Role of the Pharmacist in the Care Team to Contain Costs in Oncology

Including a pharmacist placed among the care team of patients with cancer is crucial, because the pharmacist can provide support, ensure guideline-concordant care, and educate patients, explained Kirollos S. Hanna, PharmD, BCPS, BCOP, FACCC, director of pharmacy, Minnesota Oncology, and assistant professor of pharmacy, Mayo Clinic School of Medicine.

Hanna chaired an Institute for Value-Based Medicine^® (IVBM) meeting with Minnesota Oncology and The American Journal of Managed Care^® on September 10 in Minneapolis, Minnesota.

This transcript has been lightly edited for clarity.

Transcript

As cancer therapies become more complex, how does the pharmacist’s role evolve in patient care?

Pharmacists play a critical role in the cancer care armamentarium, whether that is as a reactive role or a proactive role. It is inevitable that you have to somehow place a pharmacist among the care team. There are multiple ways that pharmacists can help in terms of cost containment and providing value. You look at biosimilar adoption and biosimilar integration and various other things. We got out of this IVBM program that we had that many of our pharmacists help support our bispecific antibody program, whether that is remote monitoring of patients or clinical interventions when patients need it.

Our pharmacists are doing clinical reviews on every brand new regimen that's selected for our patients to ensure that we're providing guideline-concordant care, not only within our pathway but also National Comprehensive Cancer Network and the best clinical practice. They can catch things like laboratory parameters that may be needed, particular monitoring that may be needed, and obviously pharmacists play a critical role in education of patients. There are multiple things that I think pharmacy has been able to demonstrate as a value or return on investment. I would say that within the care team, it's extremely important to ensure that a pharmacist is placed among the care team.

How are pharmacists and doctors working together to manage costs in cancer care?

I think there are multiple opportunities where our providers, our prescribers, and the pharmacy team really come together to really help control the cost of care. Number one, when we look at that partnership through an organizational lens, we know both of these stakeholders play a critical role on your P&T committees, your pharmacy and therapeutic committees. Through our P&Ts, we're evaluating clinical trials, we're evaluating drug portfolios, we're evaluating group purchasing organization contracts to really help us place and navigate oncology, which is always complex, always changing. We utilize our pharmacy team as well as our providers to come together and serve on a committee to help us place certain therapeutics on pathways, to help us prefer certain biosimilars. And there are a lot of opportunities I think within that space as we try to help control cost.

Now the other aspect of it is now in actual clinical practice, our providers are seeing patients and they're prescribing. Our pharmacy teams play a reactive role based on orders that come through or regimens that are adopted or selected for patients, and our pharmacists ensure that the P&T decisions, that the formulary decisions, that the pathway decisions are actually in effect, and they will reach out and work side by side with our providers to recommend potential changes or alternates based on what the system has in place.

The other side of it, too, to help manage cost—pharmacists can help avoid and prevent cost as it relates to just really oncology altogether. Oral chemotherapy monitoring programs: pharmacists calling patients, checking on adherence and compliance, responding to lab results. All of that is proactive so that your patient doesn't accidentally take the medication incorrectly. Maybe the patient needs some type of supportive care that through a collaborative practice the pharmacist can prescribe. All of these things also free up the physician time.

There’s a lot of opportunity, I think, across the spectrum and it's never a one-size-fits-all model. Every practice will find ways to integrate their pharmacist in terms of strategies to help control and contain cost.