A Discussion on oHCM: Part 3 – How Pharmacists Can Lead CMI Access, Titration, and Patient Counseling

In the third part of an interview with Pharmacy Times, Craig Beavers, PharmD, FACC, FAHA, FCCP, BCCP, BCPS-AQ Cardiology, CACP, a cardiovascular clinical pharmacist with Baptist Health System and the University of Kentucky College of Pharmacy, addressed how pharmacists should approach cardiac myosin inhibitor (CMI) recommendations when comparing mavacamten (Camzyos; Bristol Myers Squibb) with investigational agents in the same class and highlighted the best practices he has found most effective in multidisciplinary obstructive hypertrophic cardiomyopathy (oHCM) management.

When counseling patients on CMI therapy, Beavers emphasized several consistent pharmacist responsibilities across the class: proactive drug interaction screening, echocardiographic monitoring of left ventricular outflow tract gradient, and understanding each agent's half-life as it relates to titration decisions. He noted that drug interaction screening in particular represents a natural entry point for pharmacist engagement across the CMI class.

Where mavacamten distinguishes itself, Beavers argued, is in the depth and duration of its real-world safety data. With robust short- and long-term Risk Evaluation and Mitigation Strategy (REMS) data now available, pharmacists can approach shared decision-making conversations with considerable confidence, reassuring patients that mavacamten's track record is well-established compared to newer or investigational agents in the class that have not yet accumulated the same breadth of clinical experience. He noted this kind of longitudinal evidence can be especially meaningful to patients who may feel uncertain about starting a newer therapy.

On multidisciplinary collaboration, Beavers described a team-based model in which cardiologists and advanced practice clinicians manage initial patient assessment while pharmacists take ownership of comprehensive medication management, up-titration, and ongoing monitoring, freeing other providers to see new patients. He also highlighted pharmacists' critical role in navigating the access and prior authorization challenges that come with REMS-associated therapies, noting that absorbing this administrative burden directly supports the Quadruple Aim: improving patient outcomes, expanding access, reducing provider burnout, and delivering a more comprehensive care experience for patients navigating a complex, chronic disease.