Redefining Roles: Technicians Reduce Oncology Drug Waste in Specialty Pharmacy

Objectives: Oncology medications produce significant amounts of pharmaceutical waste due to high costs and frequent therapy modifications driven by toxicity or disease progression. Reducing waste is essential to enhance patient safety, alleviate financial burdens, and mitigate environmental risks. Although strategies such as split-filling and drug repository programs exist, they are often limited by regulatory and logistical constraints. This project evaluates a novel, technician-led workflow implemented at a hospital system’s specialty pharmacy to reduce oral oncology drug waste through proactive refill coordination.

Study Design: This was a retrospective chart review for quality improvement.

Methods: Pharmacy technicians reviewed electronic medical records for recent oncology provider notes and patient communications to identify treatment holds or imminent dose changes prior to initiating refill outreach. When appropriate, technicians delayed refills, documented rationale, and consulted pharmacists for complex cases.

Results: A retrospective review of this workflow over 5 months identified 53 unique interventions, resulting in 1541 therapy days held and an estimated cost avoidance of $859,167. The most affected drug classes were CDK4/6 and Bruton tyrosine kinase inhibitors, which are frequently modified due to toxicity. No safety concerns or complaints were reported.

Conclusions: This initiative demonstrates that pharmacy technicians can safely and effectively contribute to reducing oncology drug waste, allowing pharmacists to focus on higher-level clinical responsibilities. The model is scalable and particularly beneficial for institutions with limited pharmacist resources or high oncology prescription volumes, including rural or underserved areas. Targeting high-risk drug classes for tailored refill workflows may further enhance waste mitigation efforts.

Letter to the Editor: Oncology drugs are a major contributor to pharmaceutical waste due to high costs and frequent therapy adjustments in response to poor medication tolerability or rapid disease progression. Minimizing waste is crucial for improving patient safety and reducing the financial burden on patients, payers, pharmacies, and health care systems.¹ Doing so may also mitigate environmental harm caused by improper disposal of hazardous medications.² Strategies such as split-filling prescriptions and drug repository programs can reduce waste.^3,4 However, split-filling can be limited by insurance restrictions, and it may place an added burden on patients and pharmacies due to the increased coordination required.³ Additionally, drug repository programs are not available in all states.⁴

Previous literature suggests that specialty pharmacies can curb oncology drug waste through prospective pharmacist review.⁵ However, pharmacy technicians manage refill coordination and may be well-positioned to contribute to waste reduction efforts. To explore this potential, we implemented a technician-led workflow designed to ensure appropriate refill coordination while minimizing unnecessary dispensing of oral oncology drugs.

Prior to refill coordination, technicians reviewed the most recent hematology-oncology physician note or relevant patient communications in the electronic medical record (EMR) to determine whether treatment was on hold or a change was imminent. When appropriate, technicians delayed outreach, documented the rationale, and alerted the pharmacist. Pharmacists were available to review unclear cases and adjust plans as needed. Additionally, it is standard practice at our institution, the University of Vermont Medical Center Specialty Pharmacy, for technicians to assess adherence and review the number of doses on hand at each outreach. If a patient reported accumulation of doses due to a medication hold, outreach was adjusted.

A workflow review was conducted in January 2025 to assess patient safety and impact on minimizing oral oncology drug waste. For each case, we recorded the drug name, formulation, strength, duration, reason for hold, and treatment outcome. We calculated dosage units saved and estimated cost avoidance using average wholesale price at the time of the intervention.⁶

Over approximately 5 months, technicians identified treatment changes that led to the delay or avoidance of 53 unique oncology drug refills out of approximately 2000 outreach tasks. In follow-up surveys, technicians reported the process to be efficient, with most reviews taking only a few minutes and rarely exceeding 5 minutes. As summarized in the Table, this accounted for 1541 total days of therapy held, with a median hold of 23 days. The estimated cost avoided was $859,167 over a 134-day period, with a median cost avoidance of $15,065 per drug hold. Of the total cost avoided, $346,600 was due to dose changes ($183,801) or drug discontinuation ($162,799).

The most common reason for treatment interruption or change was toxicity, although therapy was also withheld for infections or procedures. CDK4/6 inhibitors and Bruton tyrosine kinase (BTK) inhibitors were most frequently affected, both in terms of volume and cost avoided. Following holds, therapy was resumed at the same dose in 62% of cases, dose-reduced in 23%, and discontinued or changed in 15%. No safety concerns were identified during the chart review, and no complaints were received from patients or providers regarding delays in therapy.

