What’s Ahead for Oncology Pharmacy in 2021?

Oncology pharmacists have been involved in caring for patients with cancer for several decades. With the explosion of new therapies for cancer, the role of the oncology pharmacist continues to expand.

The coronavirus disease 2019 (COVID-19) continues to dominate the headlines, but we will get through the pandemic and back to our core practice soon. We have already been recognized as the primary professionals to administer a COVID-19 vaccine because pharmacists are proven, accessible, clinically educated, experts in supply chain, and willing to lead.

We hope your 2021 plan of action includes strategies for approaching these and other trends in the oncology pharmacy market.

Oncology Pharmacists are Leading the Process of Medication Selection

This year, there is a shortage of well- trained oncologists, and those who are practicing are extremely busy. Oncology pharmacists are not only filling in gaps, but are also expanding the scope of their practices.

Choosing the right drug for the right patient based on a diagnosis of cancer is essential to optimizing treatment outcomes. As the drug experts, oncology pharmacists in all practice settings have evolved to become integral parts of the cancer care team.

Oncology pharmacists are found participating and leading pharmacy and therapeutics committees in the institution/ hospital setting and in advanced community oncology clinics. They also provide evidence-based care to their patients.

The list of duties for oncology pharmacists includes educating patients and caregivers about their medications, and improving medication adherence. Pharmacy education today has been “futureproofed” and, through continuous education, oncology pharmacists provide clinical knowledge using enhanced literature evaluation training and understanding of the complexity of cancer care.

Oncology pharmacists are also involved in the development of treatment guidelines, establishment of standards, enforcement of policies, and application of clinical pathways in all areas of practice, including hospital, institutional, specialty, and ambulatory.

Expansion of Specialty Oncology Pharmacy

There have been significant advancements in new oral oncology drugs, and specialty oncology pharmacists are the predominant dispensers of these products. We expect the bar to be raised even higher in 2021, given the ongoing pandemic.

Many products require specialty handling and extraordinary standards concerning logistics to ensure the cancer drug is put into the patient’s hands in optimal condition. Specialty oncology pharmacies must focus on the highest degree of quality for patients and their fellow health care providers. Specialty pharmacies will be measured on their ability to improve overall clinical outcomes, and on a patient-to-patient basis. Through the development of unique programs and services—such as patient-based drug utilization plans—optimal oncology therapy and cost- management outcomes are maximized.

Oncology pharmacy teams use multiple forms of communication to provide cancer education and drug information for patients. Integrated technology solutions used to ensure care coordination between fellow health care providers are in place to address any gaps in care, adverse effects, safety, dosing, and product selection.

I recently participated in a panel with several oncologists throughout the country who commented on and complimented the stellar experiences they had in their collaborations with specialty oncology pharmacists. Oncologists want more of that interaction and pharmacist empowerment.

Payer Influence and the Role of Oncology Pharmacy

It is no secret that newer innovations in the drug treatment of cancer will result in higher drug costs. Changing reimbursement practices will continue to have impact on the payer’s approach to new therapies and will put pressure on the conventional models of cancer care delivery. We will see more demands from health plans and prescription benefit managers (PBMs) to increase the use of evidence-based drug management strategies including comparative evidence research, and testing quality and biomarkers to drive appropriate cancer therapy selection.

The effect on patients comes into play with aggressive cost-sharing provisions in most plans. Patients and their families have been called upon to make tough decisions about therapy based on their financial standing. The oncology pharmacist will continue to be embedded in the process, navigating the bureaucracy as the patient’s advocate and on behalf of the oncology team. We will see an increase in the integration of medical and pharmacy benefits that have historically been siloed, and more coordinated care in the coming year.

As a result of mergers involving health care plans, pharmacies, and PBMs, plan sponsors are demanding that programs provide insight into medical and pharmacy benefits. Expect to see even greater impact from Integrated Delivery Networks offering comprehensive health plans as a solution.

