oncology pharmacy navigator: a novel model for medication
TRANSCRIPT
Oncology Pharmacy Navigator:A Novel Model for
Medication Management
Kelly Rice, Pharm.D.
Oncology Pharmacy Navigator
Legacy Cancer Institute
Portland, Oregon
Objectives
Understand the role of an oncology pharmacynavigator in a system cancer program
Name two cost saving programs that support theexpense of an oncology pharmacy navigatorposition
Give examples of reasons cancer patients usemarijuana and cite one barrier to access.
No disclosures
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Identification of Need The vast majority of anticancer treatment is given
outpatient, but Legacy Health had no oncologypharmacist dedicated to its outpatient clients.
Upwards of 50% of patients do not take their medicationscorrectly
Med discrepencies, adverse events, and non-complianceare leading causes of 30 day hospital readmissions
Cancer patients are highly satisfied when able to consultwith pharmacist.
Consultation allows patients and providers to focus onmanagement of their cancer
Novel model in the community, state, and nation. “BestPractice Model” according to ACS surrveyors.
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Timeline
February 2014: Development of proposal for new position,research done
April 2014: proposal presented to Legacy Cancer Institute (LCI)medical and administrative directors. Endorsed
November 2014: LGS Foundation Grant Requested for one yearpilot position. February 2015: LCI granted funds for 0.4FTEposition for one year
August 2015: First quarter pilot results presented to LCIadministration, increased to 0.5 FTE position
April 2016: FTE position budgeted into LCI annual costs.
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Launch Office in LCI Healing Center, Bldg 3, lower level
Very steep learning curve for outpatient EPIC as wellas launching a new position (referral took 3 months!)
EPIC outpatient training (4 hours)
> Med Rec over the phone (must use orders onlyencounter) and for office visits
> Creating current med lists and “Frig Lists” forpatients over the phone and for office visits
Pts can access via My Health (preferred emailformat)
Your pharmacy navigator will help you:
Understand your medications
Provide a current and accurate medication list
Understand the side effects of your medications & helpmanage the symptoms
Make it easier to take your medications correctly throughcoaching, medicine schedules, and pillboxes
Address medication related symptoms quickly
Explore financial concerns related to your medicine
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Fridge Med List:
can be accessed from AVS or from
an outpatient visit navigator
Ambulatory Flowsheet Changes
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Needs Assessment: add Concerns re: Medication Adherenceyes/noAdd new section entitled “Medication Concerns”Medication reconciliation completed in EPIC: yes/noMed Rec # of meds on med list: enter a #Med Rec changes made: enter a #Med rec additions made: enter a #Med rec deletions made: enter a #Provided with epic med list: yes/noProvided with medication schedule: yes/noAssist patient with pill box: yes/noMed teaching provided: purpose of meds, timing of meds, and/orside effect managementHealth Literacy concerns: yes/noMedication adherence concerns: yes/noPatient on high risk medication (yes/no):If yes, choose one or several of these: anticoagulants, anticancerhormonal therapy, chronic opioids, oral chemotherapy, insulin,significant drug interaction potentialFinancial/Insurance concerns: yes/noAssist patient with smartphone app for adherence: yes/no
Add
Additional Services Provided:
Chemo teaching for all LMG Gyn Oncchemo patients at LGS
6sw Bowel Protocol Quality Tracking
Cancer support group presentations
Attendance at two weekly huddles andGYN Cancer Conferences weekly
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Estimated Cost Savings
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Annual Savings FY 2016: $208,242Annual Savings FY 2017: $205,380
Examples of cost savings:
$5000 Enroll oral chemo patient on foundation grant support$7800 Enroll patient in free Humira program$60,375 Enroll several patients on Lynparza Rx program$15,000 change from oral aprepitant to IV form on formulary$1300 Revenue from LGS Apothecary selling supplements$800 copay assistance for RadOnc pts “Magic Mouthwash”
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Volumes & referrals
Medication Reconciliation
Over 110 patients had comprehensive medicationreconciliation completed in Legacy EPIC system:
Only 2% had entirely correct med lists
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Average Low High
Meds on EPIC List 12 1 42
Meds Missing 1.8 0 10
Meds no longer Active 2.4 0 12
Meds needing Change 1.4 0 5
Quality metrics
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Future Plans
Expand services to other Legacy sites viaphone consult
Conduct patient and provider satisfactionsurveys
Receive foundation grant funds to pay forsupplements for some chemo patients
Identify additional Pharma support programs
Develop an Oral Chemotherapy Program at LCI
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Oral Chemotherapy Program
Patients need financial support in obtaining their medicines
They also need experts to manage their medications.
Team members will assist the provider in:
> patient selection
> perform insurance authorization, investigate and appeal all
denied claims
> improve access to medications
> provide ongoing monitoring for adherence and side effects
Provide patient specific medication therapy management,
ensure that patients understand their medicines
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Medical Marijuana and Cancer Patients
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What do cancer patients ask for? Two main components of cannabis: THC and CBD
Most dispensaries steer cancer patients towards productshigh in CBD.
Symptom relief
Nausea sleep
Appetite stimulation depression
Pain menopausal sx
Anxiety
Cure for their cancer:
> Primarily “RSO” = Rick Simpson Oil
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Rick Simpson Oil (RSO)
85-88% THC
Patients often referred to the “SimpsonWebsite” = www.siskiyousungrown.com
Comes only as a very concentrated solutionin a syringe
Only available to MM card holders,not recreational users
Cost $30-50 per syringe, titrate up to onesyringe/day . Discounts available, butstill costs $700-$1000/month
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What types of cannabis products are available? Bud/flower: for smoking or edibles
> % THC & CBD shown
Tinctures/concentrates in dropper bottles
> Mg THC & CBD shown
Vape cartridges/syringes
“shatter/sap” strong hashish concentrate
Gummies, lozenges, candy
Topical salves, bath salts, lip balm
Plants
Sodas, drinks
Other edibles = short shelf life
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https://public.health.oregon.gov/DiseasesConditions/ChronicDisease/MedicalMarijuanaProgram/Pages/index.aspx
OR Medical Marijuana Program (OMPP)
Approved conditions:
> Cancer
> Glaucoma
> HIV/AIDS
> degenerative neurological condition
> PTSD
> Cachexia
> severe pain or nausea
> Seizures
> persistent muscle spasms (ie MS)
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Why get a medical marijuana card?
Card requires an MD or DO statement and costs$200 (reduced fees available)
Cost savings (avoids 25% Oregon sales tax)
“higher quality product”
Can grow more plants
Can buy more at a time and possess more
Access to some products not available for rec users
Need to use OMMP licensed dispensaries
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Common Questions about Cannabis
Can I recommend it to my patients?
How to choose a dispensary?
Is cannabis organic? Are there excipients?
Does topical cannabis cause blood levels?
Is there research?www.researchcannabis.org
www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq
J Natl Compr Canc Netw 2016;14(7) 915-922.Cannabinoids for Sx Mgmt and Cancer Therapy: The Evidence
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Summary A need was identified, a position created and successfully
funded for a pilot study and beyond
98% of medicine lists are inaccurate, and med rec done asoutpatient is an important role of the OPN
Financial savings projected at over $200K annually.
Many cancer patients are interested in medical marijuana.We should be knowledgeable to answer their questionsand outline the pros, cons, and logistics of accessingcannabis products.
The OPN is an innovative role which distinguishes ourcancer program, assists in accreditation, and mostimportantly benefits the cancer patients we serve.
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