A Pharmacist's Role in Selecting Effective, Affordable Breast Cancer Therapies

Pharmacists play a role in optimizing drug regimens, monitoring adverse effects, and managing financial toxicity through insurance appeals and patient assistance programs, says Tiffany Meng, PharmD, oncology pharmacist with UCSF Health.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

How can pharmacists support physicians in selecting the most effective and affordable breast cancer therapies while considering patient-specific factors like comorbidities and adherence challenges?

Pharmacists can be involved in many different aspects when it comes to helping physicians make selections for medications [that are] most effective and affordable, especially [for] comorbidities and adherence challenges; we can play a big role there. We can help optimize drug regimens by suggesting alternative drug therapies. If [a] patient has previously had an adverse reaction to the medication, tolerance issue, infusion reaction, or if patients have preexisting comorbidities like hepatic or renal impairment, then we can start them off with recommending a dose adjustment with their treatment to make sure patients can better tolerate the treatment and [be] able to stay on the treatment for a longer period of time, as appropriate.

We can also help with monitoring adverse effects. We monitor for labs in infusion centers; we check their vitals when they come in, make sure that patients are actually doing well, and we connect with the providers when we have concerns that patients [are] not able to get the treatment for various reasons. If there is a cardiotoxic drug, we make sure patients are getting their echos [echocardiograms] done regularly, which is common in our breast cancer population.

We can also help with affordability, because as a pharmacist, we know what our pharmacy inventories are, and we know what are the biosimilars that are available. If possible, we want to try to get the biosimilar that's covered by the patient’s insurance. We know that certain patient assistant programs exist, so we can refer to that when patients have insurance issues that are getting denied and can't get access to the medication. We can also help our providers figure out what our formulary preferences are within our health system and make a recommendation based on that.

There's also adherence that we can help with. If patients are having a lot of nausea [and] vomiting with their medications, we can give recommendations on how we better manage their nausea medication regimen at home, so that patient can be more comfortable continuing the treatment, and then providing that education and being accessible to the providers and the patients [to] answer drug questions to help with that.