Expert Discusses Role of Pharmacist in Oncology Practices, Biosimilars

Q: How can pharmacists remain on top of shifts in the nature of biosimilar payer benefit design?

Paul Forsberg: I think the first thing that pharmacists can do is to really closely monitor the Medicare ASP reimbursement. Each quarter Medicare will release those ASP reimbursement costs based on the J-code and understanding how Medicare is adjusting reimbursement based off of the current trends, and biosimilars are going to really key as we continue to monitor and select biosimilar products from a PT standpoint.

Once you understand that I think the next piece is to look into the new Inflation Reduction Act that was announced by the current administration within the last quarter and really try to understand how the Inflation Reduction Act is going to impact reimbursement on biosimilars. I think that's still pretty new. We're still trying to determine what this impact is going to be.

Also, the same can be said for the enhancing oncology model that Medicare is going to be rolling out but understanding how the payment from these 2 major administration changes is going to impact biosimilars reference products will be really critical as we make PT decisions moving forward.

I think a third option that's really critical is to just make sure you have open dialogue with your local payers, understand where they're looking at this, how they're evaluating biosimilars, if they're looking at moving to a really tight medical policy in which only certain biosimilars would be included or not, and maintain that dialogue and maintaining communication with the payers, so that they can understand what's important from a patient access standpoint, from a patient cost standpoint, and making sure that your practice’s initiatives align with the payers is really critical.

If you're able to have those conversations, I think focusing and trying to work on a value-based care agreement prospective with those local payers that's trying to look at overall costs and not just look at tight, narrow medical policies in which the payer is trying to mandate specific biosimilars. If you're able to have those conversations, just say, “hey, let's look at this from overall cost standpoint, not just look at narrowing or carving out certain biosimilars.”

It's going to give us more flexibility at the practice level to be able to move between biosimilars as these prices change, and the costs change on a quarterly basis, and lower the total cost of care in a more efficient way than some of these really tight medical policies will allow us to do.

Q: How can pharmacists address the most significant barriers to biosimilar adoption from the patient perspective?

Paul Forsberg: From a patient perspective, from day 1, we wanted to make sure that patients felt comfortable, confident with their treatment, and that there were no unintended barriers or concerns, from a patient perspective, on the outcomes associated with their treatment. So, we felt the best way to do that was to make sure that the nursing staff and the providers had a real clear and consistent message around biosimilars and to make sure that they would present the term of biosimilars in a way that the patients would understand.

We also found going into this, as we surveyed nurses and we surveyed physicians, that there’s not a lot of brand awareness from a patient perspective for reference products prior to starting cancer treatment. Most cancer patients have never heard of trastuzumab or pegfilgrastim until they start treatment. So, there's not a lot of brand awareness. One of the first things we did is to work with nursing staff and physician staff to try to eliminate brand name utilization when talking about patient medications and focus on verbiage that's focused on that active component, that generic name, so that we have a clear and consistent message.

If we need to move between reference product with biosimilar product, we can continue to use the same language around that drug name and not create a lot of unnecessary confusion from a patient perspective. Because talking with our physicians and talking with our PMT team, we consider the biosimilars to be equivalent from a safety, efficacy, outcome standpoint. If we use those brand names, patients get very confused if we're bouncing around.

So having clear consistent messaging around the names, just the way we address these medications, the way we can address biosimilar questions, and, from the get go, when we rolled out biosimilars we made sure we had handouts for patients that explain what a biosimilar is, how it's reviewed and approved from the FDA, why they're called biosimilars, and try to address all those questions out of the gate to try to minimize those questions, minimize those concerns, and make sure that patients feel confident in their treatment.

Q: What are the advantages of a medically integrated pharmacy within an oncology practice and what is the role of the pharmacist within this care continuum?

Paul Forsberg: There's so many great advantages of having a medically integrated pharmacy within an oncology practice. I'll try to focus on a couple of different categories. I'll focus on patient experience, quality and safety, and cost savings. So, from a patient experience perspective, having a medically integrated pharmacy within an oncology practice can create a lot of improvements from a patient perspective.

The first thing is just convenient. We've got a pharmacy located within one of our clinics. Patients can either come into our pharmacy to actually talk to the pharmacists, or they can pick up the phone and call our pharmacy directly and get a hold of pharmacist or a technician, in less than a minute. We don't have a phone tree that can get right to somebody to get questions answered, they can come in and have a conversation directly with the with the person in real life, which in a post-COVID world is just hard to believe that that's still even a possibility, but we can do that.

We also find that we have a faster turnaround time from a medically integrated dispensing standpoint than what we see with national chain. Patients are going to get a more convenient experience, they're going get faster turnaround time, and our pharmacists and technicians only focus on oncology, they're not focused in other specialty areas. They know these medications inside and out, they understand the challenges patients are faced with, or are experiencing, and they know what's best to help work those patients through those challenges. The patient experience is going to be significantly improved.

From a quality and safety standpoint, our pharmacists have access to the electronic health record (HER). They can look into the chart pull, the patient med list, that's going to be the most accurate, they can run those drug interaction checks, they can look at the patient's kidney function, they can look at their liver function, they can look for dose modifications, they can read those most recent physician notes prior to dispensing next fills, and they can really make sure that the treatment that was ordered by the provider aligned appropriately with those patient risk factors or any comorbidities that the patient might have. That really is going to give the ability for that patient have the best outcomes.

The other advantage of having that access to the EHR is we're just going have much better communication with the patient's care team. If there's questions that the patient might express around delivery of the medication or side effects, or just really anything related to their care, our pharmacists can quickly connect with either the nursing team or the physician get those questions, issues addressed in a timely manner to have minimal impact on that patient's care. That also allows us to really and significantly improve the patient's adherence, but also persistency. So how many doses is the patient missing on a day-to-day basis, and how long are we able to keep that patient on treatment?

All of those quality and safety initiatives that we put in place, we believe are going to keep the patient on the right treatment for the longer period of time, that ultimately will reduce the amount of waste associated with the patient's treatment and help lower cost of care. Because what we find is that we will not read refill any of the oral oncolytics specialty medications until we get an okay from the patient. We evaluate their chart, make sure that the patient's treatment is still appropriate. We can look to see if there's any scans, lab tests, or anything upcoming that might require a dose adjustment or maybe holding a patient's treatment prior to dispensing that medication, so we can reduce unnecessary waste. We can keep patients on treatment longer and it's going to ultimately have the best cost saving opportunities for patients from an out-of-pocket standpoint but also from a managed care perspective too.