Better and More Oncology Products

Despite the challenges brought on by the pandemic, the pharmaceutical industry continues to churn out new oncology therapies at a frenetic pace. We anticipate by the end of 2020 that more than 21 new drugs will have been approved to treat cancer, which would break the record of 17 cancer drug approvals set in 2018. These new approvals range from biologics to small- molecule drugs to chimeric antigen receptor (CAR) T-cell therapies. We anticipate some potential therapies may be approved in the first quarter of 2021, including idecabtagene vicleucel, the first CAR T-cell therapy for multiple myeloma, which is expected to cost approximately $475,000 for a 1-time infusion.

Precision medicine continues to mature, and the pace of discovery and implementation of targeted therapies will accelerate. Oncology pharmacists will have the ability to select a medication and dose based on patient-specific genomic factors. These personalized therapies will domi- nate oncology headlines this year and in the future.

Expanded Formats to Increase Oncology Pharmacists’ Knowledge

As a pharmacist, I have always found attending conferences a great way to enhance my professional education and to network with my peers. Finding time and bearing the expense of attending meetings can be a challenge. The pandemic changed all that, and we had to find new ways to stay smart and current. My crystal ball says we will see a huge shift in how continuing education is obtained. I am not saying meetings such as American Society of Clinical Oncology (ASCO), American Society of Health-System Pharmacists (ASHP), Asembia and others will necessarily go away, but we can expect more options in the future, and 2021 will be a test of the longevity of virtual meetings.

Our own PTCE team is on track to provide oncology pharmacists access to meetings they may not have been able to attend in the past. The programs are the same as would have been offered in person, but are now offered through a proprietary platform created by PTCE. Stay tuned to Directions in Oncology Pharmacy® as we provide you with oncology pharmacy education opportunities in 2021. All you have to do is register for the CE event and you’ll receive a reminder with a link directly to the program, which is broadcast with a live video of the speaker and presentation slides. Attendees can even respond to real-time surveys, and the speakers will discuss the results.

Growth of Institutional/Hospital Oncology Pharmacy and Accreditation

Accreditation has become the new norm in oncology specialty pharmacy, and the area’s largest growth is in institutional and hospital settings. Much of the shift toward accreditation has been because of the trends involving new product development. These pharmacies are in a strong position to provide a continuity of care through integrated systems and data sharing, and coordinating care with accountable care organizations that may participate in risk-based contracting.

Keeping patients in a close ecosystem provides a greater level of control and accountability. In the traditional inpatient hospital model, patients are released from the institution or hospital only to receive their outpatient drug services from traditional entities such as retail and specialty pharmacy. The shift to institutionally owned oncology specialty pharmacy facilitates a setting where orders are kept in house, resulting in increased revenues and potential profitability.

More Reliance on Technology

As oncology pharmacists face more performance-based reimbursement, they will rely more on technology, as they use data and analytics to reduce costs and to support quality patient care. Expect more pressure to create standardization so that disparate systems are better integrated, and data becomes harmonized. We learned much about virtual health care in 2020, and we will see the continued exponential growth in platforms connecting patients and providers. We will see an even greater shift in oncology pharmacy in 2021 around virtual patient care. This avenue is truly the future.

We will also see great strides in the use of pharmacy- based mobile applications, and this use will provide oncology pharmacists with relevant data to help implement and document the care of their patients with cancer.

These are some of the most significant trends devel- oping for 2021. Keep this article if you choose, and see if our predictions hold true come the end of this year. Enjoy this issue and pass it on.

Dan Steiber, RPH, operates Genesis Pharma Consultants, a consulting practice responsible for commercial operations and trade-supply chain strategy development. Steiber has served in several senior positions in pharmacy, distribution, and industry over the course of his 40-year career. Steiber is a licensed pharmacist in Texas, Washington, California, and Pennsylvania. He is affiliated with several professional associations and publications and a frequent speaker on behalf of many professional organizations. Steiber graduated from Washington State University College of Pharmacy. He has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University and Northwestern University.