Pandemic Lessons: The Evolution of Pharmacy Practice

It was a year and a half ago we saw the world’s eyes turn to health care as its rescuer. From day 1 of the COVID-19 pandemic, the pharmacist was considered a key player.

Pharmacists have continually been ranked as the most accessible health care professionals. Be it specialty, community, or institutional pharmacy, patients and fellow health care professionals can access a pharmacist willing to give time and expertise 24 hours a day. Because of our training, we pharmacists are natural problem solvers, and although we may not have an instant answer for every question, our education has taught us how to use resources to find an appropriate response and often a solution. When COVID-19 emerged, many medical offices stopped, or severely limited, patients’ access, but pharmacies kept their doors open, adjusted their physical layouts, and kept adapting to the crisis.

Everyone on the planet was waiting for a miracle to eradicate COVID-19 with a vaccine, and through Operation Warp Speed, vaccines arrived before 2020 had ended. The innovation our pharmaceutical industry demonstrated was unprecedented in human history. It came in the form of the newest technologies in our space, messenger RNA vaccines, soon followed by more traditional vaccine manufacturing processes.

It seems that COVID-19 has influenced so much of our daily lives, from wearing masks and social distancing to cancelation of many events and programs, and limitations placed on many businesses' operations. The impact on global economies continues to evolve as we reopen and attempt to get back to normal. Entire industries were shut down or severely scaled back. The production of many products was curtailed, which has resulted in shortages—and having less often also means paying more to purchase products.

Adjusting to the “New Normal”

The path out of the COVID-19 pandemic has been driven by pharmaceutical products. Traditionally, the media and public have focused on the high costs of specialty pharmaceuticals rather than the benefits; however, in times of crisis, no price is too high. Pharmacists are the world’s drug experts, and there has been an interesting shift in perception as, for many, the pharmaceutical industry is no longer the dispassionate business it was perceived to be.

Our industry has a window to demonstrate more value than ever before. And pharmacy has never been more relevant. Do you recall when the headlines were focused on which vaccine presented the fewest logistical challenges and “pharmaceutical logistics” became household words? I loved it because I could actually tell folks, “That’s my deal.”

The new normal has shifted the patterns of our professional lives. What was previously considered extreme behavior—social distancing, the use of face masks, hand sanitizers, infrared thermometers, plexiglass screens, and personal protective equipment—became the rule. Although we have gradually opened commercial channels, I predict that many behaviors will be changed forever.

A similar life-changing event that affected our daily lives was 9/11. Do you recall when we would sail through airport security? Look at the norms of travel now. Similarly, we will see many changes from the COVID-19 crisis become permanent.

Over the last year, boards of pharmacy made dozens of adjustments to professional practice, many of which empowered pharmacy, allowing our profes- sion to reach new levels of expertise, and we stepped up to the challenge. Pharmacy has been integral to access to testing, and in tandem with mass vaccina- tion sites, we brought solutions to every neighbor- hood. For those who were severely ill, we repurposed existing therapies, creating COVID-19 “cocktails.” For oncology pharmacists, this expertise was not new, because they have been doing the same with chemo- therapies for decades.

New therapies mean new learnings, and on the continuing education (CE) front, we were required to raise the bar by upgrading our knowledge. Many of us traditionally got our CE through live programs at conferences or association meetings. However, with the shutdowns, events were canceled or shifted to virtual programs. Pharmacy Times® Continuing Education (PTCE) has offered dozens of programs on the expanded role of pharmacists in the COVID-19 era. A positive effect has been that, as a direct result of this shift to real-time online programs, thousands of pharmacists are now being educated on pertinent topics in truly unprecedented numbers.

New Norms in Oncology Therapy

Infusion-based therapy has been the mainstay for most oncology treatment plans for years. Infusion of oncology products generally is split between the community oncology infusion suite and the outpatient institutional setting. The increased risk of exposure to the virus to patients, who often have severely compromised immune systems, required great modifications in treatment plans and how those plans were carried out. Oncology pharmacists played an influential role in transitioning patients from infused to oral cancer treatments whenever possible. This shift had a significant impact on specialty pharmacy, because it saw demand rise for oncology treatment dosage adjustments. The oral therapy trend is here to stay.

Not all IV therapies have oral alternatives. In many cases, however, clinics have been able to shift to home infusion, where the drugs are administered in the relative safety of the patient’s own home, thereby reducing the potential exposure to COVID-19 for all parties. The Centers for Medicare & Medicaid Services (CMS) earlier in the year issued an interim final rule that allows infused or injected Medicare Part B drugs to be administered at home. These services can be reimbursed by CMS if administered by a home health agency, so long as a provider is present or the visit is conducted via telehealth. We expect many of the shifts in sites of care to remain, as should compensation for services.

The Hybrid Practice of the Future

The pandemic forced businesses to move to a work- from-home environment wherever possible, and it seems to have been done efficiently. As society continues to reopen, both employers and employees will have to make tough choices, like moving back to the office or continuing with what is in now place. Employees who have been working from home might now be using a hybrid approach, with time in the office and time working remotely. Likewise, we saw a significant transition with specialty and oncology pharmacy, where many of the nondispensing clinical services were performed through telecommunication to reduce the risk of a patient contracting COVID-19. Our health care infrastructure supported many of the fundamental aspects of remote clinical visits, and we already had much of the technology in place; however, we were able to reach new levels of deployment. Patients and their oncology pharmacists were able to interact from the safely of their own home.

When we break down much of the activity, we find that specialty oncology pharmacists are engaged in many ways of serving the patient. These include care coordination, insurance approval assistance, financial assistance for high out-of-pocket co-pays, drug interaction checks, patient education, and adverse effect monitoring. All these services can be efficiently performed in a remote setting. The oncology pharmacist is the medication expert on the team and should be the educator when it comes to the drug therapy to guarantee a consistent and informed process. The pandemic has broadened our practice site, because much of this activity has migrated to the telephone or to digital platforms such as Zoom, Microsoft Teams, and others.

What Is Next?

The practice of oncology pharmacy has evolved greatly over the past 18 months. Pharmacists have gained many new learnings and insights into our practice. As a result of the pandemic, pharmacists were forced to adapt many of their processes. As such, pharmacists will continue to be the key resource in the delivery of optimum oncology drug treatment.

Pharmacists should consider preparing a business case for the future by tracking positive patient outcomes. Thorough documentation processes, some- thing oncology pharmacists are already familiar with, will be important. Be prepared to tell your story. In the long term, the role of the specialty oncology pharmacist is expected to expand to other services with the skills they hone during these times of adversity. Specialty pharmacy should embrace the new normal to help prepare for any future pandemics. We all should look back at the last few months and reflect on what we can take with us moving forward.

Directions in Oncology Pharmacy® will be soon be engaging our oncology pharmacy readers with a survey. We want to learn what you did to adapt your practice and the impact of those activities in improving outcomes. One goal we have at Directions in Oncology Pharmacy® is to advocate for our readers and other key stakeholders across all our publications. Directions In Oncology Pharmacy® is committed to setting the publication standard through peer-written articles focused on the real world of oncology pharmacy practice.