare. However, payer plans have emerged that create gaps in coverage tied to formulary restrictions that often put a heavy burden on patients, even those with good health insurance coverage. Patients with cancer who don’t have health insurance or adequate prescription drug coverage are often confronted with the challenge of deciding how and whether they can pay for their medications out of pocket, which may total tens of thousands of dollars.

Manufacturers of these higher-cost therapies generally make available reimbursement options for patients in the form of PAPs. These sponsored programs are promoted as a safety net for individuals who may have no health insurance or inadequate financial resources to offset the out-of-pocket costs of these therapies. The objective of these PAPs is to provide financial assistance to help patients access drugs for little to no cost.

There are also options for financial assistance for patients in the form of co-pay assistance, which helps patients with cancer who have insurance pay the co-pays related to their care and treatment. However, such payment assistance can be inadequate for the underinsured, leaving oncology patients’ out-of-pocket costs to have a detrimental impact on their financial well-being, which can potentially eliminate or reduce their access to lifesaving treatments.

To help facilitate patient access to the best therapies available, the oncology team must understand several variables, including the patient’s deductible, out-of-pocket maximum, and percentage paid by the insurance, as well as the amount paid by the insurance over what period of time. Ultimately, the oncology team produces a treatment plan that will include what the patient’s monetary responsibility is before they receive that first therapy, combined with alternative forms of payment.

Over the past several years, there has been a shift from infusion drugs to oral oncology therapies, which has been a positive trend for the industry. This shift has helped empower patients to maintain a bit more normalcy in their lives during the difficult process of cancer treatment by allowing them to be freed from long and painful infusions.

However, this positive shift has come with tradeoffs in relation to reimbursement. In most cases, an oral oncolytic will be covered by the drug benefit of a patient’s insurance, which is most often administered by a pharmacy benefit manager.

Typically, oral therapies have higher cost sharing vs infused products, which are billed by the clinic. This is referred to as buy-and-bill, which means the infused products tend to have better coverage because they are being billed through a patient’s medical benefit. With oral therapies, these higher costs frequently result in significant financial challenges for patients, which is referred to as financial toxicity.

With the challenge that is financial toxicity comes the important role of the oncology pharmacy team in working with payers to obtain prior authorizations and using their knowledge and experience to navigate the reimbursement gauntlet on behalf of the patient. This work can help ensure they are able to break through the bureaucratic requirements necessary for the approvals of the right therapies for the patient’s treatment.

Oral oncology products that have an associated limited distribution policy often have their own specific challenges. This can especially be true if it is mandated that the patient have the product dispensed by a different specialty pharmacy than the one on their care team. When this occurs, not only does the patient receive mixed pharmacy services, but they often experience treatment delays before they can start therapy. Because of these challenges, oncology pharmacies and oncologist dispensers are working to develop strategies that can help to combat limited distribution drug (LDD) practices by forming networks and advocating with the manufacturer on behalf of patients.

With the growth of oral oncology options, the number of new dispensing specialty pharmacies in hospitals and community oncology clinics has also exponentially increased. This increase is significant because the dispensing specialty pharmacy plays a significant role in facilitating patient access to therapies. The dispensing specialty pharmacy staff are trained to communicate directly with the oncology team, leading the benefits investigation process. Additionally, it is up to the oncology specialty pharmacy to react quickly and communicate with the oncology team on what they learn relative to what is covered and at what cost so any changes to therapy that may be required can happen in a timely manner.

In today’s practice environment, pharmacy systems typically do not interface with the clinic’s overall electronic medical record (EMR) system. Additionally, there is work under way at some institutions to transition oral oncology orders into the overall EMR system. This integration will lead to a faster response time, thereby facilitating better and more cost-effective patient care.

The oncology team and the dispensing specialty pharmacy can work together to help enhance patient adherence to treatment plans and administer supportive care to conquer the potential clinical implications of payer overmanagement of drug benefit and LDDs. Facing this challenge together, they can meet it head-on to navigate the waters of product access for patients, putting their needs above all other concerns.

