Oncology Pharmacists “Approve Every Regimen That Gets Built Into the Oncology EMR,” yet Pharma Often Overlooks Their Role

In terms of clinical knowledge of therapies, oncology pharmacists are the individuals with the knowledge that allows meetings with pharmaceutical (pharma) representatives to be the most fruitful, explained Phil Stover, JD, MBA, the CEO of Mission Cancer + Blood, during a panel discussion between leaders of oncology practices and pharma representatives at the NCODA Oncology Institute in Minneapolis, Minnesota. Stover explained further that when pharma wants to meet with him, he directs them to set up an appointment with an oncology pharmacist on staff who is the trusted source of information regarding oncology therapies in clinical practice.

Stover explained further that when pharma wants to meet with him, he directs them to set up an appointment with an oncology pharmacist on staff who is the trusted source of information regarding oncology therapies in clinical practice. Image credit: NCODA

“I’m not clinical. When I first started 8 years ago, I was just getting inundated [by pharma] and trying to be polite and have meetings, but I realized quickly that clinical information is not the information to provide to me. But we have 2 pharmacists and we now have a process set up [for pharma meetings],” Stover said during the panel discussion. “Our pharmacist is brilliant; [she gets] need-to-know information to the doctors when they need to know it, [such as] clinical changes and clinical indication changes.”

Stover explained further that at Mission Cancer + Blood, Corey Wilson, PharmD, has a process for meetings with pharma where she establishes a calendar for the year and judiciously allots time for a meeting with each pharma manufacturer.

“We want to be fair. I feel like if I’m going to give 40 minutes to Pfizer, then I really have an obligation to do it for everyone,” Stover said.

During the discussion, panelist Paul Bailey, Senior Director of Pfizer, noted that pharma companies can also have varying organizational strategies from company to company regarding outreach to oncology practices to inform them of crucial updates for the use of therapies in treatment. However, not all representatives within each company may be communicating with one another regarding who will be meeting with a practice to discuss their portfolio of drugs. Instead, communication on a company’s entire oncology portfolio may be piecemeal from individual representatives instead of holistic. This may mean that multiple meetings with different pharma representatives may be necessary to obtain a complete picture of that company’s oncology portfolio updates, Bailey explained.

During the panel discussion, Kate Higgins, Oncology Key Account Manager at Pfizer, stood up in the audience to explain that with Pfizer’s significant oncology portfolio, many representatives make up the team that communicates directly with practices. “We have a huge Pfizer portfolio within oncology, which means we have a lot of representatives,” Higgins said. “Within my team, we have to prioritize what’s new, what the late breaking news is, what patients need to know right now, and what the practice needs to know right now. Then we work as a team to prioritize who’s going to need to get in one week or the next.”

Higgins explained further that Pfizer also puts together large team meetings to prioritize time wisely around who will meet with individual practices. “We have a template [we provide to practices], so you have your entire Pfizer team on the template, and we’re not going to bug you—you call us when you need us, that kind of thing,” Higgins said. “We’re trying to use omnichannel resourcing websites, virtual meetings, and anything like that, but [we make sure to] come together as a team.”

Additionally, Bailey noted that pharma representatives will often have to assess the best approach to speak with each practice on a practice-by-practice basis. Specifically, Bailey explained that identifying the right person to reach out to at each practice is key.

According to Stover, at Mission Cancer + Blood, that person whom pharma representatives should reach out to is always a pharmacist. “The best approach for us [with pharma] is getting in front of our pharmacist and getting the information to her, because she’s working with our committee that approves every regimen that gets built into the oncology EMR [electronic medical record],” Stover said. “She’s constantly working with them if there’s a new drug or a new indication, [and she works on] building it into the EMR. For the whole process that we go through, she is truly the best one [for pharma to reach out to].”

Additionally, Stover explained that significant challenges are arising in oncology practices regarding patient access to care as more and more small insurance companies are establishing that they will not pay for oncology care beyond 1 oncology visit. According to Stover, these same insurance companies will also not pay for any specialty drugs; this is a concern for pharma, as they will face greater difficulties in getting these drugs to patients without free drug programs established.

“There’s nothing in the laws preventing that from happening, so we’re seeing more and more [insurance companies doing this],” Stover said. “When patients can’t afford [the drug, they] simply go to the manufacturer. From our end, having more generous support within the realm of what’s legally possible will be helpful [from pharma]."

Stover explained that his practice has a unique market in Iowa, as there is 1 payer that has complete dominance in the state—Wellmark Blue Cross Blue Shield. “They’re generally our better payers; they still treat us as partners,” Stover said. “We’re still fee-for-service, and we’re exploring valuebased care options with them. But all the other insurance schemes that get played, building on [Stover’s] point, anything pharma can do [helps].”

Brian Mulherin, MD, an oncologist at American Oncology Network, explained that a concerning patient case involving such a scheme occurred on his practice’s oral oncolytics team recently. “Our [medically integrated dispensing] patient was required [by his insurance company] to use a specialty pharmacy company called OPUS, and the OPUS PBM [pharmacy benefit manager] took 3 weeks to tell the patient that they couldn’t fill it,” Mulherin said. “The nurse is calling, fighting for the prior authorization, fighting for everything, and doing everything to get [that drug to] their patient, who is already at stage III esophageal cancer and who needed the drug to start day 1.”

Mulherin explained that OPUS then transferred that patient’s case to Accredo, and the Accredo specialty pharmacy said it wouldn’t respect the prior authorization from OPUS. “We then had to fight OPUS for another 3 weeks, and it took 6 weeks to get insurance approved. The pharma manufacturer, in that instance, provided free drug day 2 [following approval],” Mulherin said. “Anything you can do to not only help the patient but [also] help the nurse [is needed].”

Mulherin explained further that nurses are fighting for these patients every day, and when pharma provides a robust free drug program that is easy to apply for and easy to fill out, nurses are able to go directly to that program and step outside of the challenges oncology practices are facing with PBMs.

“All we’re concerned with is getting those patients the drug. We don’t make money on free drug—it goes straight to the patient. But we want these patients to start [on the drug] as quickly as possible,” Mulherin said. “Unfortunately, that black box that is the PBM that stands between [pharma] and us is making it harder and harder every day [to do so].”

Stover noted that pharma may also be receiving incorrect or insufficient information from PBMs regarding patients’ medical information in relation to treatment, which many PBMs continue to provide, regardless of whether they have the relevant information required to do so. For such cases, Stover explained that pharmacists are the individuals whom pharma should call to gain the correct information regarding a patient case.

“It is so much easier to deal with pharmacists who can look at the EMR and call the patient. If [pharma is] dealing with people in Accredo who are calling from who knows where and don’t actually know what’s going on, they won’t have all the information [for a patient. Accredo doesn’t] know all the drugs that the patient is on, and they may not have most of their labs,” Stover said. “That’s why these kinds of efforts are so important.”

Reference

Bailey P, Mulherin B, Stover P. Best practices and current challenges within the oncology landscape. Presented at: NCODA Oncology Institute; August 16, 2023; Minneapolis, MN.

Editor's Note: Article was update on Thursday, October 26.