Ensuring Patient Adherence to CDK4/6 Therapy

Ryan Haumschild, PharmD, MS, MBA: Dr DiMarco, we’ve seen that current rate in adherence to CDK4/6 [cyclin-dependent kinase 4 and 6] are suboptimal. Even some underrepresented populations aren’t staying on therapy as longer, and they’re not getting that durability of treatment or response that we want to see. Ultimately, how can pharmacists ensure that patients are fully adherent to their therapy and set up for success when it comes to their outcomes?

Rose DiMarco, PharmD, BCPS, BCOP: That’s a great question. Adherence is huge. We’re hearing it everywhere, from CMS [Centers for Medicare & Medicaid Services] to some of our other quality certifications, and it can be really difficult. I think we are the people to do this. We are highly educated, we are trained to give proper education, we’re trained to meet the patient where they’re at. When you’re counseling, you really need to know what the patient knows already, how they understand what’s around them. Sometimes you need to engage their caregivers [and] their friends. I live in an area where we have a lot of different types of people, so I need to sometimes get translation services involved. We have to think about the medications. Like you pointed out, there are different dosing schemes [and] there are different treatment schedules. Some patients who I don’t think can manage a 3-week-on 1-week-off treatment course with palbociclib or ribociclib, I might recommend abemaciclib. But then we have to think about the twice-a-day dosing. Some patients who work long hours maybe can’t take twice-a-day treatment. I don’t think the providers think about this when they’re ordering treatments. Something that I’m doing in clinic is asking, “What’s your day like? What are your barriers to taking meds and how can we fix them?” What you mentioned. Also, we need to be proactive about those adverse effects. They need to know what’s going to happen, about when it’s going to happen and what to do and when to call us. That’s all part of my initial education. But then the other really important thing that sometimes gets missed is the cost of these medications. If they can’t afford them, they’re not going to refill them. What I found is that patients who don’t address that in the beginning sometimes fall off as treatment continues. Sometimes they’re anxious and they want to start their med right away. I’ve had patients put their co-pays on credit cards and find out 6 months later that the credit card is maxed out and they can’t do it anymore. By then it’s hard to get them on assistance programs. They’re delayed. That’s all part of my initial education—to let them know that these meds are expensive. “I don’t know what your co-pay is going to be, but you need to tell me if you can afford this, because then I can help.” I think that really just changes the game for these patients who otherwise might just fill meds.

Transcript is AI-generated and edited for clarity and readability.