 spoke to Melissa Castora-Binkley at the PQA Annual Meeting 2022 and described the type of research PQA conducts.

 At PQA, our research is focused on quality of medication use, and that can mean a lot of different things. Quality is a huge area, but we really focus a lot on safety, patient engagement, access to medications, adherence to medications, health equity, and quality innovation. Our team is diverse, and we have expertise in quantitative research as well as quality.

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The PQA team is diverse, and they have expertise in quantitative research as well as quality.

The Types of Research Conducted at Pharmacy Quality Alliance

 spoke with Micah Cost, PQA Chief Executive Officer, at the PQA Annual Meeting 2022 about past pharmacy performance measures compared to measures now.

 The difference is the use of data and the opportunity to use different sets of pharmacy data to collect a more complete picture. It's also the level of attribution. These measures are specified for application to pharmacies, as opposed to health plan measures. These are actually specified for use in pharmacies and those value-based agreements that they may be put in.

These measures are specified for application to pharmacies, as opposed to health plan measures. 

Implementing Pharmacy Measures for Specific Conditions

 interviewed Joel Wayment, vice president of operations for 3PL Services at Cardinal Health, on some of the logistical challenges in the transport of chimeric antigen receptor (CAR) T-cell therapy products.

 How does the pharmaceutical supply chain currently manage the transport of CAR T products to sites of administration?

 Yeah, these products are incredibly sensitive, and so it takes a lot of unique solutions to make sure that you're transporting these products in the correct fashion. You can't utilize just your standard commercial carrier to move these products, and so these CAR T-cell products are really transported with specialized doers that can hold the temperature at the minus 115 degrees Celsius or lower, and they also can maintain that temperature for multiple days. Generally speaking, these are done through couriers versus utilizing your commercial carriers today.

 What are some of the logistical challenges of this current distribution process for CAR T products within the supply chain?

Some of the challenges to making the logistics work for these CAR T products today in the supply chain is really around making sure that these CAR T therapies are getting to the sites of administration at the same time that the patient who needs them is. Just given the challenges that some sites have in being able to maintain the storage temperature of these products for long durations, making sure that you've got patient and product matching up at the same time is a challenge that's facing the industry today.

 What are some potential solutions to the logistical challenges of the current distribution process for CAR T products?

Really, it's around making sure that all the different partners, as part of the supply chain, are talking together, making sure that you understand where the patient is, if the patient is ready for the treatment, so that you can then trigger the shipment and the transport of these CAR T therapies and making sure that both the patient side of the services, as well as the product side of the services, are uniquely connected to make sure that they're arriving at the same time.

 What is the potential impact of these distribution solutions, if effective?

The impact of these solutions is making sure that ultimately the patient gets the treatment when they need it, and that you don't have risk [of] the product being spoiled or something happening to it in transit. These are expensive therapies, and so getting it right the first time is critical and the solutions that are out there today is that they continue to evolve to ensure that happens.

What is your outlook on the future of this space?

The future of CAR T therapies and gene therapies is going to continue to grow as companies continue to look for solutions to meet some of these unmet challenges for patients. It's an exciting time for our industry, and it's exciting to see the evolution and how things continue to progress, and we expect this to continue to grow and continue to evolve over time.

Joel Wayment, vice president of operations for 3PL Services at Cardinal Health, discusses how the pharmaceutical supply chain currently manages the transport of CAR T products to sites of administration.

Solutions to Facilitate Ease in Distribution of CAR T-Cell Therapies

interviewed Ray Tancredi, divisional vice president of Specialty Pharmacy, Development & Brand Rx/Vaccine Purchasing at Walgreens, on his presentation at the 

 on specialty pharmaceutical pipeline updates.

What are some blockbuster drugs in the oncology space that have recently been approved, and how have they impacted the field since their approval?

 Yeah, when you think about that, the FDA approved, probably, I think 58 drugs in 2021, and a number of them were oncology. A number of them could have blockbuster status, including a couple of oncology drugs. I think the 10-year average for FDA approvals was 48. So think about COVID-19, and how that might have impacted clinical trials and bringing drugs to market.

I think we're on the verge of an even bigger year from a number of approvals perspective. But to answer your question, I think 2 drugs were approved recently that could be over $1 billion dollars in sales as they move ahead, and that's [

 (Abecma)] by BMS for multiple myeloma, it's a [chimeric antigen receptor (CAR) T cell immunotherapy]—could be over $1 billion dollars, I read somewhere it could be $1.4 billion a year. I think also, you saw a product, [

] from Amgen for metastatic non-small lung carcinoma, that could be over $1 billion dollars in sales.

