Specialty Pharmacy Technicians in Oncology Transitions of Care: An Untapped Workforce Resource

Oral anticancer therapies (OAT) are increasingly used in oncology but introduce complex operational, financial, and safety challenges that can delay treatment initiation and complicate transitions of care (TOC). These challenges include prior authorization (PA) requirements, high out-of-pocket costs, limited distribution networks, and patient-managed administration. Pharmacy technicians represent an underutilized workforce resource that can help address these barriers, particularly within integrated health-system specialty pharmacies.

At the University of Vermont (UVM) Health Specialty Pharmacy, technicians play a central role in supporting oncology TOC through a multidisciplinary meds-to-beds (M2B) program. Technicians are embedded within specialty pharmacy workflows and focus on PA, financial assistance coordination, and patient outreach. Integration with a shared electronic health record (EHR) enables real-time collaboration across inpatient, outpatient, and pharmacy teams, facilitating timely medication access and discharge planning.

Over a 2-year period, specialty pharmacy technicians supported 76 discharge-related medication dispenses, 88% of which were for oncology indications, most commonly hematologic malignancies. Technicians contributed to expedited medication access by navigating payer requirements, securing financial assistance, and coordinating medication procurement. This often enabled same-day or next-day discharge.

This model highlights the critical role of pharmacy technicians in improving care coordination and access to OAT during TOC. Expanded integration of technicians into oncology workflows may reduce delays, mitigate financial toxicity, and improve patient outcomes. Further evaluation is needed to better quantify their impact and support broader implementation of technician-driven care models.

Insights

OATs are increasingly used in oncology and are growing in popularity among patients and providers. These therapies demonstrate efficacy in clinical trials and real-world settings and may reduce off-target toxicity through targeted mechanisms of action, potentially lowering the overall burden and cost of care. However, OATs introduce unique challenges that require coordinated support from providers, nurses, case management, social work, and pharmacy staff to ensure affordable, safe, and timely treatment.¹ These challenges include securing PA, financial assistance coordination, manufacturer assistance programs, Risk Evaluation and Mitigation Strategies requirements, and limited drug distribution (LDD) networks. In addition, patient-managed administration increases the risk of nonadherence and may impact outcomes.^1-4

Effective OAT management is further complicated during TOC, which often involves therapy changes, dose adjustments, or treatment holds. Successful OAT use requires timely and efficient coordination across multidisciplinary teams.⁵ In this setting, pharmacy technicians are a largely untapped workforce resource and can help address operational, financial, and logistical barriers. Traditionally, pharmacy technicians have focused on operational functions; however, their role in oncology care is expanding. As oncology treatment becomes more complex, technicians can play a broader role in facilitating medication access, supporting TOC, reducing waste, and improving care coordination.⁶ 

At UVM Health, specialty pharmacy technicians have a large role in supporting oncology care. Technicians specialize in 1 of 2 primary areas: PA or patient outreach. The PA team conducts benefit investigations, initiates PA, and coordinates financial assistance. The outreach team is patient-facing and provides specialty pharmacy services education, coordinates medication delivery, and triages patient questions.

A key strength of our model is integration within the health system. Our shared EHR allows real-time technician visibility into treatment plans and changes, confirmation of coverage requirements, and anticipation of discharge needs. These shared workflows streamline communication between care teams. This coordination is most important during TOC, when discharge timelines are short, and delays in access can affect length of stay and patient safety.⁷

UVM Health’s M2B program demonstrates this integration. It provides in-hospital retail prescription processing, proactive identification of PA or cost issues, clinical review, and bedside delivery with patient education before discharge. Although M2B is a separate discharge medication service, specialty pharmacy technicians partner with the M2B team when specialty medications are needed. In these cases, an assigned specialty pharmacy M2B technician serves as the lead and works with the outpatient specialty pharmacist to support an expedited specialty workflow. The inpatient team engages this technician and pharmacist to coordinate access, often enabling same-day or next-day discharge. These medications often require PA aligned with FDA-labeled indications, and payer step therapy requirements, common for Bruton tyrosine kinase (BTK) inhibitors, can further delay access.^3,8 The pharmacist provides clinical oversight and patient counseling, while the technician drives much of the access process, accelerating therapy initiation and enabling timely discharge

Over a 2-year period from April 1, 2024, through April 1, 2026, our specialty pharmacy coordinated 76 dispenses to facilitate discharge. Of these, 67 (88%) were oncology dispenses, described in the Table. The disease states most commonly managed were hematologic malignancies (n = 50; 75%), including acute myeloid leukemia, acute lymphoblastic leukemia, and various lymphomas. The most frequently dispensed medication was venetoclax (Venclexta; AbbVie Inc, Genentech) (n = 30; 45%), followed by BTK inhibitors (n = 9; 13%). Financial assistance was secured in 17 (25%) cases. Among those requiring assistance, the median co-pay prior to funding was $911. Funding always reduced the co-pay to $0.

The implications of this integrated, multidisciplinary program are substantial. M2B programs improve patient safety and quality metrics.⁹ Within this model, technicians who facilitate M2B services may contribute to reductions in hospital length of stay, readmissions, time to therapy initiation, financial toxicity, and prescription abandonment rates. Despite these potential benefits, further research is needed to better characterize and quantify the full impact of technicians in this setting.

The American Society of Health-System Pharmacists and the Hematology/Oncology Pharmacy Association recognize the evolving role of technicians and support their involvement in processes related to obtaining high-cost anticancer therapies.⁶ This reflects a growing understanding that technicians are not limited to distributive functions alone; they can serve as essential members of the oncology care team when appropriately trained and integrated into specialty pharmacy and TOC workflows.

