Operationalizing Bispecific Antibodies in Community Oncology

In an interview with Pharmacy Times at the 2026 Community Oncology Alliance (COA) Conference, Yoni Resnick, PharmD, discusses the dual clinical and operational responsibilities pharmacists take on when integrating bispecific antibodies (BsABs) into community oncology practice. He highlights the importance of education to normalize these newer therapies and reduce uncertainty among multidisciplinary teams and external hospital partners. Resnick also emphasizes the complexity of care coordination, including caregiver requirements, geographic considerations, and collaboration with hospitals for adverse event management.

Pharmacy Times: As bispecific antibodies become more integrated into oncology care, where do you see the biggest opportunities for community pharmacists to play a more active role in operational workflows?

Yoni Resnick, PharmD: I think community oncology pharmacists have a unique role and responsibility in operationalizing bispecifics. The role of the pharmacist in this particular class of medications is both clinical, which is very important and what we’re used to for all of the drugs we’ve onboarded and educated on up until now, but there is also a huge operational component. You’re working with a multidisciplinary group, including administrators; finance teams; authorization teams; nurses; physicians; back-office staff; as well as the pharmacy team, pharmacy technicians, and pharmacy leadership.

The role of the pharmacist is intense, and you have to provide that clinical context and information about the drug, the side effects, and how to monitor the patient after administration. One of the most valuable aspects is normalizing the newness of this class of medications. We’re talking about a new mechanism of action and new side effects—new at least in the community oncology setting. In general, people have a fear of the new and unknown, so normalizing these drug names, mechanisms of action, and side effects through repeated education in different formats, meetings, and settings is important. This is a unique opportunity for pharmacists to help control that narrative, providing not just clinical education on drug efficacy, safety, and preparation, but also guidance on how to support the patient through the initial doses when these new and unique side effects are most likely to occur.

Pharmacy Times: Given your experience across inpatient and ambulatory settings, what are the key challenges community practices face when implementing BsAb therapies, and how can pharmacists help address them?

Resnick: Our experience with bispecifics has been entirely in the outpatient setting. We started giving our first outpatient doses just over two years ago, and we’re proud to have reached that milestone. We recognized that these agents are a standard of care, but there wasn’t a local hospital that was able to administer these drugs or partner with us in a hybrid model where we could administer outpatient care and admit for observation. We had to figure out how to do it ourselves.

In terms of overcoming challenges, a major component has been addressing the fear of new therapies through education and care coordination. Another key challenge was defining and establishing a hospital partnership. While we don’t proactively utilize the hospital for administration or monitoring, we still need collaboration in case a patient develops side effects that require inpatient evaluation, such as higher-grade cytokine release syndrome (CRS) or immune effector cell–associated neurotoxicity syndrome (ICANS). Educating hospital staff—emergency room, ICU, hospitalists, and nursing teams—was particularly challenging, especially in settings without oncology experience.

Pharmacists played a central role in this process by providing education to hospital staff, helping create EMR order sets, working with pharmacy teams to ensure availability of rescue medications like tocilizumab, and establishing dosing algorithms and grading scales for CRS and ICANS that could be used in the inpatient setting. Building this hospital partnership in an independent community setting was one of the most challenging and time-consuming aspects.

Another major focus was care coordination between the patient, caregiver, and treatment team. We implemented new protocols for treatment education visits that require caregiver involvement. Patients must have a caregiver before starting outpatient bispecific therapy. The caregiver must attend the education visit, sign a consent outlining their roles and responsibilities during the step-up dosing process, and remain with the patient for 72 hours after each dose.

Patient geography is also a challenge. Patients must remain within a 30-minute radius of the clinic for 48 hours after each step-up dose. For those who live farther away, we work with local foundations to cover hotel accommodations so they can stay within that required distance. Removing financial and logistical barriers is key to improving access to these therapies.

Pharmacy Times: With your oversight of formulary and drug contracting decisions, how do practices balance the clinical promise of BsAbs with cost considerations and access in the community setting?

Resnick: These therapies are expensive, so cost is a consideration. However, safety and efficacy are always the top priorities. When options are similar in those areas, we consider patient out-of-pocket costs and available support programs. In many cases, patients will reach their maximum out-of-pocket responsibility regardless, so contracting opportunities and overall cost of care also play a role. Ultimately, decisions require balancing clinical value, patient access, and operational considerations to provide the best care possible.