I think those 2 drugs were the recent approvals in oncology that will make an impact by their cost, and by their effectiveness for those disease states. But it doesn't end there. I think in 2021, you saw a number of products that you could consider blockbusters—[

] from Novartis. They're predicting $1.7 billion in sales by 2026, and that's a cholesterol-lowering agent.

Amgen brought a severe asthma add-on maintenance therapy, called [

], that could be over $1 billion dollars a year product. Argenx brought a 

product for generalized myasthenia gravis

 that could also be labeled a blockbuster. Then Aurinia Pharmaceuticals brought [voclosporin (Lupkynistm)], which is for lupus nephritis and also has a price tag of over $1 billion dollars a year.

So as you can see, 2021 had a number of products that we could potentially consider blockbuster drugs, especially as these products get expanded labels or carve out share within their therapy area. So all in all, very successful year, a lot of products in the market that are going to bring value to physicians, patients, and pharmacists in the pharmaceutical industry. A couple of them are oncology and many other disease states are included.



 So far this year, have any game-changing therapies come to market?

 When you think of game changers, I think I named a number of them in that last set of drugs, I mean, every one of those products that I mentioned are game changers. That's why they're going to be so highly utilized.

I told you the 2 oncology drugs and the other product is that [inclisiran (Leqvio)] by Novartis, that product is going to be extremely efficacious. Again, almost $2 billion in sales by 2026.

A product that may not be considered specialty, but was approved in COVID-19—even Pfizer's product—it's a vaccine called [

]. It could be, once it goes commercial right now—it's still in EUA use—but once it goes commercial it could be a $1.4 billion product. I think the game changer for asthma that add-on therapy [tezepelumab-ekko (Tezspire)] for severe asthma, it's maintenance add-on, [and it] could be a game changer in the asthma space.

 What drugs will you be watching post-2022 in terms of FDA assessment and approval, and what may be the impact of these drugs hitting the market, if they’re approved?

 Yeah, I think there's a drug in early 2023 called bempegaldesleukin for renal cell carcinoma. When you think of renal cell carcinoma, there's a number of products in the marketplace today. It's really the most common type of kidney cancer, and renal cell carcinoma is the eighth most common cancer in the United States. You see about 80,000 new cases per year and close to 14,000 deaths in 2021. There are a number of combination therapies, but bempegaldesleukin will be a product that will impact the marketplace from an efficacy perspective and a cost perspective.

Then [there are] 3 other drugs I think you'll see in early 2022 that I have my eyes on. One is for breast cancer called 

 from the Menarini Group, you have [pegcetacoplan (Empaveli)] for acute macular degeneration from Apellis [Pharmaceuticals], and 

 for myelodysplastic syndrome from Gilead [Sciences]. So I think those 4 products we can look to in early 2022 to make an impact to the market.

Ray Tancredi, divisional vice president of Specialty Pharmacy, Development & Brand Rx/Vaccine Purchasing at Walgreens, discusses blockbuster drugs in the oncology space that have been approved this year or may be hitting the market soon.

Overview of Blockbuster Drugs in Oncology Approved in 2022, in the Pipeline for Approval in 2023

 interviewed Tracy Russell, senior director, State Government Affairs at CoverMyMeds, on her presentation at 

 titled Legislation Affecting the Future of Specialty Pharmacies: From the State to Federal Level.

 What federal legislation in particular may be impacting the future of specialty pharmacies and the patient care they deliver?

There are several federal initiatives in play right now, and these are focused in 3 areas: lowering drug cost, access to care, and access to data. I will say that it would be great if we could pass federal legislation because the states will continue to move and they'll do 50 different ways of doing things, and so looking to the federal legislature to make this more universal is great.

Looking in those 3 areas, and lowering cost, the Build Back Better Act currently includes provisions that are designed to lower cost, and if it was advanced, as it is today, it would redesign Medicare Part D and establish inflation penalties, caps on insulins, co-pays, and it would eliminate the so-called rebate rule. It's not yet been approved and could change and there potentially may be an update at the time that we present at Asembia—so stay tuned.

There's also a proposal for Medicare Part D, which defines the negotiated price, or the lowest price the pharmacy could receive as reimbursement for a drug under its contract with the plans, and those 2 are working in lowering the drug cost arena and the access to care section of bills. There's an effort to expand access by improving reimbursement models, and it's been proposed with the Equitable Community Access to Pharmacist Services Act, that’s HR 7213, and that would add pharmacists as Medicare providers for some of the services that would be reimbursed at 85% of the scheduled fee, and it would help to continue some of those services that pharmacists were allowed to do during the pandemic and make those in law.

In addition to making better use of technology, the Office of the National Coordinator, or ONC, is expected to issue a rule this year that would mandate electronic prior authorization for Medicare Advantage services. That's a similar mandate to what was implemented in 2022 for medications, and that will help create better access to care.