Despite the challenges of the past 2 years, pharmacists have stronger and better positioned than ever for our future, with the role of oncology pharmacy continuing to grow as oncology pharmacists step up to fill gaps in care.

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 during his 40-year career and is a licensed pharmacist in Texas, Washington, California, and Pennsylvania.

Articles

Oncology pharmacists can help ensure patient access to lifesaving therapies.

Navigating Patient Treatment in Oncology to Fill Gaps in Care

year, pharmacists have overcome many of the challenges imposed on our profession during COVID-19. Although the virus still dominates the headlines, pharmacists have found innovative strategies to navigate through the pandemic and provide even better care for our patients.

During the pandemic, pharmacies have become the primary site of COVID-19 vaccinations—pharmacists are accessible, clinically educated experts who are willing to lead. Furthermore, with the explosion of new therapies for cancer, the role of the oncology pharmacist continues to expand.

Just as the pharmacy profession has continued to evolve, so does our publication. With the 

® platform acting as a mainstay of our profession since 1987, we decided to strengthen our tie to its history with a new name: 

Let us explore some trends that we should anticipate for oncology pharmacy in 2022.

Despite the challenges brought on by the pandemic, the pharmaceutical industry continues to churn out oncology therapies at a frenetic pace. With more than 21 new drugs approved to treat cancer in 2021, the industry broke its record of 20 cancer drug approvals, which was set in 2020.

 This is an amazing feat, considering the research and development challenges posed on the industry during the pandemic. Nonetheless, the industry has found a way to work quickly and effectively in this new virtual landscape.

We are also seeing an even greater acceleration on the precision medicine front. Precision medicine provides oncology pharmacists with the ability to select a medication and dose based on patient-specific genomic factors. Through genome sequencing, generic information is gathered so that scientists can secure specific abnormalities and design products with therapies targeting tumors.

Personalized therapies will also be a dominant player in the new molecular-entity approvals oncology stable, as this category continues to mature and innovate at an accelerated pace. Precision medicine is not only effective, but its ability to target cancer cells also allows patients to experience fewer adverse effects and complications from their therapy.

Because much of the drug approval process is the continued proliferation of clinical trials, investigators from these trials have had to work to adjust to a new practice environment to continue their efforts. Candidate recruitment has had to shift to be more virtual in nature, and thanks to these pandemic-based adaptations, the number of trials has risen. This increase in trials will likely continue this year in alignment with the increase in drug candidates. Further, not only do more trials mean a greater likelihood of clinical breakthroughs, but participating patients will have more access to new treatment options as well.

The use of artificial intelligence in the development of new drugs will also be a hot trend for 2022. With recent software innovations, it has become easier to interpret millions of pages of scientific literature and data, which can help investigators and pharmaceutical companies quicken the pace of drug development.

To succeed in their role, oncology pharmacists are trained to develop a disciplined approach to documentation of data. Although it remains a core element of the job, data management is also one of the more challenging areas of our work. In 2022, we will continue to see more efficiency in clinical data management systems and greater accessibility of those data as key points of development.

Furthermore, there is growth toward the use of a single platform that integrates all health information technology systems. Beyond the clinical benefit, this would reduce the costs associated with managing different information systems. Additionally, associated efficiency increases will better facilitate the use of health care data, which can be leveraged as a tool for research and development, as well as help create better treatment plans for patients with cancer.

Gone are the days of pharmacists being tied to computer terminals to complete tasks. Mobile health technology on smartphones, tablets, and wearable technology has now made it possible for clinicians to gather relevant data more quickly and easily than ever before. With these advances, patients are better able to communicate with their oncology teams, educate themselves on their own care, and provide self-driven data inputs that can enhance their teams’ ability to provide that care.

When combined with telehealth, digital tools offer clear health benefits, with evidence mounting that these tools may be able to reduce health care costs. In 2022, it seems likely that we can expect more innovation in software and hardware, such as smartwatches and phones, that will support wireless data-capturing systems; additionally, with the expansion of 5G, there is the potential for continuous and transparent data capture on the horizon. Patients can be monitored closely from the comfort of home as opposed to being constrained to a traditional clinical setting.

