Trispecifics May Widen Myeloma Access: Beth Faiman, PhD, MSN

Expanding scope of practice for advanced practitioners (APs) and new, more convenient immunotherapies could both widen access to care for patients with multiple myeloma, according to Beth Faiman, PhD, MSN, APN-BC, AOCN, BMTCN, FAAN, FAPO, of Cleveland Clinic Taussig Cancer Institute. In an interview at the Patient-Centered Oncology Care® (PCOC) 2026 conference hosted by The American Journal of Managed Care^® in Nashville, Tennessee, September 24-25, 2026, Faiman discussed changes in AP reimbursement and the promise of trispecific antibodies in relapsed/refractory multiple myeloma.

How AP Reimbursement and Scope of Practice Have Changed

When Faiman graduated as a nurse practitioner and began clinical practice in 2002, billing restrictions shaped how APs worked. A physician visit was reimbursed at 100%, while a visit with Faiman was reimbursed at 80%, which led to a model in which Faiman and physicians worked together in the clinic.

The institution quickly recognized the value of having Faiman see patients independently and bring more patients in, and it was willing to accept the 80% reimbursement rate. Today, Faiman is reimbursed at the same rate as a physician because of licensure as an independent practitioner in the state, a direction Faiman said more states are moving toward.

"Unfortunately, the institutional barriers prevent APs from practicing independently as much as I'd like them to, but I think that the world is recognizing the value, the added value that advanced practitioners have to that care team," Faiman said. Scope of practice is being enhanced by state and by institution, and Faiman expects that trend to grow.

Why Trispecific Antibodies Could Reach More Patients

Trispecific antibodies are a unique class of drugs for relapsed/refractory multiple myeloma, Faiman explained. The furthest along in clinical development is ramantamig, a Johnson & Johnson compound that engages CD3 and brings together GPRC5D and B-cell maturation antigen (BCMA) to cause myeloma cell death.

Recent updates presented at the International Myeloma Society meeting in Scotland showed deep, durable responses. Faiman has the study open at the center and has treated several patients with the drug.

"It is extremely well tolerated," Faiman said. "What's nice is as a trispecific antibody, it's all outpatient ramp-up dosing. So I can see that that would be expanded more into the community setting."

Monthly dosing could also ease geographic barriers that make it difficult for some patients to start a bispecific or trispecific antibody, according to Faiman.

As clinicians learn more about these drugs and their targets, they are also seeing fewer adverse effects, Faiman said. Faiman has not seen many serious adverse effects with ramantamig, with one important caveat.

"As long as we're protecting one against infection, antiviral, anti-infection prophylaxis is super important," Faiman said.