Specialty pharmacy for hematologic malignancies

The oral oncology medications used in the treatment of chronic lymphocytic leukemia, chronic myeloid leukemia, multiple myeloma, and non-Hodgkin's lymphoma are reviewed, and the specialty pharmacy services at three large academic medical centers are described.

More than one dozen oral oncology medications are being used for hematologic malignancies and afford patients increased convenience and the potential to improve their quality of life. These agents include ibrutinib, idelalisib, imatinib, dasatinib, nilotinib, bosutinib, ponatinib, thalidomide, lenalidomide, pomalidomide, panobinostat, ixazomib, and vorinostat. Despite the benefits of an autonomous-driven patient care plan, these high-risk, high-cost treatments are not without their challenges. Oral oncology medications are associated with significant barriers to adherence, including low health literacy, patient forgetfulness, complex administration instructions, troublesome adverse effects, and high copayments. Many outpatient cancer center pharmacies associated with large academic medical centers are now applying for specialty pharmacy designation. This affords the onsite dispensing pharmacy access to once-limited oral oncology medications that can be dispensed to clinic patients. In addition, the specialty pharmacy services offered within these cancer centers bridge an important gap in patient care and improve the care provided to oncology patients.

As oral oncology agents continue to be approved by FDA, oncology treatment teams must establish a comprehensive plan for their management. Because of their pharmacologic expertise, access to patients' medical records, and unique position within ambulatory care oncology teams, pharmacists can play an important role in patient education, laboratory monitoring, medication adherence, and cost saving.