Also access to data, making sure that the use of technology to access the patient specific data reduces the administrative burden for providers across the care team. Now, the Centers for Medicaid and Medicare Services, or CMS, included a beneficiary real-time benefit requirements for Part D plans that will take effect in January of 2023. This requirement would allow enrollees to view patients’ specific real-time formulary benefit cost information at the point of prescribing, which is prospectively. When this is implemented, it paves the way for the patients to navigate the affordability and benefit challenges by providing necessary action and patient-specific information, and the patient and the provider can discuss whether or not the patient can afford that medication before they leave the office. This prioritizes the interoperability aspect and can enable data flow and the data fluidity that's necessary to empower those care teams to help the patient solve the challenges through the medication access journey.

How about legislation on the state level that may be impacting the future of specialty pharmacies?

Yeah, as I said before, the states are active. If they're not going to get things overriding with Federal, they continue to move, and what we're seeing at the state level, in addition to scope and reimbursement issues, is white bagging. That particularly impacts specialty pharmacies at the state level because it's when a provider is required to order the therapy from a specialty pharmacy that's typically outside of their own health system. This kind of further complicates the cost transparency for patients. There have been 11 states that have debated proposals to either prohibit pharmacy benefit managers from mandating clinical administrative drugs to be dispensed by a specific pharmacy or prohibiting the steering to a specific pharmacy.

The prohibition to steering is a part of the white bagging challenge, and that's mostly been the concern of independent pharmacies for quite some time as they compete with the larger chains and because they tend to have their own mail order units. But for specialty pharmacies, it translates to the opportunity to help more patients access their needed medication and strengthen the pharmacist-patient relationship, and they're not opposed to the white bagging process, they're just opposed to the mandate from the plans that the patient has to have a specific way of delivering, because, really, it needs to be the patient's choice and whatever is best for the patient.

Then there's also, as I mentioned, the scope of practice and reimbursement issues. Those challenges together prevent specialty pharmacies from being able to provide a wider range of services. So better integration between pharmacy and medical services can empower the specialty pharmacists to deliver the patient care at the highest levels they need and be able to operate at the highest level of their licensure. So we see a lot of states that are working with collaborative practice arrangements that are making it better for the whole health care team to work.

 How about legislation on the state level that may be impacting the future of specialty pharmacies?

Well, as the pharmacist role expands on the care team, especially pharmacy, and especially pharmacists, they should be ahead of the movement. They've been working in collaborative practice arrangements with physicians and nurses for some time, and as I mentioned, the states are really looking to make those pathways easier. Patients have shown that they are increasingly reliant on their specialty pharmacies for the services that that are not just the clinical services, but wanting more information like information about their condition, their side effect management, and the training on the medication that's administered because many of these have to be self-administered. These services are helping the patients not only learn more about the medication, but to find affordability options, and that can have a measurable impact on the patient's medication adherence, whether or not they can afford it.

It's going to be essential that the industry make the use of technology a priority. Assessing patient specific information prospectively throughout the care is important to get the patients to therapy more quickly and to improve their adherence. Biologics [and] cell and gene therapies entering the market can also further complicate because the patient's journey gets more complicated and will increase the need for pharmacists to have that data within their systems because these are very expensive medications, and the specialty pharmacy will be working more and more with those patients to make sure that they can access the care.

Tracy Russell, senior director, State Government Affairs at CoverMyMeds, discusses state and federal legislation that may be impacting the future of specialty pharmacies and the patient care they deliver.

State, Federal Legislation Impacting the Future of Specialty Pharmacies

Cara McNulty, president of Behavioral Health and Mental Well-Being at CVS Health, discussed a 

recently published survey from CVS Health Study

 on rising concerns of mental health in Americans.

She discussed how the pandemic is increasing awareness about mental health concerns, why mental health is becoming less taboo, and how telehealth has impacted the trajectory of mental health conversations.

: Hi, I'm Ashley Gallagher from Pharmacy Times, and today I'm speaking with Cara McNulty, president of Behavioral Health and Mental Well-Being at CVS Health, on a recently published survey from CVS Health Study. The survey found that mental health concerns among Americans are on the rise. What are some notable takeaways from this study for pharmacists?

: Hi Ashley, it's great to be here. One of the things we're seeing is that take a pandemic, take all that's happening in the world, everyone's mental health has been impacted. Everybody is seeing some kind of additional stress, or situational anxiety, or sometimes even more, depression, substance use disorder, and when we think about the role of the pharmacist, most of us can picture the pharmacist that we go to in our local community, and maybe even at a CVS store. We can not only envision who they are, but we probably know their name. Pharmacists are people that are in our community, who we know to be trusted advisors, trusted health care advisors, and what we saw in our study is that people agree: a pharmacist is known to be knowledgeable, a health care advocate and someone really easy to talk to.

