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Pharmacy's Changing Role as Cancer Care Transitions From Infused to Oral Therapies

Stacey McCullough, PharmD, and Ricky Newton, CPA
The advent of oral oncolytics has changed the pharmacy's role in patient care beyond compounding infusions. Pharmacy staff now routinely engage patients, assessing adherence and tolerance to therapy as well as helping them navigate prescription benefits.

An increasing number of cancer drugs are now delivered in oral formulations, with an estimated 25% to 35% in the research pipeline being orals. Increasingly, patients prefer to receive their oral cancer drugs and ancillary oral therapies in a safe, reliable, accessible, and affordable environment, tightly integrated with their overall cancer care. Depending on state pharmacy laws, community cancer clinics have established facilities to dispense oral drugs operating either under the physician’s license or as in-practice closed-door pharmacies.
 
With the advent of oral oncolytics, a pharmacy’s role has expanded far beyond compounding chemotherapy drugs for infusion. This evolution has created a beneficial physician extension for oral therapies in the care and management of patients treated in a home environment. Today’s pharmacy teams are comprehensive, including patient access coordinators, financial counselors, and clinical staff to help navigate prescription benefits, secure co-pay assistance, educate patients on what can be complex dosing schedules, and provide specific information on potential side effects. Through strategically scheduled inter- actions, based on drug care plans, pharmacy staff routinely engage patients, assessing both adherence and tolerance to therapy. 

Pharmacy Accreditation 

As the role of pharmacies in providing care increases in prominence, so does the corresponding need to ensure quality standards and best practice benchmarks, both in general operations and patient outcomes. Pharmacy accreditation is an important way to achieve those needs.


 
Accreditation is an external and independent review that pro- vides an imprimatur of a pharmacy’s current policies, procedures, overall operations, and quality assurance programs. In seeking accreditation, pharmacies demonstrate their commitment to providing the highest quality service by complying with stringent national regulations and industry best practices. Common specialty pharmacy accreditations include:
  • Accreditation Commission for Health Care (ACHC)
  • Utilization Review Accreditation Commission
Most insurers require specialty pharmacy accreditation for application to their network, which is a means of demonstrating to the patient and payer that pharmacy services are on par with other pharmacy providers. 

ACHC Accreditation 

The Community Oncology Pharmacy Association (COPA) and ACHC have partnered to create educational resources and a customized suite of specialty pharmacy accreditation offerings.1 In addition, standards for an oncology-specific accreditation have been jointly established by ACHC and COPA.2 Undergoing both ACHC specialty pharmacy and oncology sub-specialty accreditation demonstrates proficiency in operations and patient-centric care plans specific to the complex care of oncology and hematology patients.
 
Patient Education 

Oral oncolytics are powerful chemotherapeutic agents and have the same bene ts and risk as intravenously administered drugs. With the convenience of patients taking the medication at home comes responsibilities for both the patient and the oncology practice. Patients must fully engage and commit to their care plan, including adherence to taking their medication(s) exactly as prescribed. Additionally, the oncology practice must create a remote “chemo suite” environment. Just as nursing and clinic staff establish relationships and dialogue with patients while receiving infused therapy, pharmacy staff have a similar opportunity and responsibility for patients receiving oral therapy. Because oral drugs are not taken under the direct, watchful eye of the physician, patient education and understanding of their medication is paramount to successful outcomes. Important areas for discussion include medication names (both trade and generic); how the medication works; when to begin taking the medication and how to take it, including details on days of the week and best time of day; how to take medication in relation to food and other medications; what to do if a dose is missed; and who to call if you have questions.

Patient education must also include an in-depth discussion of potential side effects and adverse reactions. Patients and/or caregivers must be taught to recognize symptoms as early as possible and be equipped with information to mitigate or manage side effects. Knowing how, when, and who to call to report the occurrence of any side effects and reactions helps minimize missed doses, discontinuation of therapy, or poor outcomes to therapy. This may require 24/7 on-call staff to address patient concerns or questions and access to both their complete pharmacy pro le and electronic health record (EHR).

Patient Monitoring 

The efficacy of many oral agents allows a pharmacy’s relationship with patients to continue for several years. Monthly refill calls, especially when performed by the same pharmacy staff member, establish a rapport that allows a congenial exchange while ensuring medication adherence and tolerance.

Completing the Pharmacy Transition 

Innovation in the development of new cancer treatments has significantly increased the number of oral treatment options and expanded opportunities for the pharmacy’s role in patient care and management. Today’s pharmacy team understands the various aspects of oral therapies, from benefits investigation to co-pay assistance and initial education to long-term adherence. Both, community oncology practices with in-house physician dispensing and licensed pharmacies can access complete patient charts within EHRs. Pharmacy staff working directly with the oncologist and their care extenders are poised to provide best management and better outcomes for patients receiving oral oncolytic treatments. For many patients on oral cancer drugs, pharmacy staff have become a regular contact and the most frequently accessible resource in their cancer care. 
AUTHOR INFORMATION

Stacey McCullough, PharmD, is senior vice president, Pharmacy, at Tennessee Oncology; member, Community Oncology Pharmacy Association Board of Directors. 

Ricky Newton, CPA, is treasurer and director of financial services and operations for the Community Oncology Alliance; advisor, Community Oncology Pharmacy Association. 

ADDRESS FOR CORRESPONDENCE 
Ricky Newton, CPA
Director of Financial Services and Operations 
Community Oncology Alliance
1634 I Street NW, Suite 1200, Washington, DC 20006 
1. ACHC accreditation. Community Oncology Pharmacy Association website. coapharmacy.com/ achc-accreditation/. Accessed September 5, 2017.

2. ACHC launching new Distinction in Oncology program [press release]. Cary, NC: Accreditation Commission for Health Care; April 27, 2016. achc.org/pdf/Distinction_in_Oncology_PR.pdf. Accessed September 5, 2017. 
PDF
 
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