Oncology Pharmacists in the Spotlight Amid Rising Drug Costs and Workforce Pressures

The prominence of the pharmacist in oncology care has increased dramatically in recent years, as the array of available treatment options—and their price tags—increases with show no sign of slowing. During the panel “Pharmacy: The Rising Stars in Oncology” at the Patient-Centered Oncology Care® 2025 conference, speakers discussed how they see the pharmacist’s role evolving amid the tightening pressures on cancer care provision.

What Is the Challenge of Handling High-Cost, Complex Regimens?

Moderator Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of pharmacy cancer care at Mayo Clinic, began by recalling “when the first drug hit $1000 a dose and we were shocked. Now we go all the way up to $500,000.”¹ In response to these complex and costly options, the panelists suggested a number of strategies their centers employ to keep costs down.

For instance, Scott Freeswick, PharmD, MS, chief pharmacy officer, Memorial Sloan Kettering Cancer Center, emphasized the importance of shifting care from the inpatient to the outpatient setting as much as possible. In community practices that only have outpatient clinics, there needs to be a holistic look at the resources required to deliver a given drug, including whether the practice needs to collaborate with a local hospital, said Kristen Boykin, PharmD, BCOP, BCPS, director of pharmacy operations, Florida Cancer Specialists & Research Institute.

“Physicians get excited about a therapy, but is this therapy going to require an entire process around it that’s not being factored into the cost of the medication?” Boykin said. “Pharmacy is a discipline that’s really difficult to demonstrate ROI [return on investment].”

How Pharmacists Can Help Combat the National Provider Shortage

The panelists agreed that pharmacists have a crucial role in offloading work from the oncologist, which has been especially important amid the ongoing physician shortage. However, now the field is beginning to see a shortage of oncology pharmacists. To attract pharmacists, Anthony Boyd, PharmD, BCPS, senior pharmacy director, Cleveland Clinic, described efforts to leverage remote work by letting them complete administrative work at home when they are not in the clinic with patients.

“We’re trying to reduce travel for professional development such as presentations,” he said, and “trying to keep folks where they’re at and stop the brain drain.”

Specific to oncology, Freeswick mentioned that it’s becoming increasingly difficult to find pharmacists who already have oncology expertise, so his institution is hiring recent graduates or retail pharmacists and then training them.

What Do Oncology Pharmacists Bring to the Table?

When oncology pharmacists are integrated within inpatient and outpatient teams, clinics operate more efficiently, Freeswick said. “The goal is to see more patients, but also for patients to go home with knowledge that maybe they wouldn’t get if a pharmacist wasn’t there, making sure they understand how to take their drugs at home, especially with all these IV [intravenous] drugs that become oral drugs.”

Their expertise is especially important as cancer treatment regimens become more complex and contain powerful drugs that carry risks of adverse events. Timothy Mok, PharmD, BCOP, BCPS, manager and assistant clinical professor, Kaiser Permanente and UCSF School of Pharmacy, explained how pharmacists are equipped to understand the various drug profiles and what they mean for patients.

“We try to identify patients who have risk factors to react,” he said. “We have pharmacists on the tumor boards, going over these patients who are about to be prescribed this, giving our input on whether a patient is a good candidate for it and whether or not they need a specialized prophylaxis.”

When patients have questions about their regimen or adverse effects, pharmacists are often their first call, so Freeswick mentioned they play an important role in outpatient education. They can also coordinate the use of wearables for remote patient monitoring during step-up dosing,² which can increase the proportion of these regimen changes done in the outpatient setting.

Pharmacists can also work to address financial toxicity, said Boykin, who mentioned that her community practice took a slow approach to incorporating new therapies until they fully understood what would be reimbursed.

How Can AI Smooth the Pharmacy Workflow?

Artificial intelligence (AI) is transforming every sector of medicine, and oncology pharmacy is no exception. Boyd highlighted its potential to generate notes, identify patients eligible for research trials, handle prior authorizations, and deal with other tedious administrative tasks. That way, the pharmacist can “get back to the patient and make sure we are delivering effective care, but realizing there might be some tasks today that are performed by pharmacists but might look different in the future.”

References

1. Leighl NB, Nirmalakumar S, Ezeife DA, Gyawali B. An arm and a leg: the rising cost of cancer drugs and impact on access. Am Soc Clin Oncol Educ Book. 2021;41:1-12. doi:10.1200/EDBK_100028

2. Beauchamp UL, Pappot H, Holländer-Mieritz C. The use of wearables in clinical trials during cancer treatment: systematic review. JMIR Mhealth Uhealth. 2020;8(11):e22006. doi:10.2196/22006