So what we found is people are willing to talk to their pharmacist willing to have their pharmacists ask them questions about their mental health well-being and also willing to take advice from their pharmacist.

: How has the pandemic helps to increase awareness around the importance of mental health discussions in general?

: It has done a lot for increasing the awareness, not only the awareness, but the action that people are taking around their own mental health well-being. We have seen because the pandemic has been long lasting, impacted all populations and all communities, that people are talking about the impact on themselves, on their communities, and on their loved ones.

If you look at our data, nearly 4 in 10 adults, so 4 out of 10 adults, feels comfortable talking not only with their friends and family about the impacts on their mental health, but also with health care providers. We also know that parents have used the tactic of talking and raising awareness with their own children to increase the openness, and we find that about 57% of parents are saying, the more they talk about mental health and talk about the realities of how hard things have been, the more their children are likely to engage and also share their feelings.

Finally, we know that in specific communities, the pandemic has hit even harder and think it might have the same outcomes around who's being affected because of the pandemic. But we're seeing in Black communities and in Hispanic communities, their increase in the need for mental health care and support because they're nervous. They want support, they want care, ut in both of those communities, it has been less likely that they're openly talking about their personal mental health and well-being.

: Well said. Why do you believe that mental health is becoming less taboo? And why are more people starting to seek out these conversations around mental health?

: We believe it's becoming less taboo the more we normalize that mental health is just like our physical health, your head health and your heart health are the same. So think about what we do for our physical health. We try to eat well and exercise and get sleep and get our preventive care all to maintain that physical body.

Well, our mental health needs that same nurturing, and that means daily care and feeding. Similar things like eating well, and getting sleep, and taking care of yourself exercising are good for our mental health well-being. It's also good to be talking about how we're feeling, sharing when we're anxious or nervous, and seeking care when things are really maybe not going as you thought or you're not engaging in activities or finding joy that you use to, or maybe you're relying on alcohol or other substances to just get you through the day.

We do see that the more we talk about mental health well-being as a part of your head and heart connected, not separate, the better it is for people to feel comfortable to share how they're doing and also to ask for help.

: Has telehealth impacted the trajectory of mental health conversations? Has it made it easier for people to have these conversations?

: Sure has, it has been profound: what it has done to meet people where they're at and get them the care and support they need. So, I'll just take one of the populations we serve, and that is people who have Aetna medical insurance.

Prior to the pandemic, we served about 1% of that population via tele-mental health. Now, 2 and a half years later, we serve about 60% of that population. It's a high utilization of tele-mental health services, and what that has done, and you can see that across many providers, that their tele-mental health rates have gone up. Why that is, is because people are feeling really comfortable connecting with a social worker, a therapist, a psychologist, a psychiatrist, via tele-video, it not only creates an easy way to get connected to your provider, but we're also seeing in some populations, like young adults, they feel more comfortable to even share some of the things that they might not share in person.

Now they're making that connection really quickly. So, we do see that people are engaging, using that tele-mental health. We're seeing that tele-mental health and the use of tele-video works really well for providers because it allows them to have more flexibility in their schedule, likely seeing people at different times that makes it more convenient for the population they're serving. Also, they're likely able to see more patients because there isn't the travel time. There isn't the setup and take down of what an in-person visit would look like. The use of tele-video and tele-behavioral health has really improved our access issues for people seeking care.

: From a pharmacist’s standpoint, what can they do to help their patients who want to have these conversations about mental health?

: Like I started with, most people can think about the pharmacist in their community, and likely even know their name. So, our pharmacists can lean into the fact that they are a trusted health provider in a community, which I know they understand, but continue to engage in those conversations.

They are seeing people when they're picking up medications or dropping off scripts, and they're engaging in conversations. They know who those people are, what kind of services they're on, and they can help to normalize the conversation by checking in with people: How are you doing? For example, in our CVS stores, a pharmacist, somebody might be picking up a script, and maybe they're a caregiver, that pharmacist is checking in on, “hey, how are you doing? And what's happening with you?” There's that conversation that pharmacist can suggest to that individual: “Did you know we have screening services within our medical clinics to help with depression and anxiety diagnosis? We have folks you can talk to if you're struggling or needing support.”

So you're really normalizing that conversation. Our pharmacists are doing this on a regular basis, and again, it removes the barriers for people feeling shame or alone or loneliness that they're the only ones suffering. The more we have pharmacists engage in these conversations and normalizing that mental health impacts us to all the better the outcomes for all of us specifically in those communities.

: And what is the role of the pharmacist in these conversations?

