Adversity: The Mother of Invention

Pharmacy Times Oncology Edition, August 2020, Volume 2, Issue 4

By their training, pharmacists are natural problem solvers, and our education has taught us how to use resources to find an answer and often a solution. The world is waiting for a pharmaceutical solution to coronavirus disease 2019 (COVID-19).

During this time of global focus on health care, who better to turn to for solutions than a pharmacist? We are continually called the most accessible health care professionals. A patient who needs information about a medication or general health care can pick up the phone and find a pharmacist willing to give their time and expertise 24 hours a day. By their training, 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 answer and often a solution.

The world is waiting for a pharmaceutical solution to coronavirus disease 2019 (COVID-19). A whiff of news about a new therapy or drug immediately becomes the public’s focus. Our global society’s survival hangs in the balance of a long-term solution in the form of a vaccine to help eradicate the deadly virus.

Beyond health, COVID-19 has influenced everyone’s daily lives in some way. Global politics are tenuous and shifting, depending on the public’s perception of who can best lead humanity toward a solution. Global economies remain uncertain as we seemingly mortgage our futures on economic bridges until health care solutions emerge.

In the middle of these potential solutions are pharmaceutical products, and we are the world’s drug experts. We must remain confident that solutions will come. Headlines often focus on the cost of specialty pharmaceuticals rather than the benefit. However, in these times of crisis, no price is too high. The perception of the pharmaceutical industry has shifted from villain to savior. We have never been more relevant.

Adjusting to the Here and Now

The impact of COVID-19 on specialty pharmacy has reshaped the pharmaceutical supply chain as well as access to lifesaving drugs. The new normal has shifted the patterns of our professional lives, and I suspect not on a temporary basis. What was previously considered extreme behavior—social distancing and the use of face masks, hand sanitizers, infrared thermometers, plexiglass screens, and personal protective equipment—has become the rule.

We must lead by example, including how we conduct ourselves professionally with the public. In community pharmacy, pharmacies’ strategic locations near centers of the population have put us in the middle of providing health care. From the initial stages of the COVID-19 crisis, pharmacy has been at the epicenter for access to testing, and when vaccines or other proven therapies emerge, we will be the prime setting for prevention, preparedness, response, and recovery.

All pharmacists will be expected to raise the bar even higher by continuing to upgrade their knowledge. Given that live, in-person professional events and conferences have been canceled, an unprecedented shift to online programs has occurred. Pharmacy Times Continuing Education™ (PTCE) has offered dozens of programs on the expanded role of pharmacists in the COVID-19 era. It has also successfully transitioned in-person events to real-time online programs at pharmacytimes.org, providing thousands of pharmacists—rather than perhaps a few dozen who may have attended an event in the past—education on pertinent topics. This year’s National Association of Specialty Pharmacists Annual Meeting will take place virtually and offer dozens of programs that you can experience from the comfort of your home office. If you want to upgrade your specialty knowledge, consider registering at naspmeeting.com.

Specialty Pharmacy and Oncology Treatment

Treatments for patients with cancer have traditionally been through infusion, and the infusion of oncology products is generally split between the oncologist’s infusion suite and an outpatient institutional setting.

Despite the extraordinary measures of physicians’ offices and hospitals to protect patients from COVID-19 exposure, many patients have found themselves in truly life-and-death scenarios and fraught with anxiety. Many oncologists have transitioned patients from infused cancer treatments to oral formulations when possible, resulting in a surge for specialty pharmacies that focus on oncology treatment. Oncology pharmacy specialists are being called on to shift therapies and to work closely with new treatments and dosage adjustments.

Specialty pharmacy at Boston Medical Center in Massachusetts provides a good example of this shift to oral therapies. Specialty pharmacists have been actively involved in transitioning appropriate patients to oral-equivalent therapies, with self-monitoring at home. Patients treated with weekly bortezomib (Velcade)-based therapy for myeloma, for instance, receive the oral proteasome inhibitor ixazomib (Ninlaro) as first-line therapy in lieu of bortezomib, so they can avoid going to the clinic for weekly infusions.

Additionally, patients receiving treatment for idiopathic thrombocytopenic purpura typically require weekly romiplostim injections in the clinic. So the specialty pharmacy team has transitioned many of these patients to an oral TPL agonist like eltrombopag (Promacta) or avatrombopag (Doptelet).

The benefits for patients include a general improvement in quality of life, fewer adverse effects, and convenience. The specialty pharmacist’s role has greatly expanded, as these professionals are more connected to patients compared with those receiving infusions in the clinic.

Leveraging Technology to Improve Adherence

There is an abundance of prescriber and patient resources designed to improve adherence to oral oncology medications. Specialty pharmacies staffed by board-certified oncology pharmacists have expertise in oncology regimens and can advise the patient on optimum dosing, as well as counsel them on the importance of strict adherence. Technology comes into play in improving patient adherence, with trackers, daily medication reminders, adherence apps, and clinical resource teams supported by pharmaceutical manufacturers. We should anticipate an even greater increase in the adoption of technology, as well as other changes to our daily lives driven by technology such as contact tracing mobile apps.

I recently participated in several virtual tours of specialty pharmacies via Zoom. The cubicles were empty, as most specialty pharmacies are having their nondispensing staff work from home wherever possible, leveraging video chats, texting, and 2-way messaging. As patients and providers rise to the challenges, their increased comfort and familiarity in interactive options have become a new standard. State boards of pharmacy have accepted flexible standards by allowing direct physician-patient visits via telehealth, thereby affording pharmacists equal or better access to their patients. Patients in turn can remain safely at home and receive equal or even better care.

These options were available in the past, but adoption was low, and reimbursement was typically not available. The Centers for Medicare & Medicaid Services and other payers have been providing payment for these interactions, and pharmacists are being recognized as providers. We should be encouraged by these trends and view them as opportunities to pursue these services and receive reimbursement for them following the crisis.

Specialty pharmacists continue to be a key resource in the delivery of optimum health care for our society. Adversity and crisis are often said the be the mother of invention, and COVID-19 has had a great impact on specialty pharmacies in the short term.

Document what you do, prepare your business case for the future, and track positive patient outcomes. Be prepared to tell your story. Long term, the role of the specialty pharmacist will likely expand to other services based on the skills they hone during these times of adversity. Specialty pharmacy should brace for the new normal and any future pandemics.

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