Social determinants of health create a myriad of obstacles to optimal care for patients receiving treatment for metastatic breast cancer.
Heather Moore, PharmD, CPP, BCOP: The other thing––we’ve touched on this quite a bit throughout––is access for the patients in those areas. And I will say,…I am at an academic center, but thinking about the range of patients that we see, I have patients [who] want to talk about the Kaplan-Meier curves, and then we have patients [who] don’t have access to drugs and don’t really understand their health. Literacy is very poor. So I think it’s sometimes finding a middle. But when you’re thinking about community centers, a lot of these patients’…biggest issues are getting to clinic and how are they going to get their drugs. We may think about a co-pay of $9 as being very reasonable, but for some patients it’s very much not. And that’s the difference between them eating one day vs not.…That’s a perspective, and it’s being able to think about how we implement what we know from the academic side, but also translate that into the community. And I think a lot of that comes with education, but also just making sure that we’re identifying the patients and the resources that they need.
Ryan Haumschild, PharmD, MS, MBA: Resources are so important, and…looking at the whole patient and even building upon resources. We’ve talked about this a little bit, but even social determinants of health [may be considered]…. Is a patient able to make it in for a certain treatment? Are they going to be able to make it in for monitoring during the pandemic? Or even are they going to be able to afford a medication? So when we’re thinking about those treatment considerations, I do want to…ask you, Dr DiMarco, when you’re sitting down with your team, whether it’s sitting with advanced practice practitioners [APPs] or physicians, how do you evaluate some of these considerations, maybe even like financial toxicity for a patient? Because if they can’t afford the medication, they may not take the medication. What strategies can pharmacists do to ensure that these APPs and providers are informed about cost-saving measures or alternative therapies or even patient assistance programs that allow patients to get the access to the medications they need?
Rose DiMarco, PharmD, BCPS, BCOP: That’s a great question. And that is also becoming a huge part of my clinic life. I am so fortunate. I have a great specialty pharmacy that we can send our prescriptions to for processing. They’re so good at financial aid assessment and getting the patient what they need. But I feel [that] over the past couple of years, more and more patients are not able to get filled through our specialty [pharmacies]. They’re being sent to mandated specialty pharmacies, and I think that’s where that ball gets dropped. And then in clinic, I find out that their co-pay is too high, and I have to put my specialty pharmacy hat on and figure out how to get their treatment. So those patient assistance programs have been huge for us. …Working with our colleagues in pharma [is] so helpful and they’ve always been able to point me in the right direction, help me fill out the forms. But something that seems to still be a problem is getting the patient to fill out the form. It’s really difficult to ask for their financial information or how many people live in [their] house. Sometimes that’s not something they want to disclose. Sometimes they don’t have the documentation. And I never actually thought [about] that as being part of my job, but it is because nobody else in the clinic can do it and nobody understands what it takes to fill a prescription like pharmacists do. So that’s becoming more and more a part of my role. And I think as new drugs get approved or indications expand, we really need to know what kind of programs are available.
Transcript is AI generated and edited for clarity and readability.