Pharmacist-Driven Outcomes for Patients on Oral Oncology Medications: Clinical Impact of an Integrated Specialty Pharmacy Model
Purpose
Use of oral oncology medications has increased; however, these therapies often involve complex regimens, intricate dosing schedules, and challenging adverse effect profiles, all of which contribute to patient nonadherence, therapy disruptions, and increased health care costs. To address these challenges, many health systems have implemented integrated health system specialty pharmacy (HSSP) models, which optimize the coordination of care and offer comprehensive patient support. This pharmacy model aims to enhance care delivery, therapy adherence, and patient health outcomes through high-touch pharmacist management and interventions. The objective of this evaluation is to examine the impact of this type of care model on prescription adherence and clinical outcomes among patients filling oral oncology medications through an HSSP.
Methods
This retrospective, observational evaluation of all patients who filled oral oncology medications between January 4, 2021, and June 9, 2025, at oncology clinics associated with a large, academic medical center HSSP. Data collected included patient demographics, prescription details, fill dates, patient-reported emergency department (ED) and hospitalization events, and pharmacist-led interventions.
Primary outcomes included the types of pharmacist-led interventions and their associated clinical outcomes. Secondary outcomes included medication adherence, calculated by the proportion of days covered (PDC), and patient-reported ED and hospitalization events related to cancer diagnosis.
Results
During the study period, a total of 6668 unique patients with a mean age of 65 years filled oral oncology prescriptions at the HSSP. The five most frequently dispensed medications were capecitabine (11.6%), venetoclax (8.3%), zanubrutinib (8.0%), temozolomide (6.4%), and abiraterone acetate (6.3%). A total of 379 unique pharmacist-led interventions were conducted and were most frequently associated with the following medications: temozolomide (15%), abemaciclib (8.4%), osimertinib (7.1%), acalabrutinib (5.3%), and capecitabine (5.0%). The most common reasons for pharmacist intervention included drug safety (56%), drug therapy adherence (25%), drug therapy effectiveness (10%), disease state education (5%), and drug therapy appropriateness (2%). These interventions led to 582 discrete outcomes reported, with the largest impact being on improved therapy adherence (27%), preventing therapy complications (24%), and resolving adverse effect challenges (15%). The average PDC for the population was 92%. The rate of hospitalization and ED utilization was 6.2% and 1.5%, respectively.
Conclusion
Pharmacist management within an HSSP model is associated with a high-quality of care for patients receiving oral oncology medications. Through clinical interventions, pharmacists promote medication adherence and reduce therapy-related complications, which may result in lower rates of unplanned hospitalizations and ED visits due to their cancer diagnosis.
Notably, high-risk medications such as temozolomide, abemaciclib, and osimertinib were associated with more frequent pharmacist-led interventions, suggesting greater regimen complexity, offering high-impact opportunities for pharmacist engagement. These interventions not only improve clinical outcomes but may also contribute to cost avoidance for the health system.
