The Association of Community Cancer Centers (ACCC), through its Oncology Pharmacy Education Network (OPEN), last year kicked off a new virtual learning series in conjunction with American Pharmacists Month. The series allowed attendees to participate in live, peer-to-peer discussions to address the current challenges facing oncology pharmacy, have their questions answered by industry experts, and learn about the expanding role of pharmacy in cancer care.

During the first webinar in the series, Pharmacy Metrics for Off-label Treatment, three oncology pharmacists discussed how the prescription of off-label treatments can present a unique set of challenges for oncology pharmacists and the programs and practices in which they work. Moderated by Ali McBride, PharmD, MS, BCOP, clinical coordinator of hematology/oncology at the University of Arizona Cancer Center, the session included discussions of case studies presented by Derek Burns, PharmD, BCPS, DPLA and Sarah Hudson-DiSalle, PharmD, RPh.

Some of the challenges posed by the off-label use of cancer treatments discussed during the webinar include how to determine which metrics to leverage for monitoring off-label prescriptions, how to accommodate differences in dispensing in community versus academic settings, how to address potential loss of revenue, how to maximize free drug programs, and how to prevent denials.

Dr. Burns—the clinical pharmacist and pharmacy manager at Rocky Mountain Cancer Centers-Aurora—provided a framework for how cancer practices can approach managing off-label drug treatments.

“We know that process ownership does not lie solely with the provider, and it does not lie solely with the pharmacy team,” said Dr. Burns. “We’re taking a multimodal approach. We take clinical pharmacy as well as the administrative trainer to develop the process, oversee the process, and maintain accountability.”

Identifying key players in that process is crucial for its success, noted Dr. Burns: “We’ve identified key players along the way. And by no means was our process perfect to start, but we’ve been slowly understanding the workflows, figuring out the pain points, and pulling more people into this group to provide that value from a buy-in and ownership approach.”

Dr. Hudson-DiSalle—the oncology pharmacy manager of medication assistance and reimbursement services at The James Cancer Hospital—said her hospital realized early on that it needed a formal approach to address claims for off-label treatments, so her department created a formal process that takes a team approach.

“It does not lie with just one department to be the owner of the process,” explained Dr. Hudson-DiSalle. “Your pharmacists are your medication experts. They can discuss rationale for off-label use within a team and retrieve supporting literature. They understand CMS-approved compendia.” To close the loop, she added, any information gleaned should be added to a database where valuable metrics can be continually analyzed.

Dr. Burns agreed: “You need accountability, consistency, and a means to collect data and analyze that data. Raw data is only useful when someone can analyze it.”

Dr. Hudson-DiSalle said that because some patients at The James Cancer Hospital rely on medication assistance programs to fund their care, it can be difficult to ensure they have access to off-label treatments.

“It’s difficult when there is a patient who has gone through multiple lines of therapy, and they’ve been rendered uninsured by an insurance denial,” said Dr. Hudson-DiSalle. “What options do you have?” She provided webinar attendees a list of options that can help such patients, including copay assistance programs, free drug programs, and working with teammates on appeals to the payers. She recommended ACCC’s Financial Advocacy Network as a resource for patient navigators and others on the cancer care team.

You may view a recording of this webinar by registering for the webinar series.

Please join ACCC for other sessions, including: Pharmacists and Older Adults with Cancer: Effective Practices; Billing for Chemotherapy Patient Management: Extending and Elevating the Pharmacist Role; and Closing the Oncology Research Gap: Pharmacy’s Role Defined. Register online now to ensure you don’t miss these webinars.

This webinar series is being offered through the ACCC Oncology Pharmacy Education Network (OPEN), which was established in 2004 to bring together education, resources, and peer-to-peer networking to help pharmacy professionals navigate the accelerating course of change in oncology—clinically, operationally, fiscally, and programmatically. ACCC thanks Merck & Co. for their financial support of the Oncology Pharmacy Education Network.

Other recent education products produced by OPEN include:

Podcast: Reducing Cancer Drug Waste
Podcast: COVID-19 & Oral Oncolytics
Lecture series on step therapy