Real-World Decisions Involving Bispecifics in Multiple Myeloma

Panelists at The American Journal of Managed Care Stakeholder Interchange held August 21, 2025, in New York, New York, discussed 3 real-world circumstances involving bispecific antibodies and multiple myeloma (MM). Prior to the case studies, the panelists had discussed issues surrounding administration of bispecific antibodies to patients with multiple myeloma.

Case 1 involved a pharmacy director at a community oncology clinic who was asked to set up collaborations with academic institutions to administer bispecific antibodies.

Moderator Nicholas Bouchard, PharmD, of Hematology-Oncology Associates of Central New York, has been through such a process at his practice and asked the panelists to weigh in. Both Tarun Wasil, MD, of New York Cancer & Blood Specialists, and Genevieve Kumapley, PharmD, BCOP, of Holy Name Medical Center, reiterated what they’d shared earlier: Wasil said that hospitals can make things difficult for community practices, and Kumapley noted that physician champions are essential.

Bouchard then asked how well pharmaceutical manufacturers educate teams about new therapies. “I think they have done a good job,” Wasil said. “They are pretty prompt. If you have a patient, you can call them, and the whole team from industry comes in.”

Marina Barsoum, PharmD, BCOP, of NewYork-Presbyterian Brooklyn Methodist Hospital, said her institution waits until it has its first patient with a new bispecific therapy before training with the manufacturer. If a session happens right after approval, “We might have a couple months until we actually get our first patient, and then everyone needs a refresher anyway,” she said.

Concerns that academic centers won’t return patients to the practice after step-up dosing have not materialized, Bouchard said. Wasil added that it is a numbers game. “These centers cannot accommodate all these patients. They have to send them back,” he said.

Case 2 involved a 60-year-old man with relapsed/refractory (R/R) MM who was considering his fifth line of treatment following disease progression; his treatments had included 2 different daratumumab combinations and an autologous hematopoietic stem cell transplant. Teclistamab seemed the right choice, but the patient was worried about treatment cost and insurance coverage. Could financial navigators help?

Bouchard explained that for patients with commercial insurance, costs typically would be covered. But those with traditional Medicare or Medicare Advantage would face 20% cost-sharing. “Is there any assistance that you are doing in the community or the hospital system to help pay for these co-pays for the patients?” he asked.

Jaime Chin-Hon, PharmD, MS, BCOP, of NYU Long Island at Mineola, said that local grants are available where she practices, but they are small—approximately $200. Barsoum Gerges noted that in certain hardship cases, a request may go to the manufacturer for free drugs.

Being proactive is challenging, she said. “We’ll do our due diligence, but we don’t really know when the next bill will hit for the patient, so we usually just [tell] the patient, ‘If you do get a bill, let us know.’… But it’s hard to get these financial supports ahead of time, not knowing what the true cost is going to be for the patients.”

Managing relationships with payers remains difficult, she said, describing the “mosh pit” of payers her institution deals with. “Most of our patients are Medicare and Medicaid patients, so those [authorizations] are very easy—it’s standard of care, so they’ll usually not need a prior authorization for a lot of these medications. But once you get into the commercial insurance, that’s where it gets a little more difficult.”

The panel discussed approaches to integrating financial navigation into the process. Marina Reed, PharmD, BCOP, of NewYork Presbyterian-Brooklyn Methodist Hospital, said when patients have financial need, it’s a matter of getting authorization “as early as possible” and making sure the multidisciplinary team is aware of the situation, using processes such as direct admit ordering. “I get a lot of eyes on it,” she said, to ensure the patient is not scheduled without an authorization.

Bouchard said having both social workers and financial navigators helps get patients directed to navigation.

Case 3 involved a 67-year-old woman with R/R MM who had progressed after the fifth line of therapy. Her symptoms included worsening anemia, renal dysfunction, fatigue, and bone pain. Clinical features included ECOG performance status of 2, International Staging System stage III, and cytogenetics notable for t(4;14). A bispecific antibody was being considered in an outpatient setting.

Bouchard said this case “sounds a little rough for outpatient.” He asked, “What factors might influence your decision of whether this patient will be appropriate for inpatient vs outpatient?”

Reviewing other available information, Wasil was concerned about the patient’s performance status and low white blood cell count; he said telemonitoring should be available if step-up dosing is done on an outpatient basis.

Bouchard noted that the different bispecifics have different dosing schedules and timings for the onset of cytokine release syndrome (CRS). Reed said these factors already are involved in monitoring and documentation, and she and Bouchard discussed how they affect how bispecifics are scheduled so that patients can be ramped up within a week.

The need for monitoring when prescribing bispecifics in the community setting brought up a discussion about data sharing, and Barsoum had some strong opinions about protecting data privacy.

“The biggest issue we’re having right now is data sharing with all these apps,” she said. “They usually want access to your [electronic medical record]. They want to share data back and forth, [and] that’s something that [NewYork Presbyterian] has been against.”

Using digital technology requires permission from an artificial intelligence governance committee, she said, “because most of the time, they’re using [these] data to build more models.”

Barsoum asked, “So how do you make sure that you’re still protecting the patient’s privacy and health information? That’s also going to be something that’s going to be looked at in the future.”