With the push toward telemedicine, both the provider community and payers urged patients with cancer to seek care through virtual platforms. Although all practice settings have developed options for a wide range of telehealth services, patients with cancer had to adapt to virtual alternatives in multiple facets of their care. With payers watching these trends, there will be a shift in 2022 toward reimbursement that enhances patients’ access to this virtual care. With telehealth continuing to play a vital role in the care of immunocompromised patients during the pandemic, this move on the payer side is a welcome change for patients.

An Increased Role for Oncology Pharmacists

In 2022, the role of the oncology pharmacist will continue to grow. Because the pharmacist pool has shrunk due to the pandemic, oncology pharmacists are filling in those gaps and expanding the scope of their practices.

Additionally, there has been a shortage of well-trained oncologists and nurses due to the pandemic’s strain on our health care system; again, oncology pharmacists stepped up. As the drug expert on the cancer care team, the oncology pharmacist has become an integral component of the work done.

With these changes, it is likely that oncology pharmacists’ responsibilities will grow to further incorporate the education of patients and caregivers on medications, as well as support the goal of improving medication adherence. Additionally, the role of oncology pharmacists in 2022 will likely be more engaged with developing treatment guidelines, leading pharmacy and therapeutics committees, establishing standards, enforcing policies, and applying clinical pathways in all areas of practice, including hospital, institutional, specialty, and ambulatory.

New oral oncology drug approvals will be an important part of 2022, and specialty oncology pharmacists are the predominant dispensers of these products. Oncology specialty pharmacies continue to develop unique programs and services to support patient-based drug utilization plans, optimal oncology therapy selection, and maximized cost-management outcomes.

We will also see more demands from health plans and prescription benefit managers 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. Pharmacy benefit managers and plan sponsors are demanding that programs provide insight into medical and pharmacy benefits.

However, there is a reason approximately 80% of the specialty pharmacy revenue is generated by 5 payer-owned specialty pharmacies. In 2022, payers will continue to impose their will and leverage in the oral oncology space and, where possible, other dosage forms, creating even more market share.

Overall, trends in the oncology pharmacy space in 2022 are ushering the industry into a new age of medicine. Although oncology pharmacists may be pressed forward by the force of this change, we will certainly not sit idly by as we are propelled toward the future of our industry—it’s not in our nature.

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 during his 40-year career and is a licensed pharmacist in Texas, Washington, California, and Pennsylvania.

1. New drugs at FDA: CDER’s new molecular entities and new therapeutic biological products. FDA. Updated on January 6, 2022. Accessed January 14, 2022. 

https://www.fda.gov/drugs/development-approval-process-drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products

The industry has been ushered into a new age of medicine.

Trends in Oncology Pharmacy in 2022

All patient treatment journeys should begin with a plan; in cancer therapy, that plan is called the clinical pathway. Oncology pharmacists play an instrumental role in these clinical pathways and often are the primary member of cancer care teams providing patients with assurance that they are on the right treatment plan.

The American Society of Clinical Oncology (ASCO) defines clinical pathways as "detailed, evidence-based treatment protocols for delivering cancer care to patients with specific disease types and stages." Additionally, ASCO goes on to note that, when properly designed and implemented, these clinical pathways can act as a tool for improving care quality and reducing costs.

With oncology teams, there is an ongoing debate regarding drug savings vs evidence-based care. Further adding to the debate is the increasing role of managed care in the clinical pathway decision-making process.

When navigating this drug treatment process, highly trained oncology pharmacists, whether board certified oncology pharmacists or specialized pharmacists working in oncology settings, are well positioned to guide oncology teams. In light of this, further exploration of the oncology pharmacist's role in clinical pathway management can provide more evidence to support this position on care teams.

It is no secret that health care costs are dramatically increasing and there is an overall shift toward a value-based health care delivery system. As a result, we have seen a significant increase in clinical pathways in oncology.

As of this year, there are an estimated 60 individual health insurance plans in the United States that are implementing oncology pathways, and more than 170 million individuals are covered by those plans and are potentially being treated under a plan-sponsored pathway.

