Getting New Cancer Drugs Chairside: Mitchell Blewett, PharmD, MS

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Formulary approval is only the midpoint of the process that precedes a first infusion, according to Mitchell Blewett, PharmD, MS, director of oncology pharmacy at Cleveland Clinic. He spoke with The American Journal of Managed Care^® at the 2026 annual Patient-Centered Oncology Care (PCOC) conference after participating in a panel discussion titled “From FDA to Formulary: A Look at Therapy Selection in Comprehensive Cancer Centers.”

Formulary Review Begins With a Physician Request

The process starts when a physician submits a formulary request. Blewett's team of oncology pharmacy specialists then builds a drug monograph covering safety, efficacy, comparative data, and cost of therapy. Supply chain staff may begin early contracting conversations with manufacturers. The hematology oncology specialty panel meets quarterly to review the monograph and vote. Approved drugs advance to the parent pharmacy and therapeutics committee, which typically follows the panel's recommendation.

After approval, teams must then load the drug into Epic, build a Beacon treatment protocol, and create an intravenous compounding recipe. Because Cleveland Clinic uses gravimetric technology, specific gravity must be entered, and vial diameter and collar height are programmed for compounding robots. Billing, coding, staff education, and workflow design follow. Go-live typically occurs 6 to 8 weeks after the panel meeting.

Complex Therapies Raise the Stakes

Blewett cited 2 recent therapies that each cost more than $100,000 per dose. One is given in interventional radiology, with a 30-minute window between compounding and infusion. The other is stored at –80^° Celsius and thawed in a 98.6^° water bath for no more than 5 minutes.

Representatives from regional sites sit on the panel and follow the same timeline. Differences arise mainly when a rare disease therapy is used only at the main campus. Blewett said care should not differ across locations when a drug can be safely given at each.