Expert: ‘Pharmacists Should Have a Role at the Table’ When Payer or Drug Availability Challenges Arise

Pharmacy Times interviewed Shannon Hough, director of ClinReview in Clinical Content for McKesson, on the growing shift to biosimilars in oncology, which is impacting patients and practices by reducing the financial burden of oncology treatments and increasing access to therapies resulting in greater medication adherence.

Alana Hippensteele: What are the advantages of including pharmacy staff as part of the care team when payer or drug availability challenges arise?

Shannon Hough: This is probably one of my favorite questions, because I, as a pharmacist, think that medications are complex and any place where the use of medications is being discussed, I think a pharmacist should have a role at the table.

Pharmacists, by trade, have training both in medicinal chemistry and pharmacology that really allows them to evaluate the scientific data behind different entities, behind different therapies to provide a sound evaluation of when alternatives should be evaluated.

The other thing that pharmacists do within organizations is they really speak the language of medications with high fluency. What that enables pharmacists to do is liaise in between physicians, patients, financial coordinators, and payers to really speak the language of the needs of medications within each of those other kinds of outskirts of the way medications are used. So having a pharmacist on your team any time you're evaluating ways medications can be used, I believe, is highly valuable.

Alana Hippensteele: Absolutely. How does pharmacy involvement in a [therapeutic interchange program (TIC)] program impact patients and providers?

Shannon Hough: Yeah, pharmacists who are involved in TIC, or therapeutic interchange programs, I think, play several roles and that has an impact on providers and patients.

So, on the provider and organizational side, having a pharmacist involved in the analysis and development of a TIC, I think, is required. The pharmacist evaluation of the clinical data and the role that they can play with the interpretation of the molecular entity is valuable and saying you should develop and implement a TIC, when it comes to the patient and actual using a TIC program within the practice, pharmacists’ involvement really can decrease the time of implementation.

So, many organizations will develop something called a protocol, where if a product within a certain class, drug A, is ordered, and drug A has been determined to be equivalent to drugs, B, C, and D, anytime that one of those agents is ordered, a pharmacist can intervene seamlessly for the physician and for the patient to have those things sorted out. So, the drug that is the most useful to the patient to the practice and required by the insurance company at times can be the one that's ordered, and really decrease that coordination time and back and forth within the ordering team.

Alana Hippensteele: Right. Absolutely. What is the pharmacy’s role in managing step edits by payers?

Shannon Hough: Yeah, I think pharmacies can have several roles within managing step edits, as required by payers. Just in general, coverage rules from payers are increasing with complexity. And so, organizations may have made a specific decision about carrying a product of choice for various reasons.

But by and large, I think organizations are needing to carry several different products within a given class based on these step edits. So, pharmacists, I think, play a role in implementing some of those therapeutic interchanges when they exist within an organization or practice to say, I see this patient, I see these other data points about the patient, such as who their insurer is, and they can help to navigate selecting the similar therapy that would be covered by their insurance, if that's clinically appropriate.

Alana Hippensteele: Right. Thank you so much for taking the time to speak with me today, Shannon.

Shannon Hough: Yeah, thanks a lot for having me.