Passing the Torch to the Next Generation of Pharmacists

Conference Correspondent - AVBCC 2019 Summit

On Friday afternoon, a distinguished panel of pharmacists from across the oncology care space discussed the recent changes in their field and contemplated potential innovations that lie ahead. As a group with deep experience in oncology pharmacy, they were able to take a longitudinal view on many of the questions posed by the moderator, Niesha Griffith, RPh, MS, FASHP, Advising Partner, McGivney Global Advisors.

As the panelists considered the ways in which pharmacy has changed since they had begun practicing, what emerged again was the increased complexity of the prescriptions they now fill. Stacey McCullough, PharmD, Senior Vice President of Pharmacy, Tennessee Oncology, stated, “Orals are rapidly becoming mainstay oncology therapy.” This, she added, has imparted multiple layers to the process of providing patient medications. Ray Bailey, BPharm, RPh, Pharmacy Director, Florida Cancer Specialists, concurred, as his specialty pharmacy annually fills approximately 80,000 scripts for oral oncolytics.

Steven D’Amato, RPh, BSPharm, BCOP, Executive Director, New England Cancer Specialists, agreed, saying that in years past, there used to be “nurses mixing drugs in the back room,” but now that image has been replaced by a vastly more technologically advanced pharmacy business. Panelists agreed that the “business of pharmacy” now consumes much of their time, and a solid understanding of its principles is essential. Pharmacists also need to be up to date on myriad policies and procedures, including billing, the USP 800, the Oncology Care Model, and the continuous research advances. Dr McCullough observed that the changes have often led to creating additional responsibilities for current staff but that the pharmacists are efficient anyway.

With the expansion in technology comes a more robust availability of options in terms of data collection, said Rob Hauser, PharmD, PhD, Vice President, Clinical Analytics, Cancer Treatment Centers of America. This discussion tied together how the need for both business skills and knowledge of the field are essential and prompted Dr Hauser to comment, “trying to track outcomes and provide value and cost-savings you need to have data, and if you don’t understand the drugs, you don’t understand the data.”

In addition to complexity, education of future pharmacists emerged as another main theme during the discussion. This includes, as Ray Muller, MS, RPh, FASHP, Associate Director, Pharmacy Services, Memorial Sloan Kettering Cancer Center, stated, the “need to get [early career] pharmacists as close to the patient as possible.” Panelists seemed to agree with him as he expressed concern that “80% of pharmacy graduates gravitate to community practice” (ie, chain drug stores and pharmacies) rather than to work as clinicians. Ms Griffith added that in her prior role in the education setting, she had tried to expose graduate students to cancer care. Yet, she saw that there were “people teaching oncology who haven’t stepped foot in a pharmacy in 30 years.” Although she acknowledged that not all pharmacists are clinicians, others work with payers, get claims paid, and go to payer negotiations.

The role of the pharmacist as clinician is enhanced in some institutions, for example, at the Cleveland Clinic, where Marc Earl, PharmD, BCOP, is Assistant Director, Pharmacy. There, pharmacists can order labs and dispense; can manage medications and prescribe; and Dr Earl believes they have enhanced patient care in the areas where pharmacists are able to do that. Mr D’Amato said he has hired 3 new pharmacists to get them closer to patients, as it is possible that “when you have the pharmacist involved from the beginning, treatment might go down a different road.”

The panel ended with consensus on the point that increased complexity required training future pharmacists with an understanding of the nuances of clinical work and the exigencies of the business side of pharmacy.