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Specialty pharmacists should be an essential partner of the care team when transitioning patients with cancer from the hospital crisis stage to the community, Stacey McCullough, PharmD, senior vice president of pharmacy at Tennessee Oncology, said in an interview with Directions in Oncology PharmacyTM.
“The purpose of the individual’s therapy and its expectations are essential in transitioning patients,” McCullough said. “Understanding what the patient goal is for the therapy helps the pharmacy team collate necessary information for the patient to absorb in the rst interaction versus what is built during the ongoing relationship.”
McCullough said one role of the specialty pharmacist is to help patients navigate the continuum of care. This includes getting prior authorization for drugs as more oral oncology treatments become available and negotiating with insurance companies over preferred drugs versus those prescribed by the oncologist, especially when navigating adverse effects (AEs).
“For example, a drug with [an adverse] effect of tingling hands may be preferable to one that has diarrhea. If another drug is needed than the one preferred by the insurance company, we try and build the case for the patient so the insurance company covers it,” McCullough said.
Tennessee Oncology has a specialty pharmacy embedded in its practice, which McCullough said provides seamless care for patients.
“We have access to their electronic medical record to track medications, labs, follow-ups, and scans all coordinated with the start date of their medications,” McCullough said. “The [electronic medical record] documents all conversations between the pharmacist and patient and can track drug tolerability following the initial screening. It is about pharmacist integra- tion in the overall care team to monitor adherence and [adverse] effects. Complete communication between the care staff, the pharmacist, and the patient is essential.”
She noted a 2019 study published in The Journal of Oncology Pharmacy Practice that showed positive outcomes managing the AEs of afatinib in treating non– small cell lung cancer, which were “successfully managed in a community-based, real-world setting with the help of collaborative pharmacist-led patient education, adverse event monitoring, and continuous support.”1
Another transitional role the pharmacist plays is connecting patients with assistance to pay for medications. McCullough said manufacturer co-pay cards should be used for commercially insured patients, which reduce co-pay amounts and make medication more affordable. However, McCullough said, patients on Medicare are at risk because they go through Medigap on their first bill and have very high co-pays for the first 3 to 4 months.
“We look for foundations to cover that amount to get through those most challenging months, so these patients can continue their medications,” McCullough said. “We address cost with them to prevent them from taking longer intervals with their treatment because they can’t afford it. We run claims a few ways to find avenues of paying for [them] and try everything possible to make sure patients can afford their medications.”
In addition to helping patients with affordability, specialty pharmacists provide support to patients and their families in this transition, according to McCullough.
“Patients need to know there is someone always available to answer their questions,” she added. Specialty pharmacists provide new patient starter kits that contain manufacturer information, calendars, and pamphlets about AE management, pictorials of how the drug is dosed, diet advice, and drug monograph information that goes with the first fill of the medication.
They also provide information about the pharmacy and how to reach them.
“This can be overwhelming for patients because of the amount of information and the number of providers they are interacting with. The pharmacy staff can be a force of navigation for them, so they are not alone in this journey,” McCullough said. “We are happy to review information with them. It’s not possible to transfer so much information in just 1 meeting, so an ongoing relationship is essential.”
Although the specialty pharmacist needs to be integrated into the care team, there may be some pushback from patients that needs to be overcome.
“There are different perceptions of pharmacists’ roles,” McCullough said. “The oncologist relationship has always been through the nurse who manages the oral medications working in tandem with the pharmacist, but it is important for the health care team to incorporate a pharmacist as a care provider. They have the special knowledge of food and other drug interactions or if the patient decides on taking supplements or other therapies that may affect their drug regimen.”
She added that sometimes the pharmacy is removed from the practice, which makes it more difficult to integrate communication within the care team. She added that the nurse has a more personalized relationship with the patient.
“The patient thinks of it as ‘my nurse versus the pharmacy’,” McCullough said. “The specialty pharmacist needs to build a relationship and be a presence. The specialty pharmacy needs to be an integrated partner.”
Sandra Fyfe, MA
Khrystolubova N, Shieh M, Patel A, Bailey R. Pharmacist-led patient education and adverse event management in patients with non-small cell lung cancer receiving afatinib in a community-based, real-world clinical setting [published online March 4, 2019]. J Oncol Pharm Practice. doi: 10.1177/1078155219833441