Multidisciplinary Teams in Medically Integrated Pharmacies Can Improve Personalized Care

In an interview with Pharmacy Times at the 2023 Asembia Specialty Pharmacy Summit, Neal Dave, PharmD, executive director of Pharmacy Services at Texas Oncology, discussed why multidisciplinary teams are crucial in medically integrated pharmacies, and what that means for patient care. With a growing expectation for individualized and personalized care, medically integrated pharmacies have a great opportunity to support patients and the care team.

Q: What role does a multidisciplinary team play in patient care for medically integrated pharmacies?

Neal Dave, PharmD: I mean, it's key, it's central. You know, we all operate off of the physician’s care plan and so the physician is kind of anchoring that patients care. And we are ensuring that patients are following that care plan to the best of their ability, whether it's with dose reductions and involving the physician, or ensuring patients are getting access to their medication on time and that they take their medication, whether it's an oral [or not]. But on the flip side, we're also taking care of patients that are on an IV therapy, even whether it's single agent IV or a mixture of the 2. So, you have full access and full kind of knowledge of what's going on with that patient. And so, you're better able to take care of that patient and the whole team is really intertwined, and mixing in works really well together.

Q: How do medically integrated pharmacies improve personalized patient care?

Neal Dave, PharmD: So when we have a multidisciplinary team, you can do all sorts of amazing kind of quality programs. When you're siloed off, if you're a standalone pharmacy, you're not going to get all the information that you need to make, like, a quality initiative. You might here and there, you know, when it's really specific to drug level, but for instance, within our MIDs and in our oncology clinics, our pharmacists play a central role in reviewing every regimen. And this is standard, I think, across all practices. We added an additional step looking at precision health and NGS testing to make sure patients are actually tested when they're first prescribed chemotherapy for any advanced cancer. And so, our pharmacists are playing a role when that's not ordered, when they don't see that in the chart, they reach out to the physician with a message saying, you know, if they can't find it, maybe it's in a PDF on the physician's desk and it's ordered or maybe it didn't get ordered. And so along with that, we're also reaching out to the precision medicine team, and we have lab liaisons that also will help coordinate that if the physician needs help ordering the NGS test. And so, without that multidisciplinary team, I mean, that that the progress we made wouldn't happen. And since pharmacists have started to look at NGS testing, panel testing, we started that last summer, we've more than doubled the number of tests ordered every single month. And that's because of that teamwork and that coordination with all key players involved.

Q: How can medically integrated pharmacies improve access to patients? Is there a lower cost for clinical drug utilization for these pharmacies?

Neal Dave, PharmD: Yes, so yeah, there's multiple ways you can do this. You know, we're heavily into value-based care and looking at lower cost options that are the same quality or maybe even better than another drug option. And so, within a clinic and within an MID, you have this multidisciplinary team, you have a P&T committee meeting, and you can make these decisions based off of overall cost of care to the patient, to the payer, to the practice, to everybody involved, and you can pick the best therapy at the lower cost and make a therapeutic interchange or make a program surrounding that. And so that's one way, you know, an MID can work to reduce costs. And we do this all the time. Our pharmacists are reviewing every regimen that goes in, whether it's an IV or an oral and that's how we can save on costs. And, you know, over the past few years, we were really early adopters in biosimilars, and that was because we had pharmacists doing a lot of the interchange. We wrote up a protocol, got physician buy-in, and we started doing interchange and we saved, you know, a lot of money to Medicare repairs based off of just using biosimilars.

The other way we do this is through avoiding waste, specifically in orals. I mean, even in IVs, too. But in the example for orals, you know, especially when patients start a new therapy, there are a lot of dose adjustments that potentially need to happen because that prescribed dose may not be the dose that they're going to end up on. And so, as we do follow up throughout that first month or 2 months, when that patient is starting a new therapy, we're able to adjust those doses really on the fly without having to dispense the old dose when the patient is trying to get the new one [and] the physician is trying to write the new dose for that patient. And so, you avoid that additional bottle or half a bottle or whatever it is. And that is significant. It's, you know, anywhere between $10,000 and $20,000 a month.

Q: What accreditations do pharmacies need to be medically integrated?

Neal Dave, PharmD: It can be state dependent. There isn't one specifically that's required for an MIT. Now, I will say, NCODA does have an accreditation that is more geared toward MID, and I say that because it's a little bit more patient-centric than some of the other accreditations that are out there. So, if you, you know, if you're an MIT and you do need to get accredited, NCODA is one that has an accreditation program for oncology. And then also, they also have one they've actually started for multi-specialty, as well.

Q: Is there anything you’d like to add?

Neal Dave, PharmD: Yeah, I mean, I just like to say like, MID and community oncology, it is the best model to get care. It really is. You have the whole team dedicated to that one patient and that care isn't fragmented, where, you know, we're able to take care of patients, we're able to help find financial assistance. We get the prior auth regardless of if we're able to fill the medication or not. So, we honestly don't even get credit for doing that. But you do all this work for a patient because you see that patient every day or every 2 weeks and you have that relationship with that patient. They know exactly who you are, they walk by your pharmacy, and you know everything that they need right then and there. And so, it really is an ideal place to really practice and an ideal place for patients to get treated in the community.