Our results demonstrate that a targeted, technician-led intervention can safely and meaningfully reduce unnecessary dispensing of costly oncology medications. Technicians in our hospital system’s specialty pharmacy efficiently coordinated appropriate refill delays, resulting in substantial cost savings and preventing unneeded hazardous medications from entering the community. Previous studies have shown that pharmacist-led review can help reduce waste during treatment holds.⁵

However, optimizing pharmacists’ time by leveraging technicians to practice at the top of their license allows pharmacists to focus on complex clinical decision-making and patient care. To our knowledge, this is the first report of a technician-led oncology drug waste reduction initiative. Empowering technicians to conduct brief EMR reviews and coordinate refill delays allows pharmacists to focus on other critical clinical responsibilities, ultimately improving patient care across the system.

A limitation of this workflow is its inapplicability to specialty pharmacies without access to an EMR. From a cost perspective, implementing a standardized questionnaire may help technicians reduce drug waste. From a safety perspective, review of an EMR generally offers a more comprehensive and accurate real-time view of a patient’s clinical status and therapeutic plan. To mitigate safety concerns, when EMR access is unavailable, technician-led questionnaires should be standardized and may require additional pharmacist oversight for interpreting ambiguous or incomplete information.

Notably, BTK and CDK4/6 inhibitors were the most frequently affected drug classes in terms of both volume and cost of avoided waste. These oral targeted therapies are often held or dose-adjusted due to toxicity, making them vulnerable to unnecessary dispensing.^7,8 Identifying these agents as high-risk for waste emphasizes the value of tailored refill workflows. Specialty pharmacies may consider prioritizing these classes when designing waste reduction strategies.

Given the success of a technician-led waste reduction model in our institution, similar workflows could be adopted by other health systems to improve efficiency, reduce drug waste, and optimize the use of pharmacy staff. This model is particularly well-suited for institutions with limited pharmacist resources or high volumes of oncology prescriptions. This approach may be especially beneficial in rural or underserved areas where efficient medication management is critical to access and continuity of care.

REFERENCES

1. Biskupiak J, Oderda G, Brixner D, Tang D, Zacker C, Dalal AA. Quantification of economic impact of drug wastage in oral oncology medications: comparison of 3 methods using palbociclib and ribociclib in advanced or metastatic breast cancer. J Manag Care Spec Pharm. 2019;25(8):859-866. doi:10.18553/jmcp.2019.25.8.859

2. Arke M, Massoud MA, Mourad YF, Jaffa MA, Habib RR. Environmental and health consequences of pharmaceutical disposal methods: a scoping review. Environ Manage. 2025;75(6):1388-1400. doi:10.1007/s00267-025-02167-5

3. Staskon FC, Kirkham HS, Pfeifer A, Miller RT. Estimated cost and savings in a patient management program for oral oncology medications: impact of a split-fill component. J Oncol Pract. 2019;15(10):e856-e862. doi:10.1200/JOP.19.00069

4. Heater NK, Kircher S, Weldon C, Trosman J, Benson A. Oncologic drug repository programs in the United States: a review and comparison. Health Aff Sch. 2024;2(3):qxae031. doi:10.1093/haschl/qxae031

5. Looney B, Crumb J, White S, et al. Financial impact of integrated specialty pharmacy efforts to avoid oral anticancer medication waste. J Manag Care Spec Pharm. 2024;30(5):465-474. doi:10.18553/jmcp.2024.30.5.465

6. Lexicomp Online, Lexi-Drugs [database]. Hudson, OH: Wolters Kluwer Health, Inc. https://www.uptodate.com. Accessed January 2025.

7. Lipsky A, Lamanna N. Managing toxicities of Bruton tyrosine kinase inhibitors. Hematology Am Soc Hematol Educ Program 2020;2020(1):336-345. doi:10.1182/hematology.2020000118

8. Thill M, Schmidt M. Management of adverse events during cyclin-dependent kinase 4/6 (CDK4/6) inhibitor-based treatment in breast cancer. Ther Adv Med Oncol. 2018;10:1758835918793326. doi:10.1177/1758835918793326