Publication

Article

Evidence-Based Oncology

Patient-Centered Oncology Care 2024
Volume30
Issue 14
Pages: SP1118

Pharmacists Show Their Value in Oncology Care

Author(s):

Key Takeaways

  • Oncology pharmacists are crucial in managing complex cancer therapies, enhancing patient care and clinic efficiency through diverse roles in therapeutic clinics and clinical trials.
  • Pharmacists face challenges, including lack of federal recognition as providers, impacting reimbursement and resource allocation, despite their demonstrated value in healthcare.
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The role of oncology pharmacists is evolving as they become more vital to managing complex cancer therapies. Insights from the Patient-Centered Oncology Care meeting shed light on the current landscape of pharmacy in cancer care, where progress has been made, and where more is needed. The role of oncology pharmacists is growing, but they continue to face critical challenges, including the recognition of pharmacists as providers.

Scott A. Soefje, PharmD, MBA, BCOP, FCCP, FHOPA | Image credit: LinkedIn

Scott A. Soefje, PharmD, MBA, BCOP, FCCP, FHOPA | Image credit: LinkedIn

The discussion was moderated by Scott A. Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of pharmacy cancer care at the Mayo Clinic and an assistant professor of pharmacy at the Mayo Clinic College of Medicine and Science. He was joined by the following:

  • Judith Alberto, MHA, RPh, BCOP, director of Clinical Initiatives, Community Oncology Alliance (COA),
  • Chris Elder, PharmD, BCOP, associate director of Pharmacy Clinical Services, Florida Cancer Specialists & Research Institute (FCS),
  • Sarah Hogue, PharmD, director, Oncology Pharmacy Services, St. Luke’s Cancer Institute, and
  • Sophia Humphreys, PharmD, MHA, BCBBS, director, System Pharmacy Formulary Management & Clinical Programs, Sutter Health.
Sophia Humphreys, PharmD, MHA, BCBBS | Image credit: photo provided by Humphreys

Sophia Humphreys, PharmD, MHA, BCBBS | Image credit: photo provided by Humphreys

At Sutter Health, pharmacists run therapeutic clinics, and they manage patient disease states. They read laboratory test results and images, they select clinical pathways, and they do all the work except for diagnosing the disease, explained Humphreys.

At St. Luke’s, there is a new pharmacist-run pharmacogenomics and precision medicine program. “From the moment the test gets ordered and sent off, the pharmacist is receiving those results, interpreting those results, and presenting [patient cases] at tumor boards so that we can make a collaborative decision on how best to go forward with those treatments.

Then, the pharmacist is also involved in writing appeal letters and [sending supporting material] to the insurance [companies] so that we can get that individualized care approved for those patients,” explained Hogue.

At the Mayo Clinic, pharmacists help offset the volume of patients in the clinic, Soefje added. For instance, the physicians preselect which patients and which cycles of chemotherapy can be seen by a pharmacist instead. For these patients, the pharmacist will see the patient, make an assessment, sign the order, and send the patient to receive their chemotherapy. This process allows the physician to instead see a new patient, increasing access to the clinic.

“This model is actually working very well for us, to the point where I have clinics lining up now, going, ‘How do I get one of those pharmacists in my clinic?’” he said.

Chris Elder, PharmD | Image credit: photo provided by Elder

Chris Elder, PharmD, BCOP | Image credit: photo provided by Elder

Elder highlighted the way pharmacists are being used to standardize practices across multiple sites through initiating and expanding the bispecifics maintenance program in the community. FCS has a cellular therapy oncology pharmacist who started integrating bispecifics at a small number of clinics, working with the physicians at each clinic to go through protocols and standard operating procedures before expanding to other clinics.

Sarah Hogue, PharmD | photo provided by Hogue

Sarah Hogue, PharmD | photo provided by Hogue

In addition to pharmacists creating protocols and stepping in to manage treatment, some clinics have clinical pharmacists working with research programs and clinical trials. Hogue said pharmacists will work with the primary investigator of a trial to decide if it’s feasible to conduct it at any of the St. Luke’s clinics. These pharmacists also work with research coordinators to screen patients. Being involved in the tumor boards, the pharmacists can let providers know when there are relevant clinical trials open for any patients whose treatment is being discussed.

Then, once patients are identified for clinical trials, the pharmacists conduct a robust medication reconciliation, because often there are certain medications prohibited by the protocol of the trial.

“So, rather than just saying, ‘Oh, nope, this patient can’t be on this trial because they’re on such and such heart medication,’ we actually have the pharmacist call [the patient’s] cardiologist or their [primary care provider] and say, ‘…there’s this cool clinical trial that we want to put this patient on for their cancer diagnosis. Can we switch them from lisinopril to enalapril or make some other changes to their medications to make it so that they are eligible to go on [that] study?’ [That] is really cool and has actually increased our rates of patients on study at our institution,” Hogue said.

Judith Alberto, MHA, RPh, BCOP | Image credit: Community Oncology Alliance

Judith Alberto, MHA, RPh, BCOP | Image credit: Community Oncology Alliance

With pharmacists getting more involved with patients beyond just dispensing drugs, there has been an increase in advocacy to promote pharmacy practice. Alberto noted that among the member practices of COA, there are pharmacists in the positions of CEO or chief operating officer overseeing contracts and strategy. They’re not only doing the clinical work, but they’re also involved in the business and they’re on Capitol Hill, lobbying for policy change to give pharmacists more responsibilities.

Pharmacists have gained some additional responsibilities through collaborative practice agreements that allow pharmacists who work with specific physicians or specific groups to establish a service line agreement for pharmacists to provide certain services, including prescribing, explained Humphreys. This allows pharmacists to provide better patient-centered care and remove repetitive work from physicians. These agreements not only elevate the importance of pharmacists but also provide physicians with more opportunities to see patients with complicated cases and focus on diagnostics, which the pharmacist cannot do.

In Washington state, where Humphreys works, pharmacists are recognized as providers and have those capabilities outside of the collaborative practice agreement. In Idaho, where Hogue is located, there are not many pharmacy practice laws, and pharmacists can do things in Idaho that they might not be able to do in other states. While the state doesn’t need collaborative practice agreements due to the lack of restrictive laws, they are in place and are “robust and broad,” she said. Pharmacists manage infusion reactions, supportive care decisions, and premedications. They also can make amendments to medications based on what they feel is necessary prior to the patient receiving their chemotherapy or immunotherapy. Under the oral oncology collaborative practice agreement, once a physician sends a prescription for an oral chemotherapy, it goes to Hogue’s team to manage everything: make dose adjustments for toxicities or based on indication, order laboratory values, order supportive care medications, etc.

The so-called elephant in the room is that pharmacists are still not recognized as providers at the federal level, Elder said. Pharmacists have shown their value, he said, but they still have to justify getting reimbursed. CMS can act, Alberto added. Pharmacists should be given provider status and get a National Provider Identifier number, she said.

“Resources are very scarce, and it’s dangerous when you try to spread…your pharmacist and your health care teams too thin,” Alberto said. “And so, we need that provider status.”

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