Behind teh Scenes of Multiple Myeloma Care: A Pharmacist’s view
Optimizing value in oncology care, particularly for patients with multiple myeloma, requires navigating complex access barriers and a significant amount of behind-the-scenes work, as highlighted by a pharmacist at Huntsman Cancer Institute of the University of Utah. A key challenge centers around supportive care therapies like intravenous immunoglobulin (IVIG), crucial for preventing infection, especially with innovative treatments like bispecifics and CAR T-cell therapy.
The pharmacist explained that securing IVIG access often involves navigating payer preferences. Insurance companies frequently favor administering IVIG at dedicated infusion centers over in-patient settings or through home health services. Though, home health administration presents logistical hurdles – identifying contracted nursing services and coordinating care within payer limitations. This process demands considerable time and resources to determine appropriate pathways.
A primary challenge for pharmacists lies in determining payer contracts and navigating prior authorization requirements. Simply knowing a patient’s insurer isn’t enough; identifying their contracted home health providers and the specific procedures for authorization (faxed orders vs. verbal authorization, phone call duration) is essential.
Huntsman Cancer Institute utilizes its own home infusion suite as an intermediate step when in-patient administration isn’t feasible. This allows the pharmacy team to maintain oversight of IVIG administration details – timing, rate, and associated notes – which is considered valuable for patient care. If the home infusion suite isn’t an option, the process extends to specialty pharmacies like CVS Specialty, Coram, or Accredo, further increasing the time commitment.
A significant frustration is the potential for delays in receiving responses to submitted orders, frequently enough requiring follow-up calls after a week or more to confirm receipt and processing. Responsibility for this follow-up can shift between the pharmacist and nursing staff depending on clinic schedules and workflow. Despite these challenges, the pharmacist emphasized the importance of this work in supporting patients undergoing advanced myeloma therapies.