In the community setting, both oncologists and oncology pharmacists have found treatment pathways essential when providing care for patients with different types of cancers. Clinical pathways serve as guides for these experts so they can select the optimal therapy based on the diagnosis.

Over the past couple of years, there has been an increasing influence from managed care on oncology treatment, principally driven by newly approved higher-cost cancer products and therapies hitting the market. The debate within oncology teams that has emerged is one around the pathway’s development, which has been principally driven by improving care and outcomes; however, when cost becomes the primary point of the selection process, patients may suffer.

The question then becomes one of balance: the improvement of patient care in balance with cost of care. As always, obtaining the best clinical outcome must be the overriding priority. But, in most cases, the patient will make the ultimate decision about what treatment they want before therapy is implemented.

In addition to facilitating the drug selection process, the clinical pathway often becomes an education tool by which the oncology pharmacist can assist the patient in learning about adverse effects, toxicity, efficacy, and treatment burden. The most accepted clinical pathways have embedded elements of the patient’s perspective and facilitate the patient’s ability to have ultimate authority in final treatment decision-making. In this way, clinical pathways exist primarily to achieve the highest evidence-based level of oncology care.

Given the acceptance of clinical pathways, several players have emerged in the field, requiring the clinical oncology team to be called on to consider the different options available. The decisions are often driven by assessing a quality pathway and finding the most currently accepted oncology treatment for a given cancer based on the patient’s diagnosis.

A significant challenge for oncology teams that has emerged as a result of payer influence is managing multiple pathways and potentially providing patients, even within a single practice, varying care depending on their insurance. Most oncology pharmacists and oncologists are uncomfortable with having different treatment pathways and standards of care based on pure economics.

The “gold standard” of treatment pathways is generally acknowledged to be those pathways established by the National Comprehensive Cancer Network (NCCN). NCCN guidelines are often updated and considered contemporary vs those driven by payers, which often have longer review cycles, thus making them potentially out of date.

Over the past decade in specialty pharmacy, oncology products have come into play as over 50% of the total drug spend. Today’s clinical guidelines often recommend a high-cost targeted therapy or immunotherapy because they offer the best efficacy and lowest toxicity. However, the concern arises around payers influencing the product selection process, as the motive of cost savings is often not the oncology team’s preferred direction.

For example, several oncology drugs have been developed, such as tyrosine kinase inhibitors (TKIs) for the treatment of chronic myeloid leukemia (CML). Although hematopoietic stem cell transplantation remains the only curative option for CML therapy, oral TKIs have transformed CML from a progressive disease with a high mortality rate into a chronic condition with dramatically reduced mortality rates. However, TKIs are costly therapies and, often, the choice of pursuing TKIs meets resistance in the payer community.

As approvals continue to provide more options for oncology teams to consider, we should anticipate this debate to continue and strengthen, thus allowing payers to leverage 1 therapy over another.

The Patient and Oncology Team's View of the Role of Oncology Pharmacists

principally being that of oncology pharmacists, it is important to note that patients' and fellow oncology team members' perspectives are also important for oncology pharmacists to consider when approaching the management of clinical pathways.

There is a strong general consensus, supported by a number of studies, that the role of the clinical pharmacist in enhancing patient-reported adherence rates is significant and validated by medication ratio rates. However, it remains unclear whether patient perceptions of the clinical pharmacist’s role in managing clinical pathways align with the findings of this research.

In a recent study, investigators asked patients whether they felt the clinical pharmacist plays an instrumental role in their oncology care—and the results were impressive. Of the patients surveyed, 87.5% stated that they believed the clinical pharmacist plays a critical role in their care.

When patients were asked about their overall satisfaction with their oncology pharmacy care, the results were equally impressive. Patients said that they were 100% satisfied with the role of the clinical pharmacist in their pharmaceutical care.

 Some important additional takeaways from this survey included:

having an onsite specialty pharmacy as a part of the clinic or hospital providing patient care facilitated greater clinical interaction with oncology patients than was possible at external pharmacies;

real-time access to medical records greatly assisted exchanges and education when making informed and patient-engaged clinical pathway decisions;

clinical pharmacists’ involvement resulted in higher patient satisfaction ratings and an enhanced overall relationship with the oncology team; and

high patient satisfaction ratings coincided with higher adherence to oral chemotherapy medications.

