The evolution of drug research and development toward oral therapies for cancer over the past decade has created a number of questions for the oncology healthcare provider. Will insurance companies pay for these exceptionally expensive medications? How and when will patients receive their medication? Who will be responsible for ensuring patient education and monitoring to maximize safe drug administration and patient compliance? In the accompanying article, Dr Hansen builds a case for specialty pharmacy providers (SPPs) to assume these responsibilities in a marketplace increasingly focused on reducing drug costs while also remaining committed to pharmacovigilance. When appropriately utilized, the SPP can become a benefit to the healthcare team and an additional resource at the disposal of the oncology pharmacist.
When a patient is initially introduced to the concept of oral chemotherapy, it often becomes the duty of the oncology pharmacist to ensure that the patient and family are well educated with regard to the dosage, schedule, and side effects related to the new medication. As these drugs are often used in the second-line (or beyond) setting, frequently counseling sessions are undertaken while patients are still processing the news that their cancer has returned or worsened. Thus, it becomes important that patients are provided with written education materials and have an available “life line” when questions arise regarding these oral drugs. While a provider from our practice is always available to the patient and family around the clock, the availability of additional highly reliable patient resources can play a significant role in ensuring that patients receive timely advice or an appropriate answer to a question or concern in the event that they feel uncomfortable asking us directly. The SPP may then provide education as an extension of the oncology team rather than having the patient seek out information or anecdotes from the Internet or other such unreliable references.
As Dr Hansen notes, “The SPP would typically be more familiar with the particular specialty drug they have been contracted to provide than a general service pharmacy.” In addition to enhanced knowledge of these drugs, many, if not all, SPPs have pharmacists available 24 hours a day to be responsive to the needs of their customers and patients. This is a significant advantage in contrast to the pharmacist in a traditional community pharmacy where patients may, otherwise, feel inclined to seek additional drug information. In an article in the Journal of the American Pharmacists Association in 2008, O’Bryant and Crandell surveyed community pharmacists’ knowledge and attitudes toward oral chemotherapy and concluded that only 45% of community pharmacists were knowledgeable regarding adverse events of these drugs. They also reported a low level of comfort in dispensing these highly specialized oral medications (mean 2.4; Likert scale 1 [low] to 5 [high]).1 Thus, an insurance company that contracts an SPP to provide dispensing services for these drugs also is more likely to ensure that patients will be the beneficiaries of competent drug information.
While the SPP may play a favorable role in patient education, there are obvious concerns related to the possibility of fragmentation of care ultimately related to communication issues. In my opinion, it is important for the oncology pharmacist in the ambulatory care setting to be aware of the SPPs used by insurance plans commonly encountered in a community. Oncology pharmacists would be well served to communicate directly with the SPPs, become knowledgeable in the drugs and services offered by specific SPPs, and maintain open channels of communication to ensure that when questions arise related to quantities dispensed, dosage changes, or delays in treatment, this information may be exchanged in a cordial and professional manner, no differently than communicating with a community pharmacy down the street. We must, as a profession, recognize that SPPs will remain a significant factor in the dispensing of expensive, highly specialized oral oncology drugs for the foreseeable future. Thus, our responsibility should be to utilize the SPP as a resource to enhance care for the patient with cancer rather than view the SPP as an insurmountable barrier to patient care.
- O’Bryant CL, Crandell BC. Community pharmacists’ knowledge of and attitudes toward oral chemotherapy. J Am Pharm Assoc. 2008;48:632-639.