Specialty Pharmacies’ Role in Improving Outcomes in Cancer Care

Ryan Motte, PharmD, CSP

Findings from an analysis published in Cancer highlight the substantial disparities in cancer cases and deaths among men globally, with rates projected to widen by 2050.¹ According to Ryan Motte, PharmD, CSP, specialty pharmacies play a critical role in addressing this growing challenge.

In the study, 2022 GLOBOCAN estimates were used to describe cancer statistics for men in 185 countries/territories worldwide. Mortality-to-incidence ratios (MIRs) were calculated by dividing age-standardized mortality rates by incidence rates. In 2022, a high MIR, which indicates poor survival, was seen among older men, those with rare cancer types, and those in countries with a low Human Development Index (HDI). Between 2022 and 2050, cancer cases and deaths are projected to increase substantially, particularly among older men, low-HDI countries, and working-age groups.

Specialty pharmacies can play a pivotal role in addressing this challenge by improving medication access, helping to manage complex treatment regimens, reducing disparities, and supporting the overall well-being of patients.

By strengthening collaborations between specialty pharmacies, oncologists, and healthcare systems, Motte, clinical pharmacist with Shields Health Solutions involved in oncology and hematology management, believes that cancer care for men can be enhanced and outcomes worldwide can be improved

“Specialty pharmacies are being implemented more into health systems. They improve patient outcomes in cancer, improve survival, and reduce the overall burden of cancer care,” Motte said in an interview with Targeted Oncology^TM.

In the interview, Motte reviewed the global cancer burden among men and its projected trajectory to 2050, highlighting the role specialty pharmacies can play in combating this issue.

Targeted Oncology: How do you see the role of specialty pharmacies evolving in response to the projected increase in cancer cases and death among men and by 2050?

Motte: In reading that study, some pretty alarming numbers have come out about the rates of cancer and deaths from cancer from now until 2050. Over the next 25 years, specialty pharmacy is going to be at the forefront. It is going to evolve dramatically when it comes to helping decrease the cancer burden.

First, specialty pharmacies will be involved in terms of the novel treatments that will come out. More novel treatments, such as genomics, immunotherapy, [and] targeted therapies, will be coming onto the marketplace, and specialty pharmacies are going to have to evolve to be able to dispense these medications to patients. A lot of times they are called limited-distribution drugs, where a manufacturer may have to put some special monitoring parameters [and] handling safety protocols in place. Specialty pharmacies are the ones who put those practices and protocols in place so that patients can [access] them. So those will evolve. We will have more patients on these novel therapies that have better outcomes for patients, and then we will have increased collaboration with oncologists, specialists, and primary care physicians.

These are complex cancer regimens that patients are going to be on, and specialty pharmacists can [have] that multidisciplinary approach. When it comes to working with patients to manage these complex medication regimens, we also want to expand financial support, patient support, and assistance. These medications are going to be high cost when they come out. We want to make sure that we are getting the lowest cost for patients that we can possibly have, and getting financial programs in terms of copay cards, financial assistance, and funds through the hospitals are going to be important. Also, we are going to leverage data [analytics] through the coming years, and then we can implement [these findings] into evidence-based practices to help treat patients with cancer.

What are some of the unique challenges that patients with cancer face when accessing specialty medicines? How do specialty pharmacies help to overcome these challenges?

First and foremost, the high cost. These medications are brand new, they are very expensive, and a lot of them require prior authorizations. At specialty pharmacies, we have liaisons who are dedicated to getting the lowest cost for their patients’ medications as possible, [with] copay cards, grants, foundations, [and] financial assistance. Those are some of the challenges, but that is what we help with. That way we can reduce the [logistical] burden on these oncologists so they can focus on treatment.

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We talked about the limited distribution of drugs, [those with] special monitoring, handling, [and] administration parameters set forth. Those are barriers to access of medication, and if we have those practices and protocols, and as those evolve, then we will be able to [provide] more access to these lifesaving medications to mitigate the cancer rates that are rising.

We talked about the complex medications and the complex regimens that patients will be on. This is where pharmacists come in, helping them to understand their treatments, understand their [adverse] effects, [and] manage these [adverse] effects so they can stay on their treatments and have the best outcomes, reducing the burden on patients.

Also, adherence is a challenge. Cancer medications come with a lot of [adverse] effects, and we use pharmacists, liaisons, [and] specialty pharmacies to help mitigate these [adverse] effects and keep [patients] on their therapies for the appropriate amount of time and then have [patients] calling for refills. Also coordinated care [is important]. Fragmented care can happen with patients who have cancer. They have specialists, they have their oncologists, so specialty pharmacies can be a central point of contact, being able to reach out to all these different providers and get [patients] on the best care possible for the best outcomes.

Disparities in cancer incidence and survival rates were highlighted in the study. Can you discuss how specialty pharmacies contribute to reducing these disparities?

One thing that we did see from the study was that low-HDI countries ended up having much higher rates to about 2-fold in some socioeconomic territories and countries than patients in high-HDI countries. What that means for specialty pharmacies is that [we need to] get access to more drugs through those limited drug distribution networks [and] payer networks, whether they be commercial or government, and provide that financial assistance to patients through the copay cards and foundations we have in underserved and rural populations. A lot of patients have issues with transportation, getting to the pharmacy, [and] being able to get their cancer medications. A lot of specialty pharmacies nowadays have free home delivery, and this can [give patients] access to medications, so they have timely and safe delivery of their medications.