: So that pharmacist is engaging and understanding, asking questions and understanding what's happening or what is that person experiencing because most of the time people don't know what a mental health issue is supposed to feel like, and we don't need people to have to be experts in their own diagnoses.

So that pharmacist, by having the conversation, can assess: is this person a good candidate to have a conversation with someone to have an assessment to think about a telehealth video, to see one of our nurse practitioners in the Minute Clinic.

They are engaging in that conversation, sharing the resources available, for example, for us within CVS, stores and footprint, but for other pharmacists within the community and ensuring that people get the care and support they need from that trusted health care provider.

Cara McNulty, president of Behavioral Health and Mental Well-Being at CVS Health, discusses a recently published survey from CVS Health Study on rising concerns of mental health in Americans.

Expert Discusses CVS Health Survey on Mental Health

, Amy Pfeifer, PharmD, BCPS, CSP, of AllianceRx Walgreens Prime, discussed the important role that pharmacists can play in the treatment of prostate cancer. In addition to staying aware of new treatments in the pipeline and working with care teams to determine the best treatment plan, Pfeifer said pharmacists can help educate patients on the importance of screenings and preventive measures.

Aislinn Antrim: Hi, I'm Aislinn Antrim with 

 and I'm here with Amy Pfeifer, a clinical program manager with AllianceRx Walgreens Prime to discuss pharmacists’ roles in the treatment of prostate cancer. So, treatments in this space have been developing really quickly over the last several years. What are some key developments that you're aware of?

Amy Pfeifer, PharmD, BCPS, CSP: One of the most recent advances in treatment is the use of PARP inhibitors for men with metastatic castrate resistant prostate cancer. PARP stands for poly adenosine diphosphate ribose polymerase. These inhibitors were the first class of targeted treatments approved for this type of prostate cancer. Targeted treatments act on proteins that are involved in the growth, development, and spread of cancer. PARP inhibitors were originally approved for use in ovarian and breast cancer and are taken by mouth.

There are currently 4 PARP inhibitors approved on the market, 2 of which can be used in prostate cancer. At the end of March this year, we saw our most recent approval in the prostate cancer space with the approval of another targeted treatment known as radioligand therapy. With this type of treatment, radiation can be delivered directly to cancer cells, thereby eliminating damage to healthy cells. It's given intravenously every 6 weeks for 6 doses, and like the PARP inhibitors it is used to treat the most advanced form of prostate cancer. It's so important to have these new treatment options, as advanced cancer is the most difficult type to treat. Both of these new treatment options have improved survival and quality of life in men with metastatic castrate resistant prostate cancer.

Aislinn Antrim: Wonderful. How are pharmacists essential to managing adverse effects that are common with a lot of oncology treatments, specifically in prostate cancer?

Amy Pfeifer, PharmD, BCPS, CSP: So, specific to PARP inhibitors, they can cause a number of gastrointestinal side effects, such as nausea, vomiting, diarrhea, loss of appetite, and constipation. Additionally, they can cause skin rashes and fatigue. Specialty pharmacists are in a prime position to inquire whether patients are experiencing the side effects and assess the severity. Based on what the patient reports, pharmacists can offer lifestyle modifications to help them deal with the side effects and reach out to the prescriber if necessary. Based on the severity, the prescriber might want to hold the medication until the side effect resolves or decrease the dose of the medication. Temporarily holding and decreasing doses are important strategies that allow the patient to continue on the treatment, which might have a benefit for them. Additionally, PARP inhibitors can cause low red blood cell and platelet counts. So, it's recommended that patients have these monitored at least monthly. Pharmacists can remind patients about the need for this testing and just encourage them to keep all their lab and provider appointments.

Aislinn Antrim: Definitely. What are some important considerations when deciding on a treatment plan for patients?

Amy Pfeifer, PharmD, BCPS, CSP: So, some important considerations are the patient's life expectancy, their family genetics, and the risk group, which is how severe the cancer is. Before deciding on a treatment plan, the doctor first needs to know whether the cancer has spread or if it's contained within the prostate. So, it could spread either to nearby organs or more distant sites such as the bones or lymph nodes. If it is still within the prostate or has spread to nearby organs, surgery, radiation or radiation with hormone therapy is often used. But if it has spread to those more distant sites, typically treatment begins with medications. Additionally, there are personal considerations for the patient. So just depending on the risks and benefits of each of the treatments and what they might prefer.

Aislinn Antrim: Absolutely. Cancer screenings overall declined sharply during the pandemic, and they still haven't returned to pre-pandemic levels. Can you discuss the importance of screening for prostate cancer?

