Bispecific Program Design Varies by Practice Size, Experts Say

There is no single template for a bispecific program, and practices from solo physician offices to large academic centers must adapt common building blocks to their own staffing and resources, panelists said at a webinar hosted by CancerNetwork^®, Pharmacy Times^®, and The American Journal of Managed Care^® as part of The Bispecifics Network.¹ The panel included Ralph Boccia, MD, hematologist-oncologist at the Center for Cancer and Blood Disorders, an American Oncology Network (AON) practice, and chief medical officer of the International Oncology Network (ION); Nicholas Bitz, PharmD, a pharmacist specialist in myeloma and lymphoma at University Hospitals in Cleveland, Ohio; and Lekan Ajayi, PharmD, chief operating officer of Highlands Oncology Group in northwest Arkansas.

Practice Size Shapes Program Design

US oncology practices range from 1 physician to 50 or more, so their programs look very different, Boccia said. In a 1- or 2-physician practice, everyone needs to learn how to deliver bispecifics. A 20-physician practice can build a dedicated T-cell team, but his includes 4 health care professionals.

“I absolutely would say there is no one-size-fits-all [model], but there are different models that can be used to develop programs in the various different-sized practices, and those are out there,” Boccia said. AON has built a full playbook, he added, and ION has embedded a playbook for its members on its website.

Bitz agreed, noting that academic medical centers have everything on site, including integrated teams trained to handle these drugs, while smaller, rural, and community sites do not have the same resources.

“If you’ve got a Super Bowl–winning team, you’ve got a really well developed playbook,” Bitz said, but an up-and-coming team still finding its way has to adjust. Practices can “take that good guidance and adapt it and be nimble and be flexible with each of your practice models,” he said.

Some Components Apply in Every Setting

Ajayi said certain elements are universal: the right policies, solid guidance, and sound reimbursement models. Differences stem from whether a practice is academic or community-based and the relationships it holds.

His practice set up its program in 2025 with a physician, an advanced practice provider, and a nurse and is now expanding the team to include pharmacists. What surprised him most was the team’s resilience.

“Prior to starting, we felt, oh my goodness, there were so many moving pieces,” Ajayi said. Instead, the team managed patients and triaged them to where they needed to go.

Volume Grows as Programs Mature

When University Hospitals finalized its outpatient protocol in 2025, “we wanted to be very conservative with what our growth might look like,” Bitz said, so the team could start small and learn the promises and pitfalls of these therapies. Volume has since grown significantly.

He credited 2 forces. One is the wider reach of bispecifics as they move up myeloma and other guidelines.² The other is a better understanding of remission rates and of how to mitigate side effects. In March 2026, the FDA approved teclistamab (Tecvayli; Johnson & Johnson) plus daratumumab hyaluronidase-fihj for relapsed or refractory multiple myeloma after at least 1 prior line.³

“If you have a good program set up, you’re able to maintain that volume, and you’re able to expand that volume over time because you get better and better with it after every administration, after every patient,” Bitz said. Other practitioners have told him bispecifics are not going anywhere. “[Bispecifics] used to be a drop in the bucket. Now, they are the bucket.”

“You will be left behind if you don’t establish programs because people are going to go elsewhere for these life-saving and changing therapies,” Boccia warned.

References

1. Boccia R, Bitz N, Ajayi L. Bispecific programs in oncology. Webinar. CancerNetwork, Pharmacy Times, and The American Journal of Managed Care; October 27, 2026.

2. NCCN. Clinical Practice Guidelines in Oncology. Multiple myeloma, version 5.2026. January 9, 2026. Accessed October 30, 2026. https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf

3. Shaw ML. Teclistamab combo approved by FDA for R/R MM. AJMC^®. March 5, 2026. Accessed October 30, 2026. https://www.ajmc.com/view/teclistamab-combo-approved-by-fda-for-r-r-mm