Also, prevention and detection [are] going to be important. Specialty pharmacies can advocate for early detection and prevention to help modifiable risk factors and underserved populations, and some of those disparities with men vs women as men tend to have higher modifiable risk factors. Being early in that, reaching out to providers, and helping to have early detection and prevention [is key]. Prevention, telehealth, remote monitoring, telephonic counseling, those things can help underserved populations where patients are not able to get to the doctor quite as often and when they are not able to make it in. Using those resources and technologies will help patients.

How do specialty pharmacies support patients in managing their adverse effects associated with cancer treatments?

With Shields Health Solutions, we use a comprehensive, integrated care model, which [consists of] dedicated medication management services. Whenever we get a new patient who is going to be on cancer therapy, we go over the therapy, how to take the therapy, [adverse] effect management, drug-to-drug interactions, all the things that a pharmacist would do from the start of a patient's treatment through their complete and total cancer care journey. So, managing these complexities, managing these patients, and making them feel comfortable about their therapies is important for optimizing the outcomes [and]reducing the cancer rising rates.

We do regular monitoring of labs, [adverse] effects, and adherence. Also, we collaborate with oncologists and share about patients' progress. Something specialty pharmacies can do is be involved and be collaborative with the patient's oncologist and be that second or third team member to help track the patient's progress. Also, what we do is empower the patients to take an active role in their treatment by having someone dedicated to call them, talk about [adverse] effects, talk about the management of these things, help them to understand their regimens, help to educate on these medications that will help patients to be empowered, feel empowered, and take control of their health and their cancer care.

What role do you think specialty pharmacies play in ensuring that these patients receive timely and effective treatment?

Specialty pharmacies are going to be important in streamlining the process. We talked about drug access and how difficult that may be by some of the manufacturers and by some FDA guidelines. So, improving that medication access, that way oncologists can focus on treatment and helping the patients the best they can and streamlining that access [is necessary]. Also, approving prior authorizations, giving financial assistance, as well as addressing insurance issues is something that specialty pharmacies can do to alleviate those administrative concerns and those logistical barriers that patients have. Patients know that we are going to be working hard to get their medications in a timely and effective manager manner, [and] they can focus on their recovery.

How important is the integration of specialty pharmacies into broader healthcare systems and improving outcomes for these patients with cancer?

It is crucial. Specialty pharmacies are being implemented more into health systems. They improve patient outcomes in cancer, improve survival, and reduce the overall burden of cancer care. With the study, we have nearly double cancer rates, almost 100% increases in rates and deaths over the next 25 years, and the cost is really high. It is projected to [cost] $25 trillion in cancer care between 2020 and 2050. Going back to those limited distribution networks for the drugs monitoring programs that are set forth for the specialty pharmacies, we can go ahead and have these in place. We can work with these pharmaceutical companies, work with the payers, work with the health systems to improve access, negotiate better pricing that can then get put back on the patient, and then help the patient with the financial assistance they need.

With the anticipated rise in cancer cases, how can experts help to manage the increasing demand for complex cancer therapies?

We need to have plans in place and be proactive about access to the medications that are going to be coming to the forefront. Each year, more medications are coming out, and we must have plans, protocols, and supply chain management [to provide patients access to] those drugs. Also, health systems need to have enhanced staff [and] enhanced training programs and to increase the overall infrastructure for the health systems. This study is a little bit of a call to action in terms of doing that, improving the infrastructure, if we are going to see this high rise of cancer cases and deaths in the coming years. Improving that infrastructure is important. Obviously, investing in more research and development for new more novel therapies that can help to treat and improve outcomes for patients. Expanding access to care, that is a hot topic for everybody, but that could be something that could help provide basic cancer care options to patients and help combat and mitigate these rising cancer rates that we might see moving towards more value-based models and care models rather than volume-based. Using the data analytics that we have to improve outcomes for patients can help mitigate the rising rates as well. Then, specialty pharmacy technologies with telemedicine, remote health, [and] data analytics will be important as we move forward as well.

How do you see the collaboration between specialty pharmacies and oncologists evolving to better support patients throughout their cancer care journeys?

I think the programs that we have in place have that collaborative approach between the specialty pharmacy and the oncologist. With our programs, we have those liaisons who help with financial assistance, prior authorization approvals, making sure that the patients can get access to their drugs, get the monthly refill calls, and get free delivery. This allows those oncologists to be able to lean into these specialty pharmacy programs and focus more on their clinical operations, focus more on the patients, focus more on the treatments that they are supplying for these patients, and know that those clerical burdens are going to be helped by the specialty pharmacy. We have everything at the specialty pharmacy that we can do for patients, from the [adverse] effect management to drug access to the adherence monitoring, the roles that we have in medication therapy management, optimized therapy tailoring, and personalized medications for patients. This is that collaborative approach that we can take with all members of the health care team, including the oncologist.

REFERENCE:

Bizuayehu HM, Dadi AF, Ahmed KY, et al. Burden of 30 cancers among men: Global statistics in 2022 and projections for 2050 using population-based estimates. Cancer. Published online August 12, 2024. doi:10.1002/cncr.35458