Over the last decade, oral oncolytic therapies have continued to increase their presence in the treatment landscape across a variety of solid tumor and hematologic malignancies. Of the 50 novel drugs approved in 2024, at least six of these approvals were for oral therapies indicated for the treatment of cancer or a cancer-related condition.1 In 2025, that number increased with nearly ten novel agents approved as oral treatments for cancer.2 Research continues to evaluate small molecule therapies that can be used to target molecular pathways involved in tumorigenesis. Subsequently, increasingly complex nuances exist in the prescribing, dosing, and management of these therapies for both patients and clinicians.
The Patient Outreach and Education Committee of HOPA has recognized some of these challenges and has created resources for both members and patients to increase their understanding of the medication acquisition process from start to finish. These resources are available on the Patient Education section of the HOPA website. One of the newest resources is a roadmap to navigate the oral anticancer medication acquisition process for patients. For patients who are already taking numerous medications, the acquisition process for various cancer medications and the jargon used by both providers and insurance companies can be quite confusing. For an increasingly growing number of cancer patients, oral anticancer therapies and their supportive medications might be the first time they’ve had to deal with the complexities and financial hurdles of the United States healthcare system. The purpose of the roadmap is to help familiarize patients with the process that often occurs unbeknownst to them but deeply impacts their access to vital medications. It aggregates some of the scenarios that our workgroup has encountered at their practices, which include both community sites and academic medical centers. Often, it will be a pharmacist who might introduce this information to patients and uses it as an accompaniment to their own counseling either as new therapies are initiated or as problems with the acquisition process arise.
Some of the biggest challenges for patients include the insurance review and adjudication process. Some cancer centers may have dedicated in-house teams that handle individual steps of the medication acquisition process, sending the medication to the next team when their part of the work is done. Others might rely on a clinical or specialty pharmacist in the cancer center to handle all steps of the insurance review process, and lastly, others might route this process to a central group that covers multiple smaller cancer centers in the community setting. Regardless, patients still appear to lack understanding of why these medications can’t be picked up at their healthcare centers or typical community pharmacy on the day that the physicians prescribe it. Terms such as “prior authorization,” “appeal,” “co-insurance,” “out-of-pocket," and “deductible” are often used by healthcare workers with little understanding of the actual meaning by patients and caregivers, resulting in frustration and sometimes anger when they still don’t have access to the medications their oncologist ordered.
In these situations, compassion and empathy will always be some of a pharmacist’s greatest strengths, as we can help patients understand why there may be delays and obstacles in this process. In my own practice, I’ve always asked patients to advocate for themselves in their own care. While that might most immediately translate to asking questions of all staff members involved and ensuring the needed processes are moving forward (because let’s face it, it is rarely one singular person that is in control of the entire process), it also means educating themselves in healthcare lingo and healthcare workflows. For some patients with a higher health literacy, that might look like taking the time to review the benefits of their insurance plans, reviewing their formulary tiers, or even taking the time to reach out to their insurance company representatives with specific questions that might expedite the acquisition process. Of course, this might not be feasible for all the patients we encounter. However, for the patients who can do this, I also take it one step further and remind them to talk to their friends, family, network, and even elected officials about the complexities of the healthcare system and its players.
One of my least favorite parts of the oral anticancer medication acquisition process is hearing about an insurance approval for a medication and that the out-of-pocket cost for a patient still amounts to thousands of dollars per month. For most patients, that’s not a financially feasible option. Without cost parity of oral anticancer therapies to infusion-based therapies that are billed to a medical plan, many patients are left in shock at the insurmountable costs of oral anticancer therapies. While we might not have a solution for every single patient, pharmacists can play an important role in helping to connect patients to various patient assistance programs, non-profit foundations that help fund healthcare costs for patients in need, or even some grants. We might bridge the link between providers and patients to make care more affordable. At the same time, our knowledge of the limitations of these programs might also help set expectations early-on with both patients and providers when therapies are sought for off-label uses that might not be covered by these programs and offerings.
For many patients, the only time they might see a pharmacist is when they are at their community pharmacy, waiting to pick up their medications. They might be given some counseling for how and when to take their antibiotics or the importance of using their medications as directed to manage some of their chronic conditions. While pharmacists who work in oncology have made some great strides to be present for patient visits and encounters, there are still many who do not know the work we do within the spectrum of cancer care. Personally, I like to share with patients how some of the different pharmacists at my cancer center function and how they might either interface directly with the patient or have a direct role in the provision of their treatment plans. For many patients, pharmacists and staff in the specialty pharmacy might be a novel concept and role. Patients may be unfamiliar with how they function as part of the healthcare team, but it might be opportune time to share the work they participate in when coordinating and verifying high-cost (and often, high-risk) medications. It’s important to distinguish why specialty pharmacies are needed in the healthcare paradigm. In the roadmap document, our committee wanted to highlight the work that our specialty pharmacists do with the ongoing management of treatments while patients are on their oral therapies. While patients will certainly follow-up with their oncologists routinely, the specialty pharmacy team plays a vital role in ensuring all key safety parameters are met prior to processing and dispensing medications for use, as well as minimizing delays in treatment.
While no single document will completely include all the details and scenarios that patients may encounter, the hope of our committee was to provide a basic understanding of the complex journey a medication takes. Our committee’s hopes are that this gives both patients and pharmacists a 10,000-foot overview of the process and provides some reminders as to how we might work ahead to keep the big picture on the forefronts of our mind. We’ve also created a document that’s geared towards (newer) pharmacists who might not have a clear understanding of the acquisition process. It provides some pearls and helpful tips for pharmacists to remember or to be aware of so that they might help provide better care. While the healthcare system and its many complex processes are everchanging, our ability to stay educated and informed will be one of our greatest assets. This will ultimately help us provide the best care for our patients, and that includes ensuring access and appropriate counseling/education for all.
