Expert Discusses A Health System Specialty Pharmacy Initiative: Abemaciclib Linkage to Care

Pharmacy Times interviewed Carly Giavatto, PharmD, a health system specialty pharmacy (HSSP)-focused research pharmacist at CPS. Giavatto is part of CPS’s clinical outcomes research team and program, which studies clinical practices, benchmarking, and outcomes across disease states, and across network of HSSPs. Giavatto discussed the CPS conducted study that highlights a first of its kind linkage to care initiative performed by health systems specialty pharmacists. Giavatto emphasized the positive results among eligible patients that caused abemaciclib prescriptions to triple. Additionally, Giavatto highlighted that linkage to care initiatives can involve a wide range of areas, which include linking patients into social services, a correct diagnosis, financial assistance, or drug programs which promotes medication access.

Pharmacy Times: Can you introduce yourself?

Carly Giavatto: My name is Carly Giavatto, I am a clinical outcomes research pharmacist and part of CPS’s clinical outcome research team, and I've been in this role for just under 1 year.

Pharmacy Times: Can you give a brief overview on the role of abemaciclib therapy and who benefits from this treatment?

Giavatto: So, in October 2021, the US Food and Drug Administration (FDA) approved abemaciclib as the first therapy to treat patients with HR+/HER2- node-positive, early breast cancer who were at risk of recurrence as an adjunct to endocrine therapy, which was considered standard of care treatment. This approval led to the adoption of this therapy into a guideline recommendation by the National Comprehensive Cancer Network, which stated that abemaciclib may be considered in combination with the current standard of care for this patient population. This approval and addition to the guidelines was based on the results from the abemaciclib phase 3 clinical trial, indicating a higher disease-free survival in this patient population.

Pharmacy Times: Can you describe why CPS conducted this study and share the methods and findings?

Image credit: Bongkarn | stock.adobe.com

Giavatto: This study highlights a first of its kind linkage to care initiative performed by health systems specialty pharmacists (HSSPs). So, we know that there can be a lengthy delay before clinical trial data translates into guideline updates, and even longer for patients to then be evaluated and initiated on new guideline-directed therapy.

So, HSSPs saw this as an opportunity to provide the best care for patients and bridge this gap and potential therapy delays by elevating their role and being involved in initiating a new guideline-directed therapy. This was accomplished through pharmacists offering an education session to the providers in clinic, aiming to increase awareness of the clinical benefits of therapy and guideline updates. In addition to that, they reviewed profiles for all their patients in clinic and evaluated them for therapy appropriateness, based on diagnosis and package insert guidance.

After selecting appropriate candidates, pharmacist made formal recommendations to providers to add this therapy to the patient's regimen. At the end of the study period, the number of abemaciclib prescriptions tripled—which was very positive—and 100% of patients who were identified by pharmacists as appropriate candidates were initiated on therapy. So, another goal of ours was to publish this work in a framework that is reproducible to many other therapies or situations like this, where other institutions can use it as a guide to complete similar initiatives. It was important for us to share the framework with others to spread awareness of 1 example of the linkage to care initiative.

Pharmacy Times: How do the findings impact the HSSP practice?

Giavatto: So, HSSPs were pivotal in linking patients into a therapy that has mortality and morbidity benefits. They were knowledgeable on guideline changes and acted on them to promote best care for their patients and serve as a therapy expert to the clinics and providers.

Pharmacy Times: What is HSSP's role in linkage to care, and how has this contributed to the outcome of the study?

Giavatto: The linkage to care initiatives can encompass a wide range of areas—like demonstrated in this study—and can promote patients on optimal therapy. But in addition to that, it can mean linking patients into social services, linking patients into a correct diagnosis, linking patients into financial assistance, or drug programs which promotes medication access. So, HSSPs are well-positioned to do these types of linkage to care initiatives, because they are embedded within clinics where they have direct access to patients, providers, health system resources, and electronic health records, which means they have knowledge of in-patient data and outpatient health status. So, this allows them to be well-versed with the patient.

Pharmacists, we know, are trusted medical professionals who are connected to these resources and have knowledge of their patients in this holistic way, allowing for them to be an advocate for their patients where they can leverage their position to address these patient needs and promote their best interests. So, I believe because of this, we were able to be successful in accomplishing this specific linkage to care Initiative.

Pharmacy Times: Is there anything you would like to add?

Giavatto: There is 1 thing that I can share, 1 study that's coming out next for us is related to the role of HSSPs during a transitional period. So, we know that transitional periods—such as a change in health care provider—introduces risks including therapy gaps, medication non-compliance, or disease progression, so a provider transition occurred at 1 of our partnered sites, and during this time, HSSPs offered special services. So, we're evaluating some pertinent endpoints to assess the effect of these services and we're really excited about the final results.

I guess in conclusion, the clinical outcomes research team is really excited and proud of our work. We hope that it is impactful to other institutions and that it's positively contributing to the current body of literature.