The Changing Role of the Specialty Pharmacist: Extension of the Oncology Care Team

The care of cancer patients has always been a team effort: from the medical and radiation oncologists, to the nurses and navigators, to the social workers and financial counselors.

The best care is delivered when patients can count on each member of this team to work to treat the whole patient, not just their disease. With the onslaught of new oral therapies in cancer care, there is an emerging new key member of the team: the pharmacist, or more specifically, the specialty pharmacist. According to the Hematology Oncology Pharmacy Association, there are more than 800 drugs currently in development to treat cancer, and roughly 40% of these are oral agents.

With this change in how and where care is delivered come significant changes in how patients interact with their caregivers and how they pay for their therapies. The difference in how oral therapies are covered, usually on the pharmacy benefit versus the drug benefit of insurance plans, is well documented in other articles, case studies, and patient testimonials.

Rather than dive again into those topics, let’s focus instead on the patient care team and the role of the pharmacist. In discussing the new collaboration between the Leukemia and Lymphoma Society (LLS) and Walgreens, Lou DeGennaro, PhD, LLS president and CEO, explains that with the high number of oral therapies, specialty pharmacies are now on the frontline of cancer treatment.¹

This is due to the increasing role these pharmacists play, be it onsite at a dispensing pharmacy, nearby at a local community specialty pharmacy, or miles away from the patient at a mail order pharmacy. In fact, it is increasingly the case that a pharmacist, either over the phone, in person, or via a mobile streaming conversation, will have the last conversation with a patient prior to the initiation of their oral therapies.

This offers a tremendous opportunity to help ensure the success of a patient’s treatment regimen. That is why specialty pharmacies need to adapt in order to fill this vital role. Many smaller practices and hospitals may not have the resources or staffing to handle the needs of cancer patients in today’s insurance and cost environment, replete as it is with insurance verification, prior authorization facilitation, patient assistance procurement, etc.

In fact, even if cancer programs do have the staff to handle these responsibilities, many can still be overwhelmed by the administrative burdens put on practitioners by insurance mandates. If specialty pharmacies can position themselves as a solution to filling these vital roles, they can more easily integrate themselves into the normal process of treating the patient.

In continuing the message from Dr. DeGennaro, being on the frontline of cancer care also means ensuring that patients stay on their therapy. Here, too, the pharmacist is the solution. As more therapies shift to being orally administered, it is more difficult to monitor adherence and compliance.

All specialty pharmacies have adherence protocols; however, many may be passive in nature, only checking on patients if refills are not filled. A more proactive approach can be much more successful, allowing pharmacists to stay ahead of adverse events and better manage side effects common to oral therapies. By managing these events, pharmacists may also be able to better triage patient care, lowering the risk of unnecessary emergency department (ED) visits, admissions, and the attendant high costs.

Walgreens recently conducted a study into this vital role of the pharmacy and found that patients eligible for pharmacy interventions experience 3% greater medication adherence and nearly 2% less hospitalizations.²

The study also found that, on a per-patient basis, those in the Walgreens intervention group incurred lower total health care costs, including pharmacy, outpatient, and ED expenditures, over a 6-month period.

“This data quantifies the role our community pharmacy platform plays in achieving better population health outcomes,” said study author Michael Taitel, PhD, Walgreens senior director of health analytics, research, and reporting. “These findings clearly illustrate that the combination of pharmacist counseling, medication therapy management, refill reminders, and telephonic and digital pharmacy interventions, tailored to patients’ needs, drive better adherence. Further, this improvement in adherence results in fewer hospitalizations and emergency department visits, ultimately benefitting payers by lowering the overall cost of care.”³

Finally, the role of the pharmacist extends beyond helping the patient to access, afford, and stay on their medication. The pharmacist, especially in a disease state such as cancer, has to truly treat the whole patient, from diagnosis through survivorship. This includes helping the patient with their medication, but it can also help them manage their side effects and successfully transition into survivorship care.

After a patient completes their therapy, and hopefully goes into remission, their needs will likely remain high. Therefore, given the important role of monitoring drug interactions, the pharmacy can, and should, remain an integral part of the patient care team.

This may be easier to do for a national pharmacy chain that can follow patients, no matter where they may be in their treatment or where they may live, given that they have the ability to connect a patient’s cancer care with other comorbidities for which they may be taking medications. Treatment for cancer takes a whole team, including physicians, nurses, social workers, nutritionists, genetic counselors, and financial advocates.

Pharmacists—long a player on that team, even when the therapies were mostly injectables—now see a future where orally-administered drugs make them potential most valuable players. With nearly half of all drugs in development destined to be administered orally, the role of the pharmacist keeps growing. Given the ability of specialty pharmacies to help patients get, afford, and stay on their medications, all while treating the whole patient, this is a role the pharmacist should wholeheartedly embrace.

References

• http://news.walgreens.com/press-releases/general-news/study-shows-that-walgreens-pharmacy-interventions-lead-to-improved-adherence-and-lower-healthcare-costs-for-commercial-patient-populations.htm
• http://news.walgreens.com/press-releases/general-news/study-shows-that-walgreens-pharmacy-interventions-lead-to-improved-adherence-and-lower-healthcare-costs-for-commercial-patient-populations.htm
• http://www.prnewswire.com/news-releases/walgreens-and-the-leukemia--lymphoma-society-create-new-approach-to-support-cancer-patients-in-their-communities-300237350.html

About the Author

Matthew Farber, is senior director, Oncology Disease State, Walgreen Co.