Amy Pfeifer, PharmD, BCPS, CSP: Sure. So, for prostate cancer, early detection can occur by measuring prostate specific antigen levels or PSA levels in the blood. A digital rectal exam may also be used. Unfortunately, neither one of these tests is 100% accurate and can lead to a false positive, which is thinking there's cancer when there's not, or false negatives. Both of these situations can either lead to unnecessary additional testing or a delay in treatment.

When prostate cancer is detected early, an additional issue that can come up is whether to treat the cancer. So, with most cancers, we think about early detection and treatment having the most benefits Prostate cancer is a little bit different in that it can grow slowly in some men—so slowly that it never would cause them any negative effects and it wouldn't lead to their death. So, finding prostate cancer early in these men can actually lead to what they call overtreatment, which means you're now treating a patient for a cancer that wouldn't cause them any problems. But the treatment itself can have some really serious side effects and greatly impact their quality of life.

So, based on all of this information, the American Cancer Society recommends that men make a decision about when to start screening for prostate cancer in conjunction with their doctor, depending on their age and any risk factors. So, I would say the most important thing is that men starting at age 40 go have their annual checkup and talk to their provider about when they should start testing. The nice thing about a PSA screening is that it is a blood test. So, if the time is now that they need to be screened, they can often do it that same day, either in the office or a lab nearby.

Aislinn Antrim: Wonderful. Well finally, what is the pharmacist’s role in prostate cancer treatment?

Amy Pfeifer, PharmD, BCPS, CSP: One of the main goals of our interactions with patients is to increase adherence. As I mentioned earlier, managing side effects is one of the main ways that we can help prevent the early discontinuation of a treatment that might have a positive outcome for the patient. So, with that, first of all, we will educate patients on the administration, storage, potential side effects, and expected benefits of their therapy. Here at AllianceRx Walgreens Prime, we call to check in with patients every couple of weeks at the beginning of their therapy, and one of the first things that we're doing is confirming that they actually started their treatment, or you know, has there been any hesitation in taking that first dose, we know that they received the medication. So, when we call the patient if they haven't started yet, we can talk about any concerns that they might be having and work to get them on their treatment plan as prescribed. If they have started taking it, we then can talk about any side effects they're experiencing or adherence barriers that they're facing.

I think it's important to ask patients about specific side effects for their medication. So again, we could catch those reactions early and manage them through lifestyle modifications, dose adjustments, or supportive care medications that will help keep them on their treatment. Additionally, we can connect patients with other services they might need, such as financial aid programs or patient support groups. We do see ourselves as part of the patient's care team and want to do whatever we can to help that specific patient meet their treatment.

Aislinn Antrim: Wonderful, thank you so much for talking with me about this.

Amy Pfeifer, PharmD, BCPS, CSP: Thanks for having me.

In an interview with Pharmacy Times, Amy Pfeifer, PharmD, BCPS, CSP, of AllianceRx Walgreens Prime, discussed the important role that pharmacists can play in the treatment of prostate cancer. 

Pharmacists Play Key Roles in Treatment of Prostate Cancer

 You’re able to be a subspecialist practicing within hematology. I feel like you have a progressive practice model that enables patients to have direct interaction with you, at the end of the day, you’re able to help improve direct patient care. Talk me through what your role looks like in terms of the team. Who are the key stakeholders you’re engaging with as you’re focusing on this patient care and quality improvement? At the end of the day, what does that dialogue look like as part of the care team when you’re rolling out these initiatives?

 Great questions. My role in the clinic has evolved greatly over many years, but what seems to be of most value is time spent with patients and then bringing that information back to the physician who has to stay on schedule, seeing patients every 20 minutes. I typically go in with the patient and see every patient on our schedule, which can be a daunting task, especially if we have 18 patients to see in 4 hours. I rarely sit down those days. I just go from 1 patient room to the next.

We pass the hematologist in the hall. We discuss patients in the clinic and try to keep things rolling. Then, at the end of the day, we sit down and go through all of the needs that we identified for different patients. Working at a University center, I have the luxury to be fully clinical in that regard. I fully understand and respect that not everyone can do that. Some pharmacists have to work with a verification queue. We all wear many hats and play different roles. But in terms of key stakeholders, it’s really the patients and physicians who are the key stakeholders who would benefit from the clinical services.

 Building on that, do the patients feel the impact you’re making when you interact with them directly? Do they give feedback in terms of what a different care model it is having a clinical pharmacist directly involved in their care plan?

 I can’t tell you how many phone calls come into the clinic asking for me specifically. Although there are some questions that should be directed toward the hematologist, sometimes they’re directed toward me because I have spent that extra time building that relationship and trust with the patient.

 How about you, Sharita? How is it working with you? Talk to me about your care model. Do you have that same interaction with patients on a day-to-day basis?

