Three Professional Perspectives on Managing Patients on Oral Oncolytics

The integral role pharmacists play in the management of patient care evolves daily, especially as it relates to the changing landscape and robust pipeline in oncology. As treatments for cancer move increasingly into the home, the ability to educate patients while providing resources to monitor compliance and adverse-effect management becomes even more critical.

Recently, we asked several leading industry experts to discuss this issue, reimbursement challenges, and where the oral oncolytic landscape will be in 2020. Ray Bailey, RPh, pharmacy director for Florida Cancer Specialists’ provider-based oncology specialty pharmacy, Rx to Go, said that managing the complex needs of an oncology patient can be enhanced by combining the human touch with technological advances.

“We have been able to leverage technology to design patient- and drug-specific oral adherence care plans. Our proprietary tool, which interfaces with our dispense system, allows us to follow and contact our patients in defined intervals based on a drug/patient risk level,” he said. “We are also in the process of upgrading this technology to allow for patient self-assessment and dose reminders through text messaging.”

Bailey added that adverse-effect management is crucial to keep patients on therapy and compliant.

“Our model gives the pharmacist access to the practice electronic health record where labs, pathology, and physician notes are available,” he said. “Having this information as we counsel patients is invaluable, because we are often able to make interventions that prevent drug waste, and also allow us to easily make referrals back to our physicians and nurses when we feel our patients may need a dose adjustment or side-effect management.”

At Johns Hopkins Medicine, pharmacists have typically been part of treatment programs. They collaborate with physicians to decide on treatment protocols and help to drive the drug development process. Megan Swarthout, PharmD, MBA, BCPS, set up an oral oncolytic task force at Johns Hopkins more than 5 years ago, just as new guidelines were released by the American Society of Clinical Oncology (ASCO) at the onset of the product pipeline growth. As Johns Hopkins prepared to launch new therapies for patients, it was even more important that the pharmacist collaborate closely with the physician in caring for these critically ill patients.

“Our pharmacists are imbedded into the clinics with oncologists and are credentialed members of the medical staff, able to facilitate anything the patient may need, from either the acute or ambulatory setting, which we find to be a critical attribute of our patients remaining compliant and comfortable about their treatment protocols,” Swarthout said. “Our ability to provide ongoing education, either by the bedside or in the clinic, allows the flexibility needed to cater to the individual needs of our patients.”

A third perspective comes from Paul Jardina, president and CEO of Onco360, an oncology specialty pharmacy.

“In addition to high-level education and recurrent positive reinforcement, Onco360 offers patients services such as pill blister packaging and ‘smart’ pill bottles,” he said. “These extra measures have been shown in medical literature to enhance medication compliance in complex disease states. Onco360 has several internal preventative and reactive protocols, to help patients manage the debilitating side effects of cancer, that have aided in making the patients’ journey a little more comfortable.”

Reimbursement, all 3 say, is among the biggest challenge facing the industry today. In fact, Jardina said that each year, Onco360 spends more of its operational dollars investing in resources to alleviate issues in access to care related to patients’ financial responsibility for their therapies. He said foundations are often moving targets, opening and closing with the availability of funds from donors.

According to Bailey, “Prior authorizations have become more and more complex with routine re-authorizations. Larger and larger patient cost share, particularly with these expensive specialty meds, is also a large problem. Fortunately, on the commercial side, pharma has stepped up with co-pay assistance in the form of co-pay cards.”

He added that co-pay responsibility for most commercial patients is manageable, but Medicare patients are a very different story.

“The coverage gap and catastrophic co-pays for Medicare Part D coverage have become, in some disease states, a nightmare for our patients,” he said.

Unfortunately, no one sees a solution for this issue anytime soon. When asked about the pipeline, and what the immediate future may bring for this subset of the specialty pharmacy industry, these experts agree that alternative payment models are needed to innovate and disrupt the market, as the pricing of new drugs may outpace the ability of most people to afford them.

“By 2020, we will have reached a crossroad. We will probably have many doublet immunotherapy regimens. Many of these may be in combination with IV or oral chemotherapy. There will likely be many ‘new target’ oral cancer drugs commercially available,” Bailey said. “However, the question remains, how will we pay for these new miracle therapies that are more and more turning some cancers into chronic diseases?” 

About the AuthorSuzette DiMascio, CHE, CMCE, CPC, is the CEO and founder of CSI Specialty Group, based in Sanford, Florida. As a thought leader, industry expert, frequent media contributor, and sought-after speaker on all things specialty, Suzette’s strategic insight on marketplace trends helps align and enlighten this continually pivoting industry. Under Suzette’s leadership, CSI Specialty Group has become known as the industry’s preeminent specialty pharmacy leadership consulting firm. It offers strategic solutions to all healthcare market channels across the spectrum, from health systems to manufacturers, and was honored as one of Consulting Magazine’s Fastest Growing Firms, ranking 5th out of 50 firms. For more information, visit www.CSIgroup.net.