As clinical pathways continue to evolve, so will the oncology pharmacist’s role. We should anticipate that we will continue to see new and innovative therapies rise in price, creating more pressure from payers to manage costs.

Many of the new, innovative therapies will be for cancers that were more challenging to treat previously; however, we are seeing replacement or updated therapies for existing treatments emerge as well. These updated therapies often create opportunities for managed care to influence product selection either through a formulary, step edit, treatment pathway, or like mechanism. For example, biosimilars are creating these opportunities in today’s market.

All oncology pharmacists have a responsibility to play a role in the rational and ethical use of therapies and the clinical application of product selection and management, whether their decisions are driven by a clinical pathway or by their professional judgment. Oncology pharmacists have before them the opportunity to spearhead initiatives that promote safe, effective, and cost-efficient medication use, allowing them to lead the efforts of patient and interprofessional education.

 Dan Steiber, RPh, 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 organizations. 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.

Dennison T, Deal AM, Foster M, Valgus J, Muluneh B. A pharmacist-led oral chemotherapy program’s impact on chronic myeloid leukemia patient satisfaction, adherence, and outcomes. 

. 2021;12(2):148–157. doi:10.6004/jadpro.2021.12.2.3

Oncology pharmacists play a significant role in clinical pathways.

The Road to Optimal Oncology Patient Outcomes Is Paved By Oncology Pharmacists

remains a monumental challenge and a devastating tragedy around the globe. Millions have been infected and the mortality rate has far exceeded initial projections. Many had hoped that with the introduction and widespread use of COVID-19 vaccines, we would see the pandemic end much sooner, but mutations of the virus have been able to circumvent our best solutions. In short, the pandemic may be with us for years.

It is generally recognized that to get the pandemic under control, 70% to 80% of the population must be immunized or, alternatively, be infected and recover. Unfortunately, we have fallen short of this immunization level in the United States. With the spread of variants and high levels of vaccine hesitancy among the public, we have not been able to meet our immunity goals.

As drug experts, oncology pharmacists have a critical role in educating patients, caregivers, and health care teams within their communities. Their role can affect not only the efficacy of advancements in our health care system but also the scope of health care progress in our country.

With pharmacists on the front lines of community and institutional health care, they remain trusted sources of information, whether or not they are called out as such by media and lawmakers. Pharmacists have been and will be a strong presence in communities, providing crucial expertise during this crisis. Pharmacists can be found in hospitals, clinics, community pharmacies, long-term care, physician offices, and national and public health offices; all these settings have strong oncology components.

Although the human tragedy of COVID-19 has been vast, so have the efforts by oncology pharmacists to meet new challenges. The pandemic has forced us to adapt, and these adaptations have created a positive evolution of professional practice that, in most cases, will remain the new standard of care. Let’s explore a few of these adaptations in the oncology pharmacy space.

Over the past year and a half, we have worked while using personal protective equipment, masks, plexiglass, computer monitors, and other measures to prevent the spread of COVID-19. This has required sacrificing the personal touch of patient care.

This necessary detachment has also forced us to adapt our methods of communicating with patients, serving as a catalyst for virtual technology adoption across the health care system. Virtual health— including telehealth, digital therapeutics, navigation of care, meeting platforms, and educational resources—is here to stay in one form or another.

Fortunately, oncology pharmacy had much of the technology already in place to allow for a shift to virtual communication. Oncology pharmacists were able to quickly move from the clinic to the home office or another remote location; likewise, patients have received care from oncology pharmacists within their homes or other relatively isolated environments.

With telehealth at their disposal, oncology pharmacists can provide initial drug education, work with patients and caregivers on establishing strong medication adherence, and make any other necessary treatment adjustments. The focus now is on scalability, sustainability, appropriate reimbursement, and optimizing the balance between in-person and remote health care. It is likely that shifts in these areas will not revert once the “new normal” standard of practice has been established.