 We have interactions with our patients, but they’re at the pharmacy level. We’re not visiting the patients when they’re being seen in the clinic, but we’re working behind the scenes and engaging these patients after they leave the office. By talking with these patients day in and day out, we can assess what their gaps in care are or how they’re feeling about their treatment, and then we’re able to report that back to our physician team.

One of the things I wanted to point out, as Jeff was talking, is that in the community practice I don’t want to forget about the value that great oncology pharmacy technicians add to the mix. Because if you’re able to get buy-in from your pharmacy technicians and your pharmacy technicians are able to engage these patients, depending on your state laws, you can use them to complete some of the day-to-day tasks that may be part of the pharmacists’ duties. We may be able to have the technicians do those.

For example, our technicians are the ones making refill calls. They’re following a script that we’ve created in the EMR [electronic medical record]. We were able to develop macros or snippets that expand so they can type in a drug name and then a script will expand and they’re able to really hone in on this script and go through it with the patients. That allows the pharmacist more time to focus on some of these clinical activities and development of these clinical initiatives. Then you can train your technicians to be able to triage certain problems. If a patient is scoring all 1s on their assessment, then we’re good to go. But if you notice that we’re starting to get 4s, “OK, this is what we do for 4s. This is what we do when the scale is closer to 10.” I want to stress to practices to lean on technicians for some of these clinical initiatives as well, especially as technicians are becoming more specialized.

 That’s a great point. I’m a huge fan of pharmacy technicians. I’ve got to tell you, I work with an incredible team. I refer to them as the MVPs of pharmacy because I truly think that they make the difference in the care model that we provide. The more that we can leverage their skill sets, the better it’s going to be for patient care and team-based care, as you spoke about. I appreciate you calling that out.

Within your practice, as you’re identifying some of these patients for your quality initiatives, how does the physician champion who we discussed earlier get involved? How do they get involved in identifying a patient? Do they tell you when a patient looks like someone you should see based on this scoring? How do you get engaged with them? How do they engage patients as part of the quality improvement process?

 In our setting with our quality initiative, the physician champion isn’t filtering the patients to our pharmacy for this service. We’re actually completing this service for all of our patients who are started on a medication. If they’re started on a treatment for their PV [polycythemia vera], ET [essential thrombocythemia], or myelofibrosis, they’re automatically falling into this queue for follow-up. What the physician champion does for us is get the word out there to the nursing staff and other physicians to say, “This is something that the pharmacy is doing, these are the data that they’ve collected, and this is how it’s impacting our patients.”

The reason it’s important in our particular practice is because when patients fill with us, they fall into our symptom management initiative. But if a patient goes to an outside pharmacy, we aren’t able to capture those patients because I don’t have a record that they have been started on therapy. There’s a huge gap there for patients who are going to outside pharmacies if we don’t capture that prescription first. One of the ways that we were able to target these patients in other disease states is by having a nurse navigator who’s running reports in the EMR and then following up with these patients who are filling outside of our pharmacy.

By being able to get the physician champion on board, I can get buy-in to our clinical director or other staff members and say, “We need help. We’re doing it for these patients who are coming to see us in our pharmacy. This is how the care is differing from the patients who aren’t seeing us in our pharmacy, and we need these extra hands to be able to increase this initiative so that all of our patients are receiving the same amount of care, no matter where they’re filling within the VCI [Virginia Cancer Institute] network.” That’s where they stand out for us in our practice.

 That’s key because even when we have some patients who are carved out due to payer mandates, we still want to provide quality care. They’re still our patient, so how do we work on that?

Pharmacy specialists illustrate the benefits of using a comprehensive team for care delivery to patients with MPNs.

Key Considerations for Bridging Gaps in Care Delivery

 Going through this entire talk, it seems like there are so many benefits to quality initiatives around MPNs [myeloproliferative neoplasms]. But I feel like not everyone is doing it. Jeff, why are others not taking advantage of improving these quality improvement projects? What barriers are people running into? Why isn’t it more widespread in terms of patient management?

 The answer to that question is multifactorial. A lot of it has to do with the resources available to you. As pharmacists, we wear many hats. We’re educating students and residents. We’re working with our IT [information technology] department to build infrastructure to make these medications orderable. We’re chasing down prescriptions to make sure they get filled and are paid for by payers. We’re signing up patients for copay assistance. We’re spread thin. We’re asked to do more and more. Time is an opportunity cost. If you’re deciding to focus on 1 project, there’s another project that may suffer from lack of attention. Also, not having an MD champion prevents a lot of forward-thinking and process improvement.

