The emerging role of pharmacists in optimizing therapeutic substitutions within the US Oncology network.

Abstract

e13565 Background: Community oncology practices bridge the gap between the growing disparity of increased cancer incidence in rural areas and a declining oncology workforce. A disintegrated system for cancer drug purchasing and reimbursement led to increased drug prices and reduced margins for oncology practices. Diverse insurer landscapes and step edits challenge community oncology practice independence to make drug selections to ensure financial viability. Pharmacists at The US Oncology Network (The Network) collaborated with individual practices to develop a strategy for using biosimilars and other clinically equivalent products to improve financial outcomes and ensure patient access to treatments. Methods: Pharmacists supporting The Network created and implemented a strategy and grid to execute therapeutic interchange (TIC). This provided guidance for selecting an optimal agent in a class for a payer using formulary, reimbursement, and purchasing data. Pharmacists used the grid to execute TIC approved by the practice. If the patient’s insurance was not in the grid, the pharmacist would choose the most preferred biosimilar and may receive feedback from the authorization team to switch the agent based on insurance preference in a process documented as “re-work”. The rework data was analyzed over a 6-month period to determine the effect payer-targeted TIC strategies had on the amount of clinical pharmacist rework. In addition, a single strategic initiative, focused on a particular payer and class, was determined by the individual practice, and subjected to monthly monitoring across 16 practices, each with a defined target objective to improve practice financial health. Results: From July 2024 through December 2024 clinical pharmacists used the grids to make 9,908 product substitutions across 16 oncology practices within The Network to a therapeutically equivalent alternative. All 16 practices created a payer-targeted drug initiative and goal, and fourteen (87.5%) practices achieved that goal in a 6-month period, suggesting positive economic gains for these individual practices. Prior to the implementation of grids, 7.9% of product substitutions required rework due to insurance formulary uncertainty. The rework was reduced to 3.5% after implementation of these grids, suggesting an absolute reduction of 4.5% and a relative reduction of 57%. The strategy reduced uncertain interchanges from 321 to 4, improving accuracy of initial TIC and creating a more streamlined workflow between the pharmacy and authorization teams. Conclusions: A payer-targeted TIC strategy and grid enabled community oncology sites to meet financial goals with decreased rework. This can be scaled to serve large patient populations with heterogeneous payer mixes. Pharmacists can play a key role in strategizing and executing these initiatives based on their knowledge of drug margins and therapeutic equivalency.