The Specialty Pharmacy Program

Annette Hood, PharmD, BCACP, discusses the role of special pharmacy programs to manage the administration of oral chemotherapy and PARP inhibitors, and emphasizes the impact medication assistance technicians have on mitigating treatment costs for patients.

Maurie Markman, MD: You commented on the differences here in the toxicity. Again, it brings up thinking about this critical role for the pharmacist, the clinical pharmacist. How again, specifically for these drugs, would you say, and even the conversation we’re having right now, what would the role of pharmacists be in potentially helping the doctors or directly the patients and their families in making some of these decisions?

Annette Hood, PharmD, BCACP: Well, I wanted to tell you about our wonderful specialty pharmacy program that we have. You think of traditional intravenous [IV] chemotherapies where in our intuition, the pharmacist does review the orders for dose reductions and appropriateness of the regimen itself. But when you think of an oral drug, usually the provider gives the prescription, hard copy, to the patient, or they call in the prescription or e-prescribe it. And in terms of the pharmacist who works in the clinic, it kind of skips over the pharmacist. We don’t really see that part because the patient is on an oral therapy and not an IV therapy that goes through us.

In our institution, any oral chemotherapy order gets entered just as a traditional IV chemotherapy, and it sends a flag to the clinical pharmacist to actually review for appropriateness, review for dosing. And it cannot be released through the specialty pharmacy until the clinic pharmacist has actually reviewed and given the OK to proceed. I think that’s a very unique program that we have. In addition, our specialty pharmacy has medication assistance technicians who help with drug costs. Any drug that has a co-pay of $50 or higher, we have technicians who will work and try to find all different ways to get assistance for these patients, either through the pharmaceutical company or through any grant programs or anything. Even if a patient does not fill through our specialty pharmacy and transfers out to their specialty pharmacy, we still do that service for our patients.

And then finally, something that we do is our specialty pharmacist will actually do follow-up phone calls. Within the first month we call the patient at least twice, and we try to assess toxicity, and we’ll report any toxicities to the providers to make them aware, and we’ll also try to assess for compliance as well.

Michael Birrer, MD, PhD: It’s a little bit of a difference in the number of co-pays if you need to reduce the dose because, as you know, 1 of the PARPs [poly ADP ribose polymerase inhibitors] is 3 tabs and it’s once a day, and that makes that a little easier. But I don’t know, Wendel, have you experienced that at all?

Wendel Naumann, MD: It is a problem, I know. And I try to look for dose reduction strategies off-label, dose reduction strategies that don’t require a new prescription.

Michael Birrer, MD, PhD: You just break the tab in half. No.

Maurie Markman, MD: But again, this is just an example of the importance of the role of the pharmacist, because the doctors write a prescription, and that often is the last they know of it or think about it until there’s a problem. And this becomes incredibly important.