At our center, we have several dedicated hematologists who see patients with MPN, and that has enabled us to start new clinical trials and partner with other centers overseas to offer new treatments at our center. I can’t say enough about having someone champion the care of these patients. We don’t work in isolation. No one does it alone. We need to reach out and work with others.

 Having a physician champion is important. I can speak to that as well. I have the chance to work with some awesome hematologists. You do need their buy-in, especially as we’re working on collaborative practice agreements for pharmacists to treat these patients, to be part of the initiation of supportive care medications or to titrate doses. You have to have someone who’s also going to be an advocate of that practice for pharmacy. That’s important. That’s a barrier, because even if it’s a great academic practice, not everyone has those champions. If they do, there’s varying levels of engagement. I’d love to see that improved.

When we think about barriers, you talked about electronic medical record [EMR] data and building in some of these functional systems that overlay so we can keep track of patients. That’s also very innovative. How do we get that to be more widespread? As we hear about the academic setting and some of the barriers to implementation or how quality improvement projects look in the academic setting, I’ve got to turn to you, Sharita. I love to hear how you complement your view in the community setting. When we think about community and MPNs, you’ve talked greatly about the different projects you’ve done. But how does implementation differ from Jeff? What are some of those barriers that may be unique to the community setting that may not be the same as the academic?

 When we speak to some of the barriers that are available in the community setting, I can’t speak to all community practices, but something that may be difficult is having the bandwidth to be able to take on some of the initiatives associated with MPNs. A lot of times our initiatives start as theses, and from there we have to work our way up. Barriers that we can come across include getting that physician buy-in. Because if the pharmacy itself comes up with an initiative, and we hammer that initiative out but it’s only in the pharmacy, then it still could be broken apart at any time. We need to make sure we’re having that physician champion so we can speak with them and say, “This is what we’ve been doing.” Then from there, we can get buy-in of other stakeholders within the practice. From there, we may be able to build something solid in the EMR.

Some of the initiatives that we start maybe started at the pharmacy level, but our ultimate goal is to make sure that we can get these implemented into the EMR so that they’re long-lasting and we’re not only communicating at a pharmacy level but at a level with the physician team, nurse team, and our patient financial counselors. Sometimes there’s information that they can tease out while completing prior authorizations or trying to get patients approved for therapy. If we’re implementing this and putting it in the EMR, we have a larger picture of what’s going on with our patients. One of the largest barriers in the community practice is being able to get that off the ground because sometimes we’re spread thin and don’t have the time. We need to figure out how to make the time, answer questions and solve problems for these patients, especially with MPNs.

 I’d add that regardless of what setting you work in, as pharmacists, we tend to be perfectionists by nature. We have to be because dosages must be perfect. Everything needs to be precise. When we think about a quality initiative, we try and package it in this perfect little way before we deploy it or set forth on trying to achieve our goals. That may be unrealistic. Patients can derive a lot of benefit just by putting 1 foot forward in front of the other. Like Sharita was saying regarding the EMR, putting in any level of standardization that you’ve learned from past experience or attending meetings on new therapies will go a long way in benefiting patients, and you can build on this over time. It doesn’t have to be perfect the first time out.

 These are great comments. I’m realizing that so much too is that stakeholder engagement. You can’t just say, “We’re pharmacy. We’re going to carry this through.” You have to create ownership from others in the organization, and that generates that sustainability. That’s important too. We have to come up with ideas and help the team figure out how we improve patient care but get them bought in. I think about that all the time because you can’t get something in the EMR without also engaging others and getting on the priority list. With the pharmacists, it’s also interaction with the team.

Highlighted are proposed solutions for current barriers to care for MPNs.

Navigating Barriers to Care for Patients with MPNs

 interviewed Sneha Sharma, director, specialty clinical solutions at Magellan Health, on her presentation at Asembia Summit 2022 titled Future Focused: Trends, Pipeline, and Oncology Highlights.

 What are some trends in the rare disease space that you’d recommend pharmacists keep an eye on?

 So currently, in terms of utilization, I recommend pharmacist keep an eye on [teprotumumab-trbw (Tepeeza)] utilization, [onasemnogene abeparvovec-xioi (Zolgensma)] utilization, [immune globulin injection (Gammaked)] utilization, as well as other high cost therapy drugs for this unique patient population.

 What lessons has the pandemic taught around the importance of strategizing for the future and also perhaps the occasional futility of certain aspects of preparing for the future in the field?

 I think the pandemic taught us that things can shut down and patients may defer treatment. So we need to be prepared to help patients that should not be deferring treatment or diagnostic [testing], to feel safe to come in and make sure that we're still diagnosing our patients that are maybe non-pandemic treated.

Sneha Sharma, director, specialty clinical solutions at Magellan Health, discusses some trends in the rare disease space that she recommends pharmacists keep an eye on this year.