Ways to Mitigate Financial Toxicity for Patients With Breast Cancer

Pharmacists can collaborate with payers and providers to improve patient outcomes and reduce hospitalizations by ensuring medication access and adherence, says Tiffany Meng, PharmD, an oncology pharmacist, UCSF Health.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

What role do pharmacists play in mitigating financial toxicity for patients with breast cancer, particularly regarding specialty medications?

I will be speaking from my own very specific experience working at our academic centers [and] outpatient infusion center. A lot of specialty medications can come in the form of either an IV infusion or subcutaneous injection or an oral. Essentially, patients are getting them either in an infusion center setting, or maybe they're getting it as ambulatory care, or outpatient prescription for the oral agents.

Specifically for an infusion center standpoint, as an infusion pharmacist, we often help by ensuring treatments are actually covered by insurance or if the patients are part of the PAP [patient assistance program], we make sure it's billed correctly. We can help obtain insurance approved biosimilars, because there are some times that we carry a certain type of biosimilar, but their insurance is very strict and only allows another alternative type of biosimilar. Then we will have to make sure we special order for the patient so that they can get the medication instead of carrying the financial burden. As for oral specialty medications, at least at our institution, the oral chemo team, they often help with appeals, they help with prior authorizations with insurance, [and] they can also provide alternative options. Some things like helping patient get grants, helping patients get involved in patient assistance programs (which also exists for oral medications), getting them copay cards, finding them cheaper cash options with low-cost pharmacy, or utilizing a coupon from GoodRX or something to help with medication coverage. I think as a pharmacist, it's important to make sure we can do what we can to help our patients gain access to the medications.

How can pharmacists collaborate with payers and providers to improve outcomes and reduce hospitalizations for patients on complex treatment regimens?

I think from our discussion previously, one of the biggest things is to make sure patients do get access to medications, because if they can’t get access, they can't start treatment, then obviously, their disease could be out of control. We can make sure the whole process of when the time point of providers ordering the medication to when the patient is receiving it is being is carried through. So that includes what the effective therapies are, if it's dosed appropriately, when there needs to be dose adjustments that is properly addressed, what insurance are willing to cover, whether the patients can afford it, what are the alternative options, whether provider accepts the biosimilars, and how comfortable they are with whatever recommendations we may have. Pharmacists can play a role to kind of bridge the gaps throughout the process to make sure patients can receive the medication, and hopefully that can improve outcomes as long as patients stay the course, take their medication, and minimize their adverse effects.

We can also help with the improving medication adherence that we mentioned previously. Whether it's by educating the patients, looking out for adverse effects, how to manage them if they have side effects, educating them to contact the team if needed, when to come into the ER, and just optimizing their overall experience while on therapy.

And lastly, providing suggestions for generics and biosimilars and making sure that medications are administered correctly and appropriately, because one of the worst things would be a medication error that leads to a hospitalization or some serious consequences. Sometimes we even help with making sure that patients are not coming in for duplicate appointments, because, as we know, when patients are getting cancer treatment, they have so many different appointments, sometimes therapy changes, but there is a leftover appointment that was previously made that wasn't adjusted. Then patients end up showing up to clinic when they don't need to. That's like wasted time, wasted transportation for the patient, and that can also incur financial burdens for them. That's kind of what we do as pharmacists, to kind of help out as much as we can to make the experience a little smoother for the patients.