Expanding the Pharmacist’s Role in Myelofibrosis: Education, Adherence, and Access

Jessica Lewis-Gonzalez, PharmD, BCOP, discusses the evolving role of pharmacists in supporting patients with myelofibrosis, emphasizing the importance of education, individualized care, and ongoing follow-up. She explains how pharmacists help patients integrate new therapies into their daily routines, using tools such as medication lists or calendar-based schedules, while also assessing adherence and identifying barriers through structured follow-ups. By empowering patients with clear explanations of side effects and treatment recommendations, pharmacists ensure patients feel confident and informed in managing their care.

She also highlights the impact of newer therapies, particularly JAK inhibitors, which not only alleviate symptom burden but also help prevent further progression, allowing patients to maintain a better quality of life. With the emergence of novel agents and combination regimens, pharmacists are increasingly responsible for monitoring complex and overlapping toxicity profiles.

Pharmacy Times: What strategies can pharmacists use to support adherence and patient education, particularly given the chronic nature of treatment?

Jessica Lewis-Gonzalez, PharmD, BCOP: I think education is key—both the initial education and the ongoing support—so that patients have all the materials they need. I like to take a really individualized approach. Some patients can seamlessly integrate a new medication into their routine without any issues, while for others it can be more complex to figure out how to set things up.

Sometimes I’ll provide cell-therapy–style medication lists to make it clear what time of day they should be balancing all of their medications. Others prefer to see things from a calendar standpoint, which can also be helpful. For oral chemo education, we do an initial session, then a seven-day follow-up, and a first refill follow-up. I always check in with patients at those points to see if they’ve missed any medications. Our whole team does that, whether the therapy is an oral targeted agent or oral chemotherapy, and we try to assess what barriers to adherence they’re facing so we can tailor our approach to their unique needs.

Another thing that’s very important to me is empowering patients. When there’s a specific side effect to watch for, or something they need to avoid, I like to explain why. That way, they understand the reasoning behind our recommendations and feel empowered to act in the best way possible.

Pharmacy Times: How do you see the role of pharmacists evolving as new JAK inhibitors and novel combinations enter the treatment landscape?

Lewis-Gonzalez: I think this role is going to continue to expand significantly as these therapies grow. We’re really just scratching the surface of how involved pharmacists can be in the management of myelofibrosis patients. With the new combinations—not only JAK inhibitors, but also BET inhibitors and anti-apoptotic agents—we’re going to have to manage unique toxicity profiles. This will be especially important as we begin combining these agents, since they can present both overlapping and distinct toxicities. We’ll need to carefully determine when to adjust the dose of one agent versus another.

Another important area is financial navigation for patients. In the clinic setting, pharmacists often serve as a middle ground between retail and dispensing pharmacies, while also understanding the physician’s perspective and the broader health care team. That position allows us to act as liaisons, helping mitigate some of the financial toxicities patients experience. It’s about giving patients the best possible chance to access the therapies they need for their disease—without feeling like they have to take out a second mortgage.

Part of that involves setting realistic expectations about timing. While there are many excellent assistance programs available, the process to enroll can be time-consuming. Patients shouldn’t feel pressured to immediately accept the initial copay quoted by a specialty pharmacy or insurance company. Instead, we can step in to work with them to find ways to reduce those costs and ensure they can continue their treatment.

Pharmacy Times: Is there anything else that you would like to add?

Lewis-Gonzalez: When it comes to the overall symptom burden that patients experience, I think that’s one of the biggest areas where JAK inhibitors have truly made a difference. They’re not only helping us manage existing symptoms but also preventing those symptoms from progressing, more often than not. That shift has really changed how myelofibrosis patients feel day to day and has allowed them to live more regular lives compared with what was possible before the advent of having so many different JAK inhibitors available to us.