Pharmacist Highlights the Impact of Integrated Care and NCODA’s PQIs on Patient Access

In an interview with Pharmacy Times®, Stephanie White, PharmD, CSP from Vanderbilt University Medical Center, shares her journey to becoming an oncology and hematology pharmacist, how she got involved in NCODA, and the power of PQI and medically integrated systems to improve patient cancer care.

Pharmacy Times: Can you share your journey to becoming an oncology pharmacist?

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Stephanie White, PharmD, CSP: My journey to becoming an oncology pharmacist is a little non-traditional. I worked for retail pharmacy after graduating pharmacy school and was in that practice setting for about 7 years. I then worked for a company completing telephonic MTM services before joining Vanderbilt Specialty Pharmacy.

Vanderbilt Specialty Pharmacy is an integrated health system specialty pharmacy, with both pharmacists and pharmacy technicians embedded within specialty disease state clinics. When I was hired, I was just hired as a general floater, so I didn't really know where I was going to be, just kind of wherever I was going to be needed. But very quickly, I can't remember it was my first or my second week, I was asked if I'd be willing and interested to work and cover the oncology and hematology clinics, and being, of course, a new hire, I said “sure, let's do it.” And it was a huge learning curve. I had very little experience with oral oncology products prior to this time, maybe the occasional imatinib [Gleevec; Novartis] or capecitabine [Xeloda; Genentech] within from my retail days, but still a huge learning curve. It was a challenge, of course, but I was excited to take on that challenge and learn a new area and become an expert in that area, and I'll never look back.

I've been with Vanderbilt, especially for 5 years now, I really feel like I've found my space within the pharmacy world. And even though oncology is a difficult practice space, both emotionally and mentally, it's also so rewarding and I really feel honored to be part of my patients’ cancer journeys.

Pharmacy Times: In your practice, what are the most common barriers to cancer care experienced by patients?

White: I think the biggest barrier that we're faced with right now is both insurance coverage and financial assistance coverage for our patients, especially with a lot of more insurance plans moving towards those maximizer, accumulator, alternative funding plan setups, they are very discouraging to pharmacists and cause a lot of frustration over their existence, and it's just caused us to need to be more and more creative for our patients. It keeps us on our toes. I also feel like over the past couple months, we've started encountering more denials on med appeals, which has kind of been a surprise for us, because that's not really been a huge hurdle that we've had to overcome in the past, but everything's changing, and we're kind of in those changes.

So again, across the boards, both commercial and Medicare challenges that we're seeing. Financial challenges have always been, you know, at play, because we know how expensive these medications can be, and ensuring that costs not be a barrier for our patient continues to become more of a hurdle, one that we try to be as successful as possible, because we don't want that to prevent somebody from starting a really needed medication. But in the past, always using manufacturer copay cards, manufacture patient assistance programs, foundational assistance, they've been instrumental in us gaining access for patients that otherwise would not have been able to afford the medication. But even these programs are changing, and each year they get a little bit more stringent. And so again, with that creativity and finding ways that we can still get a needed medicine for a patient, keeping up with those changes is difficult, of course, and I think it'll be interesting to see what 2025 brings, and of course, beyond that.

In addition, though, and despite these hurdles, I feel very grateful to work on a team that feels equally passionate about finding solutions for patient access to their medications. And not only do we collaborate as a team within the hematology/oncology space, but across the entire Specialty Pharmacy. Because this isn't, this isn't just an oncology issue. It's a specialty medication issue. And, you know, team members can share things that maybe we haven't seen yet, and just ensuring that we're always on top of and looking out for the next thing.

Pharmacy Times: How and why did you get involved with NCODA?

White: One of my colleagues introduced me to NCODA. She and a couple of our team members were invited to participate in 2 different encoder PQI in action initiatives and NCODA’s mission and vision just really spoke to me and drew me in their focus on patient centered care within that medically integrated oncology team and really uplifting the uniqueness of the medically integrated care model, having collaboration among all team members. Whether that be physicians and social workers and nurses and pharmacists, it's really imperative to that patient centered care and giving them superior care, at least in my opinion, and because we all have something that we can offer and giving the best of each role to the patient, I think it's just excellent. Having an organization that has that as their mission, and providing the education and resources that we need has just been wonderful.

Pharmacy Times: What will your session at the NCODA Fall Summit focus on? What is NCODA PQI?

White: I will be on a panel with 2 other pharmacists highlighting NCODA’s PQI in action. PQI stands for Positive Quality Intervention, and it serves as a precise and concise—the keyword, concise—clinical practice resource that's been peer reviewed. And so, it really provides that clinical background, a really quick synopsis of trial data and safety data, as well as how to analyze an order. It's like a step wise approach of you've been given an order for this specialty medication or this oral oncology agent. Is the patient appropriate? Do they meet the indication? Do they have comorbid conditions that might affect us? Choosing this agent, what other medications are they on? Are we worried about drug interactions? Kind of everything that would go into place to ensure that it's the right drug for this patient.

Additionally, it's got patient centered activities, so ensuring that you're providing the education that patients need to be on the medication, know what to look for and expect, and those tips for how we need to check in with our patients. We need to be monitoring what side effects they're having, and their labs for safety monitoring. In addition to “hey, are you missing any doses? We need to check in on our patients. Is there something as simple as they just couldn't get to the pharmacy, or some kind of hurdle that we can help ensure that they're being adherent to their medications? They also provide these nice, really quick links to patient education, handouts and financial assistance tools, and I love that they're just 1 “pagers,” so we're really going to be highlighting how they can be utilized in practice.

Pharmacy Times: What is the significance of the NCODA Fall Summit? What are you looking forward to?

White: I think it's important to have a space where we can all share our ideas and concerns and be with others that practice and similar care models. Even though we are structured a little differently amongst different practices, I think that's great to learn from each other at what's worked in your practice, or what hasn't worked so we can all become better, because I think that's something we're always going to strive for. What ways can we improve ourselves?

In addition, I know we talked about some of those challenges that we're facing, especially within the coming year, and I think this will be a great space to bounce ideas with others and walk away hopefully recharged and reinvigorated for the new year, because January always is. It is a challenging month as a pharmacist and just having that fire relit underneath us to start that new year.

This is actually my first in COTA conference, so I'm really excited to participate in any of the educational sessions that are being provided. I'm interested to see other people's poster presentations and just in general, taking it all in, I think it's going to be a really great conference.