Studies have indicated that the use of telehealth has exponentially expanded over the course of the pandemic. Patients and providers have become comfortable with consulting over the phone or over Zoom, Teams, or Skype.

Boards of pharmacy, payers, and other policy makers have seen the value of this shift toward virtual care and have supported these changes through new regulations and financing options. With the challenges imposed by the new COVID-19 variants, we have seen these policies kept in place, and they may become permanent.

Outside of health care, we see that the traditional Monday-through-Friday office commute has shifted to telecommuting or hybrid models, leading to the question: Why not oncology pharmacy? Given the risk profile of a typical immunocompromised oncology patient, it makes sense to implement this shift in the oncology pharmacy space as well.

Many of our oncology pharmacist colleagues have estimated that nearly half of oncology pharmacists are working remotely because of the pandemic. By using various platforms, oncology clinical pharmacists can be found doing their rounds remotely from an office location or their home. This requires working closely with colleagues and the entire medical team.

As we entered lockdowns, work elements such as order verification and chart reviews in the clinic and ambula tory settings shifted almost instantaneously. Rather than limit access to care, we have potentially expanded care through adapted use of technology. As a result, oncology pharmacists were able to take on greater responsibilities when interacting with patients and other medical disciplines on issues such as patient safety, satisfaction, and cohesiveness to overall oncology care.

Additionally, remote oncology pharmacists have been able to successfully shift their medication therapy management and medication reconciliation efforts to a virtual environment. Even the oncology infusion pharmacists have been able to shift to performing their order verifications and completing their validation processes remotely, as well as checking the final administration of oncology infusions remotely via a photographic safety checking system.

Health care has historically been viewed as a locally managed process; through technology, many elements of patient care have been proven to be accessible remotely on a national scale. Post pandemic, we may see the emergence of a hybrid approach to patient care in oncology pharmacy. We will need the oncology pharmacist to be embedded with the overall oncology team to facilitate this, supporting oncologists and nurses directly.

Oncology pharmacists have demonstrated that follow-up and support can take place through technology, saving time and resources by expanding the scope of patient care. I see this as a reimbursable process through collaborative practice agreements made with providers and payers.

Although standardization and accreditation strive to provide relatively equivalent oncology care, no 2 settings can be totally alike. Additionally, it has been predicted that we will see a general decline in the number of oncologists and other oncology support personnel. With virtual health, we have an opportunity to expand care across traditional borders and institutions within the health care system.

Driven by the continued increase in the costs of cancer care, we have seen disparities in oncology care based on population groups and subgroups, income level, access to insurance and care settings, and proximity to clinical trials assessing novel treatments. Individuals affected by these disparities may experience decreased access to higher levels of oncology treatment, potentially leading to greater risk of financial challenges or poorer treatment outcomes.

These disparities have had greater attention and focus during the pandemic. Often, patients with less access to higher-quality cancer care are also at greater risk of acquiring SARS-CoV-2 due to their work or living environments. This exposure can also lead to a greater likelihood of hospitalization from COVID-19, resulting in a negative impact on cancer treatment outcomes.

Through the expanded use of virtual care, our profession can level patient access to higher-quality cancer care by closing disparities, improving access, and optimizing cancer care for all populations. With the recent move to expand access to broadband across the nation, more standardized oncology care is possible. A system in which patients would have broader access to their oncology pharmacist regardless of their location is foreseeable.

To make this future a reality, we must continue to make advancements in data sharing and set new standards in integrated health systems through electronic medical records. The pandemic has accelerated access to virtual care, but innovation coupled with adaptations to current methods of reimbursement and care access will need to rise to the occasion as well.

The pandemic forced oncology pharmacy to make great shifts in practice, resulting in the need to further optimize the quality, care, and costs of oncology treatment. By bringing technology and innovative thinking to the fore, we have been able to significantly shift the paradigm of oncology care.

 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 organizations. 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.

Oncology pharmacists can affect not only the efficacy of advancements in our health care system but also the scope of health care progress in our country.

The Pandemic Compelled Oncology Pharmacy to Shift the Paradigm of Oncology Care

, 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.

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 

® is to advocate for our readers and other key stakeholders across all our publications. 

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