Practice Pearl 3: Challenges for Obtaining Therapeutic Agents on Formulary for NETs


Experts in the management of NETs share the challenges of getting therapeutic agents on the formulary.

Daneng Li, MD: Looking a little forward, thinking about the areas that we can potentially work on, it would possibly be good to understand the challenges with getting any of these potential treatment options for formulary. I would like for you both to mention to me how it works with providers at each of your institutions in terms of ensuring that patients get any of these medications and that they get it in a timely manner. Are there any challenges that you have encountered with any of these various treatments for neuroendocrine tumors that might be worth highlighting for our colleagues?

Megan May, PharmD, BCOP: Where I practice [Baptist Health Lexington], to start with formulary, we have an inpatient and an outpatient formulary, and they are not the same because some of these agents—like those we are talking about—we will give on an outpatient setting. The first step for us is that the pharmacists are in charge of presenting the medication. Of course, we are going to research the data behind the drug’s efficacy and safety and understand that. We also need to rely on our pharmacotherapy knowledge, understanding on-label and off-label indications, being familiar with clinical practice and other literature that is available and looking at the safety profile of all these drugs. For us, once I would do that, I would go to my providers to discuss all the data found and get their opinion on the medications, to determine what we are going to put on formulary or if we pick 1 over the other. Where I practice, we have them all on formulary, so our providers can choose what they want. It is a conversation that we have, and we value everyone’s opinion when making those big decisions for our institution and our patients.

Cecilia Lau, RPh, BCOP, APh: I agree with Megan. We [at City of Hope] also have all the products on formulary, but generally speaking, the process and the dialogue are the same.

Daneng Li, MD: Great. That is good to hear that all these products are on formulary, and it is important. As a provider, I would hope that there are not restrictions on me in terms of what I order and everything, but we also understand that there are potential cost implications for each organization and everything, so it is potentially going to be on a somewhat independent basis.

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