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The Oncology Pharmacist's Role in IO Delivery

By Sarah Hudson-DiSalle, PharmD, RPh

Sarah Hudson-Disalle
Sarah Hudson-DiSalle, PharmD, RPh
Oncology Pharmacy Manager, Medication Assistance Program and Reimbursement Services
The James Cancer Hospital and Wexner Medical Center, Ohio State University Department of Pharmacy
Columbus, OH

Dr. Hudson-DiSalle is the manager in the Medication Assistance Program and Reimbursement Services at the Wexner Medical Center and James Cancer Hospital in Columbus, OH. She is responsible for managing and advocating for the Medication Assistance Program for patients who cannot afford their medications, as well as overseeing reimbursement authorization for off label medication use, high dollar therapy usage, infused medication and medication denials. Dr. Hudson-DiSalle serves on the Board of the Charitable Pharmacy of Central Ohio, the Health Policy Committee of the Hematology/Oncology Pharmacy Association (HOPA), and the Legislative Committee of the Ohio Society of Health System Pharmacists.

  May 1, 2019

Oncology continues to see rapid growth in the role of immunotherapy for cancer. Evolving in tandem is the expanding role for oncology pharmacists in delivery of IO. With each new approval and new indication, oncology pharmacists help to bridge the gap between science and real-world medical practice. Oncology pharmacists bring expertise in the most effective medication use, reimbursement processes, medication management, supportive care, immune-related adverse events, and training and education.

Oncology pharmacists are involved in all aspects of patient care from diagnosis to treatment decisions, symptom management and supportive care. As experts in cancer medicine, pharmacists should be on the team that evaluates various levels of management of immune-related adverse events, and participate in development of care plans for patients who may present in the Emergency Department or the ICU with symptoms related to IO therapies. Leveraging pharmacists’ medication expertise, these team members should be involved in development of internal clinical practice guidelines that improve quality and safety for patients and staff.

New IO therapies have come with a very high price tag that impacts both patients and providers. Oncology pharmacists have the skillset to address economic aspects of integrating IO into practice, including inventory and reimbursement processes. Pharmacists’ involvement in the reimbursement process begins with assessing usage of IO agents in the clinical setting for appropriateness of use, on-label or off-label indications, dosing, and use in combination or sequential therapy. Pharmacists can evaluate clinical policies of third party payers and compare these with the clinic’s usage. Identifying deviations from these policies in practice is critical, as adherence to payer clinical policies increases the likelihood of approval of treatment requests and reimbursement for IO therapies. Moreover, the pharmacists’ knowledge on operations of compounding, supportive care, and the rationale of therapy can help educate those staff responsible for obtaining authorizations and/or developing appeal letters. In support, the pharmacist can identify approved therapies, curate peer-reviewed literature, assist in pathway development and product selection, and cite compendia that recognize the usage of IO agents in practice. These tools combined with knowledge of the revenue cycle process are a powerful force in the reimbursement of IO agents.

The rapid pace of knowledge accrual in immuno-oncology makes it imperative for the cancer care team to keep current. Oncology pharmacists can provide ongoing education on immunooncology for those on the frontlines of care: nursing staff, medical residents, mid-level providers, and other healthcare providers who may interact with patients treated with these agents. As medication experts clinical pharmacists can contribute to the development of education materials on critical areas of care such as side effect management, potential drug interactions, and the best agents to combat adverse events.