Pharmacist-Led Model Targets Uncontrolled Hematocrit in Polycythemia Vera

A collaborative care model that paired leukemia oncologists with a specialty pharmacy team identified 108 patients with polycythemia vera (PV) whose hematocrit was at or above the recommended target of less than 45%, according to an interim analysis from Atrium Health’s Levine Cancer Institute published in Journal of the Advanced Practitioner in Oncology.¹ The model, which launched in October 2022, uses electronic health record (HER) screening to identify patients with uncontrolled hematocrit and specialty pharmacists to review treatment, adherence, thrombotic risk, symptom burden, and medication access between hematology visits.

PV is a chronic, myeloproliferative neoplasm driven primarily by JAK2 mutations and characterized by erythrocytosis, which contributes to increased blood viscosity and thrombotic risk. Treatment goals include reducing thrombotic risk by maintaining hematocrit below 45%, managing symptoms, and addressing other disease-related risks. However, variability persists in real-world PV management, including inconsistent symptom assessment, treatment monitoring, and medication access, study authors explain. Previous research backs up their concerns, highlighting gaps between guideline recommendations and real-world treatment patterns.²

How Pharmacists Contributed to Patient Outcomes

To be included, patients (n = 503) had to have active PV diagnosis codes in the HER and recorded hematocrit levels of at least 45%.¹ Of the total study population, 108 (21.5%) had uncontrolled hematocrit and from among the 61 (56.5%) enrolled in a specialty pharmacist–driven support program, 54 (88.5%) had completed clinical reviews by the time of the interim analysis. The median age of the 54 patients was 69 years, and 79.6% had high-risk PV. Eighteen percent also have a history of venous thromboembolism. Overall median hematocrit at enrollment was 47% (range, 45%-55%), and the top 3 treatments at baseline were phlebotomy (27.8%), hydroxyurea (27.8%), and hydroxyurea/phlebotomy (33.3%).

In their clinical reviews, the pharmacists collected information on patient risk factors, treatment adherence, and symptom burden via the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-10). Among the patients whose hematocrit was unresponsive to treatment or remained above goal, dose titrations, medication changes, and supportive-care interventions were proffered. Patients with subtherapeutic hydroxyurea exposure were suggested dose adjustments according to hematocrit and mean corpuscular volume. For patients refractory or intolerant to hydroxyurea or who needed to start or transition to newer agents, financial navigation services were provided (eg, prior authorization assistance and co-pay support).

Pharmacists also directly engaged patients, providing disease-state medication education, adherence support, and symptom assessment. Where an MPN-10 was documented, the pharmacists administered it or asked the provider to obtain it at the next visit. Nonadherent patients could be placed on pharmacist-led care plans with check-ins, refill reminders, and assistance with clinical, logistical, or financial barriers. Interventions were documented in the EHR for hematology to cosign, and follow-ups were scheduled for 3 to 6 months out.

Across the 54 completed reviews, the pharmacists provided a median of 2 clinical recommendations and 2 patient services per encounter. Even though providers acknowledged 100% of documentation, only 15% of recommendations had been implemented by the time of the authors’ analysis. The modest uptake was attributed to timing, with the authors noting, “PV patients are typically seen in clinic only every 6 to 12 months.” They expect uptake to improve as the program matures.

What Is Next for the Program?

Lab abnormalities can emerge between infrequent visits, the authors explained, and pharmacists may be able to catch uncontrolled hematocrit, adherence issues, or access barriers before other members of the care team. Atrium Health plans to expand into additional hematology clinics and other MPNs, including essential thrombocythemia and early myelofibrosis, with goals of full EHR integration of the MPN-10 and increased specialty pharmacy staffing.

The analysis does not yet show improved longitudinal hematocrit control, and this remains the program’s key end point going forward. For now, these findings show a specialized pharmacy team can systematically flag uncontrolled PV and deliver structured reviews on treatment optimization, adherence, thrombotic risk, and access.

References

1. Yogarajah U, Tran T, Cichonski E, et al. Optimizing polycythemia vera management through a collaborative care model between leukemia oncologists and an integrated specialty pharmacy. J Adv Pract Oncol. 2026:1-5. doi: 10.6004/jadpro.2026.17.7.22
2. Kaltwasser J. Polycythemia vera management often does not follow guidelines. AJMC^®. April 23, 2023. Accessed August 21, 2026. https://www.ajmc.com/view/polycythemia-vera-management-often-does-not-follow-guidelines