Cancer is the second leading cause of death in the United States. Traditional treatment for cancer was cytotoxic intravenous chemotherapy, infused in an outpatient setting. Newer targeted therapies work by constantly inhibiting cancer-specific growth pathways which are more cytostatic in nature. Many of these more targeted therapies are in the form of capsules or tablets, which allow for self-administration at home. These medications are dispensed by specialty pharmacies, generally through mail order. Specialty pharmacies differ from traditional retail pharmacies in that they tend to handle medications that are more expensive, are for complex diseases such as cancer, and may require specific handling instructions.
There can be several reasons the delivery of an oral oncology medication to a patient is delayed, including insurance mandates to a particular specialty pharmacy, the specialty pharmacy having access to the medication prescribed, insurance processing requirements such as a prior authorization and the potential for a substantial out-of-pocket copay obligation.
To explore how this process is handled, five nurses at a community oncology practice were interviewed to understand what, if any, challenges are experienced in the process of ensuring patients receive these medications efficiently and accurately. The interviews revealed that there is no consistent manner for training a nurse new to the practice on how to successfully obtain medications for a patient from a specialty pharmacy. A new nurse would learn by shadowing the nurse manager or one of the other nurses. There was no Manuel outlining the process or education for new nurses. Based on the interview responses revealing the gap in the lack of a Manuel or education, a Manuel for the nurses was created.
Donoris, JD, MBA, Laurie, "Experience of Nurses in a Community Oncology Practice in Securing Oral Oncology Medications for Patients from Specialty Pharmacies" (2021). Master of Public Health Capstone Presentations. Presentation 377.