Ali McBride speaks to the challenges of medication adherence, especially in the various settings.
Especially right now with the changing marketplace for insurance. I know new drug therapies are coming in the market, but how do we get those drugs to patients? Sometimes patients can't afford the out of pocket expenses for either an IV or oral therapy.
We have to do a lot of work in terms of pharmacy, especially the ambulatory setting, the outpatient setting in which we're working with our healthcare providers, our physician teams, our advanced practitioners as well as our financial, and specialty pharmacy people to make sure we're getting those drug therapies to the patient.
Sometimes those patients can't actually have certain types of access which means that you can't get a copay card for assistance for these patients for oral therapies. We have to work with foundations. Working with our specialty pharmacy is a key ingredient to make sure these patients are actually getting their drugs on time.
There are numerous issues that happen when orals come about. Sometimes a patient may get a prescription.
They may not start for several weeks later. It actually happens much more often than not.
A lot of issues can arise from working in the ambulatory setting where the pharmacist, especially the clinical pharmacist in the ambulatory setting can work with adherence measures with either nurse navigators, advanced practitioners, and also physicians.
This really provides a roundabout group to buffer any type of situations that can go through that Swiss cheese model for errors. In that situation, we can deal a lot with hands on direct patient contact. In some cases, we can also see insurers do the same thing.
Payers may actually require a follow‑up phone call, or they themselves may do it to make sure the patients are adherent to their therapy, and therefore providing a better a measure for outcomes because these are again high cost oral therapies.
In the IV situation, we're looking at more premeds, evaluating the patient for their first treatment, and side effect profiles as well in terms of adherence to certain premeds which we usually have on board of chemotherapy order sets as well as any issues that may happen in the future in terms of dosing or infusion reactions.