Despite its advantages, this model has limitations. Staffing and training can be challenging because not all technicians receive M2B-specific training, and low volume makes it difficult to maintain proficiency. Payer-related barriers, including variable PA timelines; step therapy requirements; and strict adherence to FDA-labeled indications, particularly among Medicare plans, may delay access.^3,10 Coordination between inpatient and outpatient teams can also be difficult in the acute care setting, where clinical status, dosing plans, and discharge timelines may change rapidly.

Medication-specific factors add further complexity, as many OATs are administered in cycles and require precise dispensing to minimize waste and errors.⁵ Limited inventory, LDD networks, and drop-shipping requirements may increase the risk of discharge delays.¹¹ Given their operational expertise and familiarity with payer requirements, inventory, and distribution channels, technicians are well equipped to identify barriers, anticipate delays, and escalate issues to the care team for discharge planning. They are also well positioned to support communication during time-sensitive TOC. However, the successful implementation of this model depends on infrastructure such as an integrated health-system specialty pharmacy, shared EHR access, and direct communication pathways with inpatient and outpatient teams.

Looking ahead, the continued evolution of technicians in oncology presents important opportunities to further expand their role and impact within multidisciplinary care models. Potential opportunities include technician involvement in workflows related to pharmacogenomic screening, data tracking and outcomes research, and the development of more standardized training and oncology-focused specialization.^12-14

OAT and TOC present significant challenges, underscoring the essential role of technicians in navigating operational, financial, and logistical barriers to ensure timely and safe treatment. Integrated specialty pharmacy and M2B programs illustrate how technician-driven processes may enhance care coordination, improve access to therapy, and impact patient outcomes and institutional performance. Further research is needed to better characterize the full impact of technicians in this setting, but their value as an oncology workforce resource is increasingly clear.

References
1. Wong SF, Bounthavong M, Nguyen CP, Chen T. Outcome assessments and cost avoidance of an oral chemotherapy management clinic. J Natl Compr Canc Netw. 2016;14(3):279-285. doi:10.6004/jnccn.2016.0033
2. Harris V, Tai MH. Risk Evaluation and Mitigation Strategies (REMS) for oral oncolytics: increased safety or barrier to access? J Oncol Pharm Pract. 2026;32(1):156-160. doi:10.1177/10781552251377770
3. Kyle MA, Keating NL. Prior authorization and association with delayed or discontinued prescription fills. J Clin Oncol. 2024;42(8):951-960. doi:10.1200/JCO.23.01693
4. Mackler E, Segal EM, Muluneh B, Jeffers K, Carmichael J. 2018 Hematology/Oncology Pharmacist Association best practices for the management of oral oncolytic therapy: pharmacy practice standard. J Oncol Pract. 2019;15(4):e346-e355. doi:10.1200/JOP.18.00581
5. Heffner C, Dillaman M, Hill J. Pharmacist-driven medication reconciliation reduces oral oncolytic medication errors during transitions of care. Am J Health Syst Pharm. 2020;77(suppl 4):S100-S104. doi:10.1093/ajhp/zxaa168
6. Bergsbaken J, Roman D, Earl MA, et al. ASHP-HOPA guidelines on the roles and responsibilities of the pharmacy technician in ambulatory oncology pharmacy. Am J Health Syst Pharm. 2018;75(17):1304-1311. doi:10.2146/ajhp180270
7. Daly B, Cracchiolo J, Holland J, et al. Digitally enabled transitional care management in oncology. JCO Oncol Pract. 2024;20(5):657-665. doi:10.1200/OP.23.00565
8. Narang M, NCODA. Provider perspectives on clinical and non-clinical considerations in BTKi selection. Network for Collaborative Oncology Development and Advancement. December 2025. Accessed April 29, 2026. https://ncoda.org/wp-content/uploads/2025/12/BTKi-Selection-WP.pdf
9. Muir A, Rodriguez MC, Kang SC, et al. Provision of medication supply at hospital discharge: a rapid scoping review of the “Meds-to-Beds” care model. Am J Health Syst Pharm. 2026;83(3):e105-e114. doi:10.1093/ajhp/zxaf151
10. Preserving patient-centric oncology care amid step therapy changes. Network for Collaborative Oncology Development and Advancement. February 6, 2025. Accessed April 29, 2026. https://ncoda.org/news/preserving-patient-centric-oncology-care-amid-step-therapy-changes/
11. Suchanek D. The rise and role of specialty pharmacy. Biotechnol Healthc. 2005;2(5):31-32,34-35.
12. Borchert JS, Phillips J, Thompson Bastin ML, et al. Best practices: incorporating pharmacy technicians and other support personnel into the clinical pharmacist’s process of care. J Am Coll Clin Pharm. 2019;2:74-81. doi:10.1002/jac5.1029
13. Cheng V, Markarian A, de Lemos ML, Schaff K. Evaluation of the role of pharmacy technicians in reviewing the eligibility for Oncotype DX genomic test and the impact of the test on treatment plans in breast cancer patients. J Oncol Pharm Pract. 2019;25(5):1167-1173. doi:10.1177/1078155218803703
14. Holle LM, Bilse T, Alabelewe RM, et al. International Society of Oncology Pharmacy Practitioners (ISOPP) position statement: role of the oncology pharmacy team in cancer care. J Oncol Pharm Pract. 2021;27(4):785-801. doi:10.1177/10781552211017199