Expert: Infusion-Trained Pharmacy Technicians Can Reduce Workload for Oncology Pharmacists

The infusion pharmacy technician is a specialized role that plays a pivotal part in optimizing financial and clinical outcomes for infusion patients, explained Curtis Hudson, BA, CPhT, senior pharmacy technician at the University of Kentucky Specialty Pharmacy and Infusion Services, in a presentation at the American Society of Health-System Pharmacists 2022 Summer Meeting.

“We assist patients with selecting the most appropriate site of care for their infusions, and we determine how those infused drugs will be billed,” Hudson said. “Training pharmacy technicians to evaluate appropriate site of care and waived plan benefits can reduce the workload for the pharmacist and lead to advancement opportunities for technicians.”

Billing: Medical vs Pharmacy Benefit

Infused drugs can be billed either through the medical or the pharmacy benefit, explained Hudson. For this reason, the first thing an infusion pharmacy technician does when beginning their work for a patient is begin an investigation into the patient’s coverage, maximum out-of-pocket, deductible, and expected co-payments.

“Whenever we’re given the option of choosing between medical or pharmacy billing, it may be more financially viable to go one route over the other for the patient,” Hudson said. “The next step is we review the patient’s clinical data and try to obtain the prior authorization. Let’s say we try to submit it through the medical coverage, and then they deny it saying, ‘It’s not medically necessary for the patient’s diagnosis.’”

In these cases, the infusion pharmacy technician would try to appeal the denial. If that appeal is unsuccessful, then it’s appropriate to pursue the pharmacy benefit route instead.

“When we hit a road block with one coverage, it’s nice to have a second option,” Hudson said.

Lastly, when looking at billing, Hudson explained it can be advantageous for pharmacy technicians to look at the pharmacy’s own reimbursement to keep the process patient centered. However, when the billing decision is cost neutral for the patient, the infusion pharmacy technician can choose the most financially responsible option for their organization.

Evaluating Site of Care

Some of the factors the infusion pharmacy technician considers when helping to determine site of care for patients are insurance requirements, patient preferences and needs, and drug availability.

For insurance requirements, if the patient is ensured under Medicare, then the patient needs to go to a provider-based department or hospital for treatment, Hudson explained. Additionally, a growing trend for commercial payers is requiring a lower site of care, such as a home infusion or an ambulatory infusion suite.

“Luckily, at my organization we have both [home infusion and ambulatory infusion] now, so we’re able to keep more of our patients in-house,” Hudson said. “We would have lost quite a few patients with these recent changes.”

If a drug is only covered by the pharmacy benefit, then the chosen site must either have a specialty pharmacy that can fill it or it must be able to accept an outside medication, Hudson explained.

Additionally, infusion pharmacy technicians consider patient preferences and needs when deciding on the appropriate site of care. In order to help patients remain compliant, Hudson noted it’s beneficial to find a site of care that is close to their home so they can make it to that site every month.

Hudson noted there are also patients who need social services and financial services. In these cases, the pharmacy technician can help the patients either pursue in-house financial assistance programs or manufacturer assistance programs for support.

Lastly, when looking at drug availability, Hudson noted that facilities usually have their own drug formularies that can impact the availability of different drugs. For example, some organizations will only infuse using biosimilars. When this occurs, if a provider is unwilling to change the therapy to a biosimilar, then pharmacy technicians can help make the decision to not pursue that site of care.

Furthermore, some institutions will exclude certain drugs from their formularies entirely, impacting where the patient will need to go for that specific drug. Additionally, there can also be restrictions placed on how and where medications can be ordered, Hudson explained. In these cases, some drugs may require enrollment into a REMS program, and that’s not an easy process. When this occurs, pharmacy technicians are a critical resource in supporting the patient through this process and decreasing the workload burden for oncology pharmacists.

REFERENCE

Hudson C. Infusion Confusion and Financial Solutions: Advancing the Pharmacy Technician Role. Presented at: ASHP Summer Meeting 2022; June 14, 2022; Phoenix, AZ.