Bispecifics in the Community: Infrastructure, Education, the Future

Bispecific antibodies are emerging as one of the most consequential drug classes in oncology, offering durable responses for patients with relapsed or refractory hematologic malignancies. In addition, they are increasingly being evaluated in earlier lines of therapy. However, translating the promise of these agents into routine community practice is no small undertaking, explained Lekan Ajayi, PharmD, chief operating officer of Highlands Oncology Group.

Unlike more familiar infusion therapies, bispecifics require step-up dosing protocols, specialized toxicity monitoring, robust triage infrastructure, and tight coordination between clinic and hospital settings, Ajayi said in an interview with The American Journal of Managed Care^® (AJMC^®). As more patients become eligible and treatment volumes grow, the pressure on community oncology practices—already strained by resource and reimbursement challenges—is intensifying.

Remote therapy monitoring is one strategy for keeping patients on track and reducing unnecessary emergency department visits during active treatment, with bispecifics emerging as a particularly high-stakes area where proactive monitoring will be critical.¹

Community pharmacists are also playing an increasingly central role in building the workflows and protocols that make community bispecific programs viable. Pharmacists at networks like the American Oncology Network are developing scalable toxicity management protocols, patient monitoring tools, and step-up dosing schedules tailored to outpatient community settings—helping ensure that patients can receive these complex therapies close to home rather than requiring hospital-based administration.²

Ajayi told AJMC what step-up dosing demands of community practices operationally, what successful outpatient bispecific administration looks like, and where the most significant infrastructure gaps lie as these agents move earlier in the treatment paradigm.

This interview has been lightly edited for clarity and readability.

AJMC: Bispecifics often require step-up dosing and close monitoring. What does that mean for site-of-care decisions, and how does that affect cost and resource utilization?

Ajayi: Step-up dosing usually happens when a drug is given gradually over time, with the dose increasing over a period of time. One of the basic things about step-up dosing from an operational standpoint is just how much time and resources that takes. In community oncology currently—and in oncology in general—those are things that are not really reimbursed for. What happens is it becomes a substantial cost to the practice to be able to deliver these therapies and step up dosing over time. That's definitely one of the things we're going to have to think about as we implement step-up dosing regimens in our practices.

The other thing about step-up dosing is coordinating between multiple sites of care. With bispecifics, a lot of doses are initiated in the hospital, so you have to get the patient in there while you're stepping up their dose. The level of acuity involved in that is also resource-intensive. Those are really important things that we will need to iron out as we continue to implement bispecifics in our practices.

AJMC: What does successful outpatient or community oncology administration of bispecifics entail?

Ajayi: The greatest win for bispecifics in the community is giving patients their therapies close to home, because nobody wants patients traveling for their therapies. For that to happen, there are so many moving pieces that you have to coordinate together in a way that makes sense.

The first is the right education at the right level—making sure that those who are going to administer the medication, as well as those who are going to be monitoring the patients, have the right education on what to look out for and how to anticipate symptoms that may occur. Having a very good education program is extremely important. The other piece is even the language we use within a community setting, among the different players, between the clinic and the hospital. Being able to standardize that language across the board is really key.

We also have to have a very good reimbursement program. If we're going to take the risk to deliver these drugs at a very high cost, we need to make sure that we are getting reimbursed for them as well. All those things are very important elements in having a successful bispecifics program within the clinic.

AJMC: As bispecifics start to move into earlier lines of therapy, what infrastructure gaps do you foresee as larger patient populations become eligible?

Ajayi: Again, it goes back to education. It also goes back to ensuring that we have the right people in place who can respond at the right time to the patient's needs. I think that's going to continuously be a gap. We need enough providers who can respond; triage pathways and all those things still need to be built.

I'm going to borrow a phrase from Debra Patt, MD [executive vice president of policy and strategic initiatives at Texas Oncology and a past president of Community Oncology Alliance], who says that these treatments are like Ferraris, but they're on really underdeveloped roads. You have really advanced treatments, but the infrastructure for delivering those treatments is not well advanced. Making sure we have very good workflows and the right education for the right team is going to be really key.

References

1. Shaw ML, Ajayi O. Remote therapy monitoring could be community oncology's secret weapon: Lekan Ajayi, PharmD. AJMC. April 29, 2026. Accessed May 15, 2026. https://www.ajmc.com/view/remote-therapy-monitoring-could-be-community-oncology-s-secret-weapon-lekan-ajayi-pharmd

2. Shaw ML, Peters B. Community pharmacists are redefining bispecific antibody care beyond academic centers: Brooke Peters, PharmD, BCOP. AJMC. May 12, 2026. Accessed May 15, 2026. https://www.ajmc.com/view/community-pharmacists-are-redefining-bispecific-antibody-care-beyond-academic-centers-brooke-peters-pharmd-bcop