The Oncology Drug Pathway: Getting Medications From the Pharmacy to the Patient
Despite advances in cancer care, patients typically face obstacles to treatment. Navigating these barriers on the oncology drug pathway is complex and requires specialty pharmacists to be proactive.
“You have to make that move away from traditional [care] to being more into the care of the patient,” said Howard Levine, PharmD, pharmacy director at Queens Medical Associates (QMA), when describing the pharmacists’ role in facilitating access to timely treatment for patients in the oncology space.
In cancer, one of the primary tenets of treatment is to, ideally, start therapy immediately, before disease progression. In reality, there are several barriers that can hinder patient access to care.
According to Levine, insurers tend to be the primary barrier for patients. Through pharmacy benefit managers (PBMs), insurers may limit drug therapy choice and only cover the medications that they prefer the patient to use first. Levine noted that this can make managing care especially difficult in the oncology space, as many therapies may be indicated for the same cancer but have varying adverse effect profiles.
Moreover, insurance companies may deny coverage of a prescribed therapy. Working to get approval for the drug means a delay in the patient starting therapy.
“We’ve had experience in our practice where it takes 4 or 5 weeks for the patient to get the drug, which is highly inappropriate for a patient with cancer,” Levine said.
Levine gave an overview of the oncology drug pathway at QMA and how his pharmacy staff contributes. At the practice, an accredited specialty pharmacy dispenses medications, which are primarily oral treatments, along with any needed supportive therapies for patients to take home.
For infusion/injectable treatments, the pharmacy prepares the medication, which is administered by a nurse in the infusion suite. However, the pharmacy staff does much more than just prepare and dispense drugs. They are often on the front lines of ensuring that patients are able to access the lifesaving treatments they need.
Once the physician prescribes the treatment, the prescription goes through numerous checks before being deemed appropriate for the patient, with the pharmacy being the last checkpoint. At this time, the pharmacy staff ensures that the patient’s insurance will cover the medication. According to Levine, several staff work together to make this happen, from the technicians to the financial counseling department.
“This is all done right up front, before anything is even filled,” Levine said. “We have to make sure that the patient can get that prescription.”
With the increasing costs of therapy, patients often face a significant nancial burden. In his practice, Levine indicated that if a patient is facing a high co-pay, a technician will reach out to the manufacturer to arrange co-pay assistance. In some cases, the practice will contact third-party foundations to obtain financial help for patients.
According to Levine, pharmacies that want to serve patients with cancer must commit to taking on the financial portion of care delivery as well.
“We will get on the phone with insurance companies and PBMs all the time, and we will fight for our patients,” Levine said. He noted that at any point, 4 or 5 staff members may be on their phones trying to ensure their patients have coverage.
At QMA, Levine said they are typically able to get the medication into the patient’s hands in less than 72 hours. Most of the time, the medication is available for the patient on the day they come in. If a change in treatment occurs or the medication is not in stock, a new order will come in the next day.
Pharmacies must also consider how to manage the flow of expensive drugs while catering to the needs of their patients. At QMA, Levine explained that not every drug is kept on the shelf, only those that multiple patients are receiving. For drugs that few patients are prescribed, Levine said that orders are placed so that the prescription can be filled the next day. By checking with the prescriber, the pharmacy can look ahead and ensure that the medications patients need are in stock.
Levine said that the pharmacy at QMA is also able to access patient records easily, allowing his staff to review a patient’s information and look ahead to when they are scheduled for their next visit. For pharmacies not associated with a practice, it may be more difficult to follow a patient this way. In this case, being proactive in staying updated on patient care is especially important, according to Levine.
“If you make the decision in your pharmacy that you want to take care of these patients, it’s a different approach,” he explained. “It’s the pharmacy being, for lack of a better term, ‘more clinical,’ where you’re actually looking at the patient.”
Levine emphasized the importance of establishing a clear line of communication with the physician’s office. “It behooves the outside pharmacy to try to establish a relationship, and it doesn’t have to be with a physician per se, but somebody in the office,” Levine said.
He added that presenting this relationship as a partnership that helps the patient generally leads to good responses. Levine noted that this level of communication is
typically not standard, which is why pharmacies need to shift away from their conventional role and take on a more dedicated component in overall patient care. He recommended that pharmacists ask prescribers whether they can help the pharmacy follow their patients so that their medications are filled on schedule. Having a pharmacist call to check in a week before a patient is due for a refill is an efficient way to keep tabs on any changes in the patient’s care and prepare accordingly.
Enhanced communication between the practice, the prescribers, and the insurers is key to speeding up the process. According to Levine, specialty pharmacies have to be willing to put in the time and effort to best serve their patients, and that means ensuring that they receive access to their treatments in a timely fashion.
“There are hoops to jump through